The role of leadership in nurses' wellbeing and performance: A cross-sectional survey using a dual motivational pathway model.

AIM: To examine the positive motivational paths from perceived autonomy-supportive leadership, and the negative motivational paths from perceived controlling leadership to satisfaction and frustration of basic psychological needs, work motivation, work performance, work engagement and somatic symptom burden among nurses using Self-Determination Theory. DESIGN: The study used a cross-sectional design mapping nurses' perceptions of the various study variables through a survey. METHODS: Nurses working in the municipal healthcare in Norway were recruited through an electronic questionnaire sent out via a link to their emails between 29th of August and 29th of September 2020. Of them, 219 nurses completed the questionnaire. Study hypotheses were tested using structural equation modelling. RESULTS: Higher levels of perceived autonomy-supportive leadership were associated with reduced levels of somatic symptom burden and increased levels of work performance and work engagement through the satisfaction of basic psychological needs and autonomous motivation, specifically identified regulation and intrinsic motivation. Perceptions of controlling leadership were associated with heightened levels of somatic symptom burden through basic psychological need frustration, amotivation and introjected motivation, along with lower levels of work engagement through need frustration and amotivation. CONCLUSION: This study underscores the positive motivational paths of perceived autonomy-supportive leadership on nurses' work performance and wellbeing through the facilitation of basic psychological need satisfaction and autonomous motivation. Conversely, the study highlights negative motivational paths of perceived controlling leadership on reduced work engagement and heightened ill-being through the basic psychological need frustration, controlled motivation and amotivation. IMPACT: This study provides insights and actionable recommendations for nurses and their leaders, emphasizing the significance of understanding the adverse impact associated with perceived controlling leadership. The findings underscore the importance of addressing these issues to mitigate detrimental effects on motivation and overall work functioning. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Will They Stay or Will They Go? Motivational Profiles, Retirement-Related Correlates, and Retirement Intentions Among 58-72-Year-Old Workers.

Demographic changes indicate that the number of people aged 60 years and above will double in the next 30 years, and politicians around the world have an interest in delaying retirement in order to benefit national economies by lowering the burden on public pension systems. In this study, it is examined whether and how combinations of multiple types of work motivation based on self-determination theory (SDT) would be associated with retirement-related factors and retirement intentions. Using a person-centered approach to identify latent work motivation profiles among older workers, four profiles emerged: (1) the Low Motivation Profile with below-average levels on most motivational regulations, but in particular, lack identified work regulation; (2) the Autonomous Motivation Profile with higher levels of autonomous motivation and lower levels of controlled motivation and amotivation; (3) the High Motivation Profile with simultaneously high autonomous and controlled motivation; (4) the Amotivated Profile. Compared to the Low Motivation and Amotivated Profiles, the Autonomous and the High Motivation profiles show higher levels of vigor and lower levels of job stress, exhaustion and turnover-, and retirement intentions. However, the High Motivation Profile seems to pay a cost because they experience significantly more job stress than employees in the Autonomous profile. In addition, variable-based correlations showed higher levels of vigor and lower levels of job stress, exhaustion, and turnover intentions to be associated with lower levels of retirement intentions. The results are discussed in relation to managers and organizational endeavors to rebuild lost work identification and reduce extrinsic work motivation and amotivation in order to motivate older workers to stay longer at work.

Losing sleep over work: A self-determination theory view on need frustration, sleep disturbance, and mental ill health.

Given the centrality of sleep and work in most individuals' lives, it is interesting to note that an empirical understanding of the association between what happens in the workplace and how well people sleep is in an early stage of development, at least relative to other topics that are of interest in the literature on stress and health. Using self-determination theory, the current study examined how maladaptive motivational processes at work relate to sleep disturbance and mental ill health. In line with hypotheses, the results of a cross-sectional analysis and analyses using data from two time points over 15 months revealed that employees are more likely to report sleep disturbance, anxiety, and depressive symptoms when they experience frustration of the basic psychological needs for autonomy, competence, and relatedness in the workplace. Additional results revealed an indirect effect of change in basic psychological need frustration on change in anxiety-but not on change in depressive symptoms-through change in sleep disturbance. Taken together, these findings add to the burgeoning literature on the maladaptive motivational origins of ill health and dysfunction in the workplace.

Dental hygienists' biopsychosocial beliefs and giving autonomy support in treatment of patients: A self-determination theory perspective.

OBJECTIVES: Self-determination theory posits that managers' autonomy-supportive behaviour and employees' autonomy causality orientation are motivation constructs to explain internalization of values, functioning and wellness at work. Hypothesis 1 tested whether profiles comprising perceived dental clinic managers' autonomy-supportive, as opposed to their controlling interpersonal style, and dental hygienists' autonomy, as opposed to their control and impersonal, causality orientations at baseline, would be positively related to dental hygienists' biopsychosocial (BPS) beliefs and giving autonomy support in treatment of patients after 18 months. Hypothesis 2 tested whether dental hygienists' BPS beliefs in treatment of patients will be positively associated with their autonomy-supportive behaviour given to patients after 18 months. MATERIAL AND METHODS: A prospective cohort design with 299 (Mage  = 42.71; SDage  = 12.62) dental hygienists completed an online survey at baseline and after 18 months. RESULTS: Latent profile and correlational analyses supported the hypotheses. Effect sizes were moderate to large. CONCLUSIONS: Both perceived managerial styles and dental hygienists' causality orientations are important for dental hygienists' BPS beliefs and autonomy-supportive behaviours when working with dental patients.

The Basic Psychological Need Satisfaction and Need Frustration at Work Scale: A Validation Study.

The aim of the present study was to adapt and validate the Basic Psychological Need Satisfaction and Frustration Scale within self-determination theory (SDT) within the work domain. Confirmatory factor analyses of three Norwegian samples and one English sample as well as multi-group analyses to examine measurement invariance were performed. The results showed that the adapted work-related scale with its six-factor structure fitted the data well in all four samples, and partial measurement invariance was obtained across samples and languages. Furthermore, internal consistencies for the subscales were acceptable and the subscales predicted work-related correlates as expected, demonstrating the criterion validity of the scale. The current study contributes to a unifying measurement for future research on one of the central underpinnings of SDT within the work domain.

Narrative Tensions in Strained Junior Elite Performers' Experiences of Becoming Elite Performers.

Contextualized within narrative theory and the field of talent identification and development systems (TIDS), this interview study examined strained junior elite performers' experiences of becoming elite performers while participating in prestigious national TIDS. The study explored how junior elite performers perceive and negotiate their personal narratives of becoming within a cultural master narrative of being. The focus is on how the quality of person-environment interaction, characterized by narrative alignment or tensions, relates to perceptions of identity, agency, and physical and mental health. We purposefully recruited eight participants (Mage = 17.31, SD = 0.9) from a previously published study, who reported experiencing suboptimal psychological functioning compared with their peers to explore narrative tensions in their storylines. The data were collected through semi-structured interviews and examined, using narrative analysis. We identified "the performance narrative" as the dominating cultural narrative within the TIDS and three distinct personal narratives of negotiation with unique characteristics: obsessive and externally driven alignment - "striving to stay at the top of the game"; tensions - "just hanging in there"; and disruption from alignment - "when the going gets tough." The results indicated that tensions and lack of alignment between the dominating cultural narrative and the individual narrative seem to increase the risk of experiencing identity challenges, suboptimal functioning, and aspects of ill-being. The study offers critical reflections on the dominating performance narrative within TIDS and additionally suggests an alternative athlete-centered and more holistic approach that combines both personal and performance developments.

Composites of perfectionism and inauthenticity in relation to controlled motivation, performance anxiety and exhaustion among elite junior performers.

The present study identified profiles of perfectionism and inauthenticity at baseline and tested whether they differed in the maladaptive outcomes of controlled motivation, performance anxiety, and exhaustion after a nine-month period. We purposefully selected elite junior performers (NT1 = 219; NT2 = 156), 16-19 years of age, from Norwegian talent development schools in sports and performing arts. The participants completed questionnaires to report their perceptions of the study variables. The results of the latent profile analysis indicated a multidimensionality of perfectionism, thereby identifying four profiles. Although our identified profiles are in line with the 2 × 2 model of perfectionism; however, the results of the mean differences between the identified profiles did not align with the 2 × 2 model's hypotheses. The elite junior performers who displayed non-perfectionism demonstrated to be the most adaptive profile. They reported the lowest level of inauthenticity and the maladaptive outcomes of controlled motivation, performance anxiety, and exhaustion. The mixed perfectionism profile, displaying high levels of perfectionistic concerns (PC) and perfectionistic strivings (PS), demonstrated to be the least adaptive profile. This profile reported higher levels of inauthenticity and was even more maladaptive than the PC dominated profile contrary to the proposed hypotheses. Findings showed that a heightened vulnerability of perfectionism seems evident in PC, independent of the reported PS levels. Because only one out of five elite junior performers were distributed in the non-perfectionism profile, the vulnerability of perfectionism might be an important risk factor to note in talent development settings.

The Roles of Patients' Authenticity and Accepting External Influence, and Clinicians' Treatment Styles in Predicting Patients' Dental Anxiety and Avoidance of Dental Appointments.

A substantial proportion of adults suffer from high dental anxiety, which is related to poor oral health and functioning. Using authenticity theory and self-determination theory, we applied a model testing two moderated mediation hypotheses: (i) the negative indirect association between authenticity and avoiding dental appointments through dental anxiety would be more evident when clinicians provides higher levels of autonomy support; and (ii) the indirect positive association between accepting external influence and avoiding dental appointments through dental anxiety would be more evident when clinicians provides higher levels of controllingness. Participants (N = 208) responded to a survey with validated questionnaires. The model with hypotheses were tested using Structural Equation Modeling (SEM) in LISREL and Conditional Process Modeling (moderated mediation). The results supported our hypotheses. The SEM model tested was found to fit the data well. Patient's personality and dental clinic treatment environments predicted 38% of the variance in dental anxiety, which explained 38% of avoidance of treatment.

Change in basic need frustration in relation to perfectionism, anxiety, and performance in elite junior performers.

The present study examined whether there were different growth profiles in basic need frustration in elite junior performers over a nine-month period. Subsequently, we examined whether the identified growth profiles differed in their levels of perfectionistic strivings and evaluative concerns measured at baseline and, additionally, whether they were associated with higher or lower levels of anxiety and perceived performance level in the end of the period. A sample of 259 (Mage  = 17.31; SDage  = 0.97) elite junior performers from sports and performing arts completed an online questionnaire to report their self-ratings of the study variables. The analyses were conducted using growth mixture modeling in Mplus 8.0. Two main contrasting growth profiles were identified in each of the basic need frustration. Perfectionistic strivings were overall higher than evaluative concerns, but did not differ between the growth profiles. Conversely, evaluative concerns differed significantly between the identified growth profiles. Higher levels of evaluative concerns were associated with the most maladaptive growth profiles. Indeed, elite junior performers, who experienced moderate and increasing levels of competence and autonomy frustration, reported higher levels of anxiety and lower levels of perceived performance level than those who reported low and decreasing levels of competence and autonomy frustration. Based on these findings, evaluative concerns and basic need frustration appear to play key roles in the development of maladaptive motivational processes over time.

The Role of Perfectionism and Controlling Conditions in Norwegian Elite Junior Performers' Motivational Processes.

Conceptualized within the framework of self-determination theory, the aim of the current study was to investigate the relation between perfectionistic concerns and (a) controlled (non-self-determined) motivation and (b) performance anxiety through basic psychological need frustration (frustration of competence, autonomy, and realtedness), and if these relations would be moderated by controlling teaching/coaching conditions. We used a cross-sectional moderated mediation design and purposefully selected Norwegian elite junior performers (N = 171; mean age = 17.3; SD age = 0.94) from talent development schools, who completed an online questionnaire to report their perceptions of the study variables. Associations were examined using structural equation modeling. The results showed that perfectionistic concerns were positively associated with controlling conditions, basic needs frustration, controlled motivation, and performance anxiety. Reported controlling teaching/coaching conditions moderated the positive indirect relationship between perfectionistic concerns and (a) controlled motivation and (b) performance anxiety through competence need frustration. Specifically, these indirect associations were evident for performers reporting moderate or high levels of controlling teaching/coaching conditions. In contrast, there were no indirect associations via competence need frustration for those performers who reported low levels of controlling conditions. In conclusion, the results indicate that perfectionistic concerns appear to be a vulnerability factor that exposes elite junior performers to higher risks of entering a debilitative motivational process. This seems especially likely when exposed to controlling teaching/coaching conditions. Coaches and teachers working with elite junior performers should avoid using controlling mechanisms and instead foster autonomous functioning.

Autonomy-supportive dental treatment, oral health-related eudaimonic well-being and oral health: a randomized clinical trial.

Objective: We tested the hypotheses that a dental intervention designed to promote oral care competence in an autonomy-supportive way, relative to standard care, would positively predict patients' perceived autonomy support from oral health-care professionals, increases in eudaimonic well-being (i.e. both personal growth and purposeful behaviour goals) and improved oral health (i.e. reduced dental bacterial plaque on tooth surface and reduced gingivitis) over 5.5 months. We also tested a self-determination theory model with the intervention positively predicting perceived autonomy support, which in turn would predict increases in eudemonic well-being, leading to improved oral health.Design: A randomised two-group experiment was conducted at a dental clinic with 138 patients (Mage = 23.31 yr, SD = 3.5). Variables were measured before and right after the intervention and 5.5 months later.Results: Overall, the experiment and hypothesised process models received strong support. The effect sizes were large for perceived autonomy support, change in personal growth, change in dental plaque and change in gingivitis, whereas the effect size for purposeful behaviour was moderate. The measurement and structural equation models for the SDT process model received good fit.Conclusions: The current field experiment extends previous knowledge by showing that promoting patient oral care competence in an autonomy-supportive way improves oral health through patients' eudaimonic well-being.

Worksite physical activity intervention and somatic symptoms burden: The role of coworker support for basic psychological needs and autonomous motivation.

Suffering from somatic symptoms can seriously hamper one's quality of life and ability to function, causing lost work productivity, sickness absence, and extensive medical utilization. Physical activity (PA) has demonstrated promising results related to mild to moderate cases of somatic symptoms. The present study explored whether a worksite health promotion intervention was able to increase PA and cardiorespiratory fitness, and to reduce somatic symptoms and sickness absence. The intervention was designed based on the tenets of Self-determination theory. A pre-post cluster randomized controlled trial was conducted with 202 industrial workers in a Norwegian logistics company. Results from repeated measures, multivariate analysis of variance, revealed an overall intervention effect and significant change between groups related to somatic symptoms in favor of the intervention group, albeit no significant change in sickness absence. We applied structural equations modeling to test a model of health behavioral change, which posited that increased support for PA from coworkers and autonomous motivation for PA predicted changes in PA, cardiorespiratory fitness, and somatic symptoms. The results underline the effectiveness of including coworker social support in health promotion programs aimed to increase PA and reduce somatic symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study).

The relation between musculoskeletal pain and sickness absence was tested in an adult county population. Maximal explained variance in absence from work due to chronic musculoskeletal pain (sickness absence) was tested in a model in which subjective health was expected to mediate the associations between such pain and dysphoria, respectively, and work efficacy. In turn, work efficacy was expected to mediate the link between subjective health and sickness absence. All the residents in the County of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2%) participated. Prevalence of musculoskeletal pain, dysphoria, subjective health and work efficacy were assessed, as well as sickness absence last year due to musculoskeletal pain. The model test was performed by use of the LISREL procedure based upon data from 30,158 employees reporting chronic musculoskeletal pain last year. The measurement model fitted the data well: χ2 = 9075, df = 52, p < .0004, Critical N = 1041, RMSEA = 0.038, CFI = 0.99, SRMR = 0.020. The structural model fitted the data equally well, and the best prediction of sickness absence was obtained with lower back pain, upper and lower extremity pain, as well as dysphoria as the primary variables affecting subjective health that, in turn, was the convergent predictor of work efficacy that, finally, best explained the variance in sickness absence (56%). The data supported an indirect sequence of complaint-health-efficacy (CHE-model) as the best predictor of sickness absence due to musculoskeletal pain.

Associations between physical activity and motivation, competence, functioning, and apathy in inhabitants with mental illness from a rural municipality: a cross-sectional study.

BACKGROUND: There is increasing evidence for physical activity (PA) having a positive impact on physical and mental health as well as illness symptoms in individuals with severe mental illness (SMI). However, individuals with SMI experience several barriers that makes it difficult to take advantage of the benefits associated with PA. One barrier consistently reported to impede PA is motivational issues. Thus, the main aim of the present study was to examine associations between PA and motivation for PA, perceived competence for PA, functioning, apathy, and demographic variables among individuals with SMI. This was conducted within a larger study aiming at including all inhabitants with SMI in one particular small, rural municipality. METHOD: A total of 106 participants were recruited to the study. Questionnaire-based interviews conducted by two mental health nurses assessed self-reported PA, motivation and competence for PA, functioning, and apathy. Additionally, 71 participants accepted to wear an accelerometer-equipped wristwatch yielding an objective assessment of PA. RESULTS: The participants engaged in little PA. However, they did not lack motivation, as over 90% stated that they would like to be more active, and participants across PA level displayed high scores of a motivation reflecting that they valued the benefits of PA. Results showed that higher self-reported PA level was associated with higher levels of integrated regulated motivation and perceived competence for PA while it was unrelated to functioning and apathy. In the subpopulation with objectively measured PA, integrated regulated motivation for PA remained significantly associated with PA level, whereas poor scores on functioning lowered the odds ratio for higher PA level. CONCLUSION: The results show that PA specific motivation is associated with PA even when controlling for functioning and apathy. This highlight the importance of facilitating context specific motivation (i.e., motivation for PA) and that health care practitioners should emphasise helping people with SMI develop more intrinsic forms of motivation.

Motivational Mechanisms in the Relation between Job Characteristics and Employee Functioning.

This study investigates the job demands-resources (JD-R) model in relation to work motivation in a self-determination theory (SDT) perspective, with the purpose of developing a model where social-contextual factors are seen in relation to psychological needs in order to explain autonomous work motivation and, in turn, self-reported work performance and somatic symptom burden. SEM-analyses of cross-sectional survey data including 405 waiters/waitresses in Norway were conducted to evaluate the hypothesized model. Results indicate that different job resources have different relations to psychological need satisfaction, and that certain types of job demands (i.e., job challenges) actually may enhance satisfaction of specific psychological needs. In particular, task autonomy had a positive relation to autonomy satisfaction (p < .001) and to competence satisfaction (p < .05), positive feedback had a positive relation to autonomy-, competence-, and relatedness satisfaction (p < .001), and workload had a positive relation to competence satisfaction (p < .001). Furthermore, psychological needs for autonomy, competence, and relatedness positively related to autonomous work motivation and, in turn, positively to work performance and negatively to somatic symptom burden (p < .001). Indirect relations were also detected between the job characteristics and autonomous work motivation and between the basic needs and work performance (p < .05). Hence, when explaining autonomous work motivation and work outcomes, it is important to distinguish between different job demands and job resources, as well as among the three psychological needs.

Motivational factors associated with physical activity and quality of life in people with severe mental illness.

BACKGROUND: There has been increasing interest for investigating the role of motivation in physical activity among people with severe mental illness (SMI). Autonomous motivation has been suggested to have a potentially important role in adoption and maintenance of physical activity. However, the knowledge about factors that facilitate autonomous motivation among people with SMI is scarce. AIM: The aim of this study was to examine factors associated with motivation for physical activity as well as the relationships between motivation, physical activity and health-related quality of life in individuals with SMI that were currently physically active. METHODS: A cross-sectional design was used, and 88 participants were recruited from a public health network promoting physical activity for people with SMI. They answered a questionnaire package consisting of scales measuring psychological need support - psychological need satisfaction - and motivation for physical activity, physical activity and health-related quality of life. RESULTS: The majority of participants reported to be in regular physical activity. Associations between variables were tested according to the self-determination theory process model. Structural equation modelling yielded good fit of the process model to the data. Specifically, a need-supportive environment was positively associated with psychological need satisfaction, while psychological need satisfaction was positively associated with autonomous motivation and mental health-related quality of life, and negatively associated with controlled motivation and amotivation. Physical activity was positively associated with autonomous motivation and physical health-related quality of life, and negatively associated with amotivation. CONCLUSION: This study indicates that individuals with SMI can be regularly physically active when provided with suitable opportunities. Furthermore, the present results suggest that it is vital for health-care practitioners to emphasise creating a need-supportive environment when organising physical activity because such an environment is associated with both increased autonomous motivation for physical activity and mental health-related quality of life.

Changes in return to work among patients in vocational rehabilitation: a self-determination theory perspective.

PURPOSE: The aim of the current study was to examine whether patient perceptions of autonomy support from the treatment team in a vocational rehabilitation program will be associated with change (increase) in need satisfaction, autonomous motivation, perceived competence, well-being, physical activity, and return to work (RTW), and whether the self-determination theory (SDT) Model of Health Behavior will provide adequate fit to the data. METHOD: A total of 90 participants were enrolled in a longitudinal study and completed measures at four time points over 15 months. RESULTS: Participants reported increases in all variables, and in general these changes were maintained at six weeks post-rehabilitation and at 15 months post-baseline. As well, the SDT Model of Health Behavior provided adequate fit to the data. CONCLUSIONS: These results underscore the importance of health care practitioners' providing support for their patients' autonomy, competence, and relatedness to improve well-being, physical activity, and RTW in the context of vocational rehabilitation. Implications for Rehabilitation Vocational rehabilitation that emphasizes physical activity is associated with increases in patients' well-being, physical activity, and return to work (RTW). It is important for health care practitioners to provide support for their patients' autonomy, competence, and relatedness in the context of vocational rehabilitation, as doing so is associated with increases in patients' autonomous motivation, perceived competence, and psychosocial outcomes.

Predicting dental attendance from dental hygienists' autonomy support and patients' autonomous motivation: A randomised clinical trial.

OBJECTIVE: To test the hypothesis that a Self-Determination Theory (SDT) intervention designed to promote oral health care competence in an autonomy-supportive way would predict change in caries competence relative to standard care. Further, to test the SDT process path-model hypotheses with: (1) the intervention and individual differences in relative autonomous locus of causality (RALOC) predicting increases in caries competence, which in turn would positively predict dental attendance; (2) RALOC negatively predicting dental anxiety, which would negatively predict dental attendance; (3) RALOC and caries disease referred to the dentist after an autonomy-supportive clinical exam directly positively predicting dental attendance; and (4) the intervention moderating the link between RALOC and dental attendance. DESIGN: A randomised two-group experiment was conducted at a dental clinic with 138 patients (Mage = 23.31 yr., SD = 3.5), with pre- and post-measures in a period of 5.5 months. RESULTS: The experimental model was supported. The SDT path model fit the data well and supported the hypotheses explaining 63% of the variance in dental attendance. CONCLUSIONS: Patients personality (RALOC) and hygienists promoting oral health care competence in an autonomy-supportive way, performance of autonomy-supportive clinical exams and reductions of anxiety for dental treatment have important practical implications for patients' dental attendance.

Motivational mechanisms in the relation between job characteristics and employee functioning

This study investigates the job demands-resources (JD-R) model in relation to work motivation in a self-determination theory (SDT) perspective, with the purpose of developing a model where social-contextual factors are seen in relation to psychological needs in order to explain autonomous work motivation and, in turn, self-reported work performance and somatic symptom burden. SEM-analyses of cross-sectional survey data including 405 waiters/waitresses in Norway were conducted to evaluate the hypothesized model. Results indicate that different job resources have different relations to psychological need satisfaction, and that certain types of job demands (i.e., job challenges) actually may enhance satisfaction of specific psychological needs. In particular, task autonomy had a positive relation to autonomy satisfaction (p < .001) and to competence satisfaction (p < .05), positive feedback had a positive relation to autonomy-, competence-, and relatedness satisfaction (p < .001), and workload had a positive relation to competence satisfaction (p < .001). Furthermore, psychological needs for autonomy, competence, and relatedness positively related to autonomous work motivation and, in turn, positively to work performance and negatively to somatic symptom burden (p < .001). Indirect relations were also detected between the job characteristics and autonomous work motivation and between the basic needs and work performance (p < .05). Hence, when explaining autonomous work motivation and work outcomes, it is important to distinguish between different job demands and job resources, as well as among the three psychological needs (AU)

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Stuck between a rock and a hard place: the work situation for nurses as leaders in municipal health care.

BACKGROUND: The paper aims to present how nursing leaders in the municipal health care perceive the interaction with and support from their superiors and peers. The paper further aims to identify the leaders' vulnerability and strength at work in the current situation of shortage of manpower and other resources in the health care sector. This is seen through the lens of self-determination theory. METHODS: Qualitative interviews were conducted with nine nursing leaders in nursing homes and home-care services, which, in part, capture the municipal health care service in a time of reform. RESULTS: The nursing leaders are highly independent regarding their role as leaders. They act with strength and power in their position as superiors for their own staff, but they lack support and feel left alone by their leader, the municipal health director. The relation between the nursing leaders and their superiors is characterized by controlling structures and lack of autonomy support. As a consequence, the nursing leaders' relations with subordinates and particularly peers, contribute to satisfy their needs for competence and relatedness, and, to some extent, autonomy. However, this cannot substitute for the lack of support from the superior level. CONCLUSION: The paper maintains a need to increase the consciousness of the value of horizontal support and interaction with peers and subordinates for the municipal nursing leader. Also, the need for increased focus on "the missing link" upward between the municipal health director and the nursing leader is revealed. The impact of extensive controlling structures and lack of autonomy support from superiors might lead to reduced motivation and well-being.