The group of respondents consisted of 615 students of nursing. The criteria for inclusion in the study were: 1) the status of a student of nursing at Medical University of Warsaw (MUW), 2) informed consent to participate in the study. The criteria for exclusion in the study were: 1) the status of a student of a discipline other than nursing at MUW, 2) lack of informed consent to participate in the study. Students of all years at the discipline nursing were included in the study. B.A. Students (n=353) and M.A. Students (n=262) participated in the study. Among B.A. students, 169 were 1st year students, 134 2nd year students and 50 3rd year students. In the case of M.A. students, 129 were 1st year students, and 133 2nd year students. In the academic year 2017/2018 911 students studied nursing, out of which 549 B.A. students, and 362 M.A. students. The ratio of filled in questionnaires from B.A. students was 64.30 %. In the case of M.A. students, the ratio was 72.38 %.
Average age of the respondents was 24.26 years (SD=4.721). The youngest student of nursing was 20 the oldest 53. Women prevailed in the analyzed group (96.3%; n=592). Men constituted 3.7% of all respondents (n=23). Students from very large cities dominated in the study (n=243; 39.5%) and villages (n=183; 29.8%). Further there were students from small towns (n=98; 15.9%) and medium size towns (n=66; 10.7%). The smallest share of students came from large cities (n=25; 4.1%).
The context of the character of nursing education in Poland
Education of nurses in Poland takes place in accordance with norms determined by the EU Directive (21) and the Regulation of the Minister of Science and Higher Education (22). In light of the abovementioned legal regulations, nurses in in Poland are educated according to a split level approach. First-degree studies have a practical profile and last no shorter than 6 semesters, and second-degree studies have a more general profile, include elements of pedagogy, management and methodology of research and last no less than 4 semesters. After first-degree studies and passing a vocational exam, a student gets the right to exercise their profession and may work as a nurse. Second-degree studies are of supplementary character, aiming at increasing their professional competencies and preparing to take management post. A very extensive offer of postgraduate education is an additional form of educating nurses in Poland. Already after graduation a nurse can apply to a specialty training (providing she has a minimum two years of professional experience), qualification degree course (providing she has at least 6 months of professional experience), which is a smaller form of specialty training and training course, aiming at increasing the competences of a nurse (e.g. cardiopulmonary resuscitation (CPR), wound treatment, communication, etc.)(23). Although a graduate of nursing has multiple paths of development, there are too few new nurses in this profession. In light of the data of the Supreme Chamber of Nurses and Midwives, the average age in the profession in 2018 was 52.03, and the number of nurses was 233 012, which approximates one nurse for every 165 Poles (24, 25).
Theoretical assumptions of the model
On the basis of data from the literature, a positive relation between self-efficacy and authentic leadership skills can be assumed (15, 17). Taking into account the nature of the variable such as perfectionism (20, 26-28), it may be assumed that it will be a mediator of relations between self-efficacy and leadership skills (Figure 1). Taking into account the complexity of personality such as perfectionism, the dimension which is directly connected with setting high standards to oneself was selected for further analyses. The High Standards taps into having high standards and expectations about one's performance and achievements (20). Such an attitude may have particular significance for acquiring and improving one’s own leadership skills.
Data collection procedure
Before commencing to the study, essential consents for conducting the cross-sectional study were obtained among students of nursing at the MUW. Next, a person responsible for didactics in nursing (coordinator of nursing) was contacted in order to enable executing an auditorium questionnaire. The coordinator was in charge of the accuracy of conducting the research and was part of the research team. The coordinator was instructed in terms of data collection supervision. The training was conducted by a psychologist. It was connected with the fact that the contents of the research tool concerned the realm of psychological functioning. In this regard the risk of potential influence of outsiders on answering questions by the respondents had to be minimalized. The data was gathered on the premised of the Medical University of Warsaw from October to December 2019. Students filled in the survey at the beginning of their classes in the presence of the coordinator. There were no third parties present during data collection. The students were informed on the aim of the study, as well as on the possibility to deny participation in it. The coordinator assured the students of full anonymity of the studies. The mean time of data collection was 10 minutes. The studies were conducted in two stages. The first stage included B.A. studies, and the second stage M.A. studies. No detailed register of the students who denied participation in the studies was kept. Only the number of students who denied participating in the study was recorded.
The following research tools were used: Authentic Leadership Questionnaire (8), Almost Perfect Scale-Revised (APS-R) (20), and General Self-Efficacy Scale (GSES) (19).
Authentic Leadership Questionnaire (ALQ) is designed to measure the components that comprise Authentic Leadership, and has four scales: Self Awareness, Transparency, Ethical/Moral, and Balanced Processing. The Polish version of ALQ was used which consist of 16 items. The respondent replies to each question using a 5 point scale (Not at all - Once in a while - Sometimes - Fairly often - Frequently, if not always) (8)
Almost Perfect Scale-Revised (APS-R) consists of 23 items, which contains three variables: High Standards, Order, and Discrepancy. Respondents replied to particular questions using a 7-point scale (Strongly Disagree, Disagree, Slightly disagree, Neutral, Agree Slightly, Agree, Strongly Agree). The designers of APS-R (20) consider Standards and Discrepancy as defining elements of perfectionism. High scores in Standards mean high expectations being set with a high need for excellence. This defines perfectionists, whether they are ‘maladaptive’ or ‘adaptive’. A high score on the Discrepancy Scale combined with a high score in Standards is what indicates a maladaptive type of perfectionism. Maladaptive basically means less flexible to the point of frustration and inability to reach goals or just the continual ‘not good enough’ (20, 29)
General Self-Efficacy Scale (GSES) is a self-report measure of self-efficacy and consists of 10 items. A respondent replies to each question using a 4-point scale (Not at all true, Hardly true, Moderately true, Exactly true). The total score is calculated by finding the sum of all the items. For the GSE, the total score ranges between 10 and 40, with a higher score indicating more self-efficacy. Cronbach’s alpha for GSES is between .76 and .90. (18). In this study, the Polish version of GSES was used (19).
Consent of the bioethics committee
The authors of the present study obtained the opinion Institutional ethics Committee of Medical University of Warsaw on no contradictions for conducting studies with the use of non-invasive research methods (30).
All of the statistical analyses were performed using STATISTICA 13.3 (TIBCO©, Inc., Palo Alto, California, United States) under the MUW licence. P-values <0.05 were considered to be statistically significant.
Assessment of prevalence of partial mediation was conducted according to the procedure proposed by Cohen et al. (31). Mediation analysis is made up of three stages, which consists of a series of regression analyses. The parameters of regression function were estimated with the use of the method of least squares. Non-standardised (b) and standardised (β) regression coefficients together with 95% confidence interval were determined.
In the first stage, the influence of own efficacy (GSES: independent variable) on the level of leadership was evaluated (ALQ: dependent variable). In the second stage the influence of the feeling of one’s own efficacy (GSES: independent variable) on the level of perfection standard (potential mediator) was assessed. In the third and last stage of the analysis, it was evaluated whether the independent variable (GSES) and mediator (perfection standard) significantly influence the dependent variable (ALQ). It was assumed that the mediation was significant when intermediate relations – of independent variable and the mediator as well as mediator and dependent variable, were statistically significant. In such cases the determining factor was the result of Sobel test, which evaluates whether the product of nonstandardized regression coefficients of both relations was significantly different from zero (32).