Nurse Staffing And Academic Knowledge Gaps University Essay Example


The issue of an inadequate nurse-patient ratio is backed by a significant amount of studies. However, the findings of the studies often lack consistency and scientific rigor. The current literature review analyzes five studies on nurse staffing in order to identify the gaps in academic knowledge and suggest a potentially feasible direction for further research.

A Comparison of Research Questions

The studies selected for the literature review utilize both qualitative and quantitative approaches. For this reason, the research questions differ in both precision and scope. At this point, it should be mentioned neither of the studies contains an explicitly formulated question, which is a common occurrence in the studies with the qualitative design. However, in all cases, it can be extrapolated from the context and the stated purpose of the study.

For instance, a study by Backhaus, Verbeek, van Rossum, Capezuti, and Hamers (2014) explores the impact of nurse staffing on quality of care by summarizing the findings of the longitudinal studies. Therefore, it can be inferred that the research question was, “Is there a consistent relationship between nurse staffing and quality of care in nursing homes?” (Backhaus et al., 2014).

In a similar manner, the research question for the study by Cho et al. (2016) can be formulated as “Is there an association between nurse staffing and overtime and nurse-perceived patient safety, nurse-perceived quality of care, and care left undone?” The study by Hill (2017, p. 1) formulates the following research question: “Do nurse-staffing levels affect patient mortality in acute secondary care?” Dabney and Kalisch (2015) use the following research question: “Is there an association between nurse staffing levels and missed care as reported by the patients?” Finally, a research question inferred from the article by McHugh et al. (2016) is, “Is there an association between nurse staffing and the mortality among in-hospital cardiac arrest patients?”

The questions are similar in all five studies, with the difference being the clinical setting and, in some cases, a specific outcome. However, it should be emphasized that on three out of five occasions, the absence of a clearly formulated research question could compromise the reliability of findings.

A Comparison of Sample Populations

Three of the five studies used primary data in their analysis. The study by Dabney and Kalisch (2015) administered a survey to 729 inpatients in the setting compatible with the staffing criteria. Such size of the sample is sufficient to obtain statistically significant results representative of the population. Cho et al. (2016) collected the data by surveying the nurses from 60 out of 65 hospitals selected from the study. The departments which participated in the survey were selected randomly within each hospital, which eliminates the possibility of bias and further strengthens the feasibility of the results.

Finally, McHugh et al. (2016) retrieved data on 11160 patients in 75 hospitals across four states using three databases. Such a sample population is highly representative of the population in question and is consistent with the requirements of cross-sectional studies. Two other studies used secondary data for the analysis. In these cases, samples were comprised of the academic sources. Backhaus et al. (2014) employed 20 quantitative, longitudinal studies.

While such a sample is arguably insufficient for conducting a systematic review, it should be understood that it was most likely caused by the narrow scope of the inquiry and the rejection of cross-sectional studies that allowed for a more reliable result. Finally, Hill (2017) utilized 58 articles, all of which were verified for relevance, which can be considered a sufficient amount for the systematic review.

A Comparison of the Limitations of the Study

A study by Dabney and Kalisch (2015) has several limitations. For instance, the demographic data was not included in the analysis, which means that the applicability of the findings could not be established. In addition, the authors used a convenience sample, which means that the findings are not representative. Cho et al. (2016) specified that the cross-sectional method employed by their team could not be used to establish the causality among variables.

In addition, the data was based on the self-reports by the nurses rather than an objective evaluation, which reduces the study’s objectivity. Finally, the obtained results were not positively verified for clinical significance despite the conclusive statistical significance determined by the analysis. McHugh et al. (2016) also point out that the cross-sectional design of their study prevents the researchers from definitively establishing the causality and the convenience nature of the sampling procedure undermines the reliability of the data.

In addition, the established relationship may be subject to certain confounding variables that may have been overlooked during the design phase. Backhaus et al. (2014) identify an inconsistency in the data selection criteria that permitted using longitudinal studies with no initial baseline measurement as well as the lack of uniformity of scales used in the initial studies. Hill (2017) does not identify the limitations, although it is apparent that the lack of uniformity across the sample and the inclusion of cross-sectional studies are two of the most evident limitations.


Despite the significant coverage in the current academic literature, several gaps can be identified in the understanding of the issue. Based on the literature review, it would be reasonable to suggest a longitudinal study with a properly conducted baseline measurement to eliminate ambiguity. It is also necessary to conduct a systematic review that would exclude results based on self-reports and establish the clinical significance of the outcomes obtained by the previous researchers.


Backhaus, R., Verbeek, H., van Rossum, E., Capezuti, E., & Hamers, J. P. (2014). Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. Journal of the American Medical Directors Association, 15(6), 383-393.

Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International Journal of Nursing Studies, 60, 263-271.

Dabney, B. W., & Kalisch, B. J. (2015). Nurse staffing levels and patient-reported missed nursing care. Journal of Nursing Care Quality, 30(4), 306-312.

Hill, B. (2017). Do nurse-staffing levels affect patient mortality in acute secondary care? British Journal of Nursing, 26(12), 698-704.

McHugh, M. D., Rochman, M. F., Sloane, D. M., Berg, R. A., Mancini, M. E., Nadkarni, V. M.,… Aiken, L. H. (2016). Better nurse staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care, 54(1), 74-80.

The Book “Naked Diplomacy” By Tom Fletcher


Diplomacy has always been one of the most powerful tools used by people in negotiations to attain an advantageous position or make an opponent accept a certain proposal or follow an outlined course. It appeared at the dawn of human civilization and since that time had experienced numerous challenges that shaped its main sense and contributed to the appearance of numerous tools that could be applied in different situations.

Having evolved, it become one of the main aspects of the modern world. It impacts not only the functioning of a certain state; however, it also creates a setting for the international discourse and cooperation between different states. For this reason, there are numerous attempts to analyze this very issue and determine the main aspects of its formation and becoming one of the most important human activities. The book Naked Diplomacy by Tom Fletcher could be considered one of these attempts.


Therefore, the improved comprehending of the given book could result in the reconsideration of the main sense of diplomacy and its impact on the modern world. Moreover, there are also some other important concerns that could be obtained when reading the book and applying it to the real life conditions. First o all, it is the realization of the model that impacts every state and guarantees its being a part of the international discourse. Therefore, the modern international policy could be characterized by the appearance of new actors that become more and more influential and the UAE is one of these. In this regard, its current diplomacy could be analyzed in terms of the given book and its main concepts.

Preface and Part I

Besides, the book starts with the preface that explains the main issues related to the diplomacy and the way it shapes the world. The author clarifies the unique importance of this very tool using a powerful example of Shen Weigin, the diplomatic adviser to Emperor (Fletcher 1). This story emphasizes the way diplomacy serves people and how it could either improve or deteriorate the situation. The same ideas could be applied to the modern diplomacy. In case a diplomat fails to function at the high level, a state will suffer from the significant weakening of its position. It is especially topical for rising states like the UAE as its diplomats should be ready to face all challenges and overcome them.

Delving into the issue, the author provides a historical context to demonstrate the way diplomacy evolved and acquired its main features. It appeared when a survival instinct prioritized cooperation over conflict and resulted in the increased survival prospects (Fletcher 12). People understood that the ability to negotiate result in the increased efficiency of the cooperation and improved flexibility in large groups. However, not all messages and attempts to align relations were successful, and people realized the need for a tool that could help them to solve problems. It was the birth of diplomacy. Thus, communities evolved in different ways and states obtained their unique approaches to diplomacy. China created treaties to avoid conflicts; Ancient Greece sent short missions to other countries; Mongols also created their sophisticated way of cooperation (Fletcher 14). The great success of these states evidences that any rising commonwealth, like the UAE, has to create its own approach to diplomacy and explore it to attain success.

Continuing to highlight roots of diplomacy, the author states that at the first stages of its evolution, Eastern cultures were more acknowledged in the main diplomatic issues and promoted the evolution of the sphere greatly (Fletcher 30). In this regard, the idea that Europeans are the main contributors to its development is false. Only in the 15h century, they created a certain system of diplomatic relations with embassies and representatives of different states (Fletcher 32). In the 17th century, the first Ministry of External Affairs appeared and resulted in the intensification of the relations of this sort (Fletcher 33). Numerous geographical discoveries also contributed to the rise of diplomacy as states needed to align relations with new entities. Additionally, it became closely connected with the capital. To impact decision-making of different actors and to support their own actions, diplomats started to use capital as a powerful tool.

All these factors promoted the blistering rise of diplomacy and the age of its empowerment. Numerous innovations boosted diplomatic relations, and the tool became able to guarantee fast and efficient results needed to attain a certain goal. Moreover, the increased complexity of the international relations and the alterations in peoples mentality preconditioned the appearance of the new ways to impact public opinion and reconsider existing relations. The unique events of the 18th century, Napoleonic wars, a new pattern of the international relations increased the need for efficient diplomatic tools greatly. The author demonstrates that any serious alterations of the vector of international relations are a good background for the evolution of diplomacy. This could be applied to the modern age as the world passes through the period of change, and the UAE could use this opportunity by giving specific attention to its means of diplomacy.

In the following chapter Tom Fletcher emphasizes the importance of a new stimulus that diplomacy obtained in the 20th century. The author states the rapid development of technologies had a great positive impact on diplomacy as it obtained a number of new tools that it could use to guarantee a success of a certain issue and introduce new and more efficient ways of communication. The usage of telephone and television became the turning point in a new history of diplomacy. However, at the same time, the application of these tools was complicated by two world wars that were “a fallow period for democracy” (Fletcher 60) as states preferred to use military logic. However, any war ends with negotiations and diplomacy obtained a unique opportunity to shape the modern world.

Finally, Fletcher states that nowadays diplomacy remains the issue that supports the existing model of the international relations (82). It rests on such international organization as the UN that was created by diplomats to solve conflicts and avoid military conflicts that might appear in case the problem is disregarded. Furthermore, the increased complexity is compensated by the wide usage of innovations and revolutionary technologies. Emails and the Internet became the main tools that help modern diplomats to remain efficient. Analyzing this very part, we could state that the UAE should realize the unique importance of membership in these international organizations as they could be used as a platform to protect its own interests and attain success in relations with some states. Additionally, it is extremely important to be able to equip diplomats with all necessary tools to assure that they will function efficiently.

The following section could be considered one of the most important parts of the whole book as the author revolves around the idea of a good diplomat and qualities he/she should possess to be able to help its state to acquire a certain competitive advantage. This chapter is also important for states like the UAE that try to alter the current balance of power and become important actors in the international relations. The UAE has to cultivate its own unique approach to diplomacy and create a generation of ambassadors, councils, and other specialists who will be able to possess all qualities peculiar to a good diplomat. However, it is also crucial to avoid stereotypes when speaking about the issue as they might contort the main idea.

Part II

The second part of the book starts with the idea of so-called iDiplomacy which means the overwhelming prevalence of technologies. Fletcher states that “the coinage of the modern politics is now digital” (Fletcher 107). Technologies are used in every sphere of human activity, and the modern age could be defined as a networked society (Fletcher 107). Humans are able to exchange information without any delays and using tools available to them. This fact could not but impact the sphere of diplomacy. The faster people could communicate with each other the more efficient solution to a certain problem they could suggest. The same deals with diplomacy.

It obviously benefits from the increased speeds and becomes more and more efficient. However, there is also a certain threat as some non-digital nations or states might be excluded from the international discourse and suffer from their isolation. That is why it is crucial to assure that the process of a states development is supported by the usage of innovations in the sphere of diplomacy as it is one of the key aspects of any nations rise.

The UAE should perfectly realize this fact. At the moment, we could observe its tendency towards the usage of the newest technologies in its international relations. This approach helps the state to remain a part of the international discourse and not get isolated. However, the use of technologies also results in the high probability of information attacks and other attempts to corrupt real motifs of some actions. In this regard, security becomes another important concern, and the UAE should be ready to meet numerous challenges resulting from the altered character of the international relations.

Besides, speaking about the problem of security and privacy, the author states that a great threat to secrecy could be observed. Suggesting the case of Assange, or Snowden as powerful examples, Fletcher demonstrates us that the wide usage of technologies is a two-edged weapon that introduces numerous vulnerabilities. Diplomacy has always been associated with privacy as the majority of treaties have some hidden aspects that should not be known to other parties. Moreover, very often the remedies that are used by diplomats could be condemned by the publicity. For this reason, secrecy has been considered one of the integral points of diplomacy.

Nowadays it is threatened. For instance, WikiLeaks “creates dangerous implications for the ability of diplomats and government to protect confidential information and exchanges” (Fletcher 120). At the same time, it also complicates the process of negotiation as parties will be deprived of their main levers of influence. In this regard, the question of data security becomes one of the major issues for the modern diplomacy. Like any state which is engaged in the international discourse, the UAE should be ready to face this new problem and protect its data from leaks as they might do a great harm and weaken its position. At the same time, increased transparency of the international affairs should be taken into account when trying to achieve a certain goal and using doubtful remedies. The UAEs diplomats should keep in mind the fact that their actions might destroy the image of the state.

Considering all these facts, the book states the rise of a new power in the sphere of diplomatic relations. It combines the use of the most popular topics and appeals with numerous leaks and information bombs that might astonish the public and shape its attitude to a certain event or even state. There are numerous examples of information attacks on powerful persons and states which resulted in a great public response. For this reason, diplomats should obviously be ready to face such sort of threat and preserve the image of the UAE which also might suffer from the results of such actions.

However, Fletcher states that despite all alterations “nations and peoples still need diplomats to mediate the issues that divide them and help them avoid conflict” (Fletcher 168). It means that the nature of diplomacy remains the same and numerous ambassadors and councils have to solve problems that appear at the international level and guarantee a states evolution. For this reason, the author gives certain recommendations that could also be followed by the UAE diplomats. First of all, “decent peacemakers need to know their interests” (Fletcher 169), “their opponents” (Fletcher 169), and “to know when to turn off their smartphone” (Fletcher 169). These pieces of advice might seem obvious; however, they are crucial in the modern setting. Moreover, “Good negotiators sometimes let their opponents win” (Fletcher 174) in case some better position could be achieved as the result of these actions. The adherence to these rules could help to increase the efficiency of a diplomat and guarantee success at the international level.

Part III

In the final part, the author revolves around the perspectives of diplomacy and the way it might evolve. He is sure, that diplomacy will remain one of the main tools of the international communication as only its usage could guarantee the preservation of the existing word order and peace. It will obviously become even more digital and technologies-dependent; however, at the same time it will also save its nature and help people to make a compromise and solve some problematic question.


In conclusion, the book Naked Diplomacy could be considered an important source that outlines the most important aspects of diplomacy and the way it could be used to solve the most topical issues. The majority of assumptions provided by the author are supported by real-life examples. It contributes to the increased importance of the given source. The author also suggests his ideas about the qualities a good diplomat should possess to be able to function efficiently. These assumptions could be used by the UAE in its attempts to enhance its international policy and create a generation of efficient diplomats who will be able to preserve its interests and contribute to the development of the state.

Work Cited

Fletcher, Tom. Naked Diplomacy. William Collins, 2016.

Exploration Of Leadership And Entrepreneurship Fields


The scholars in the leadership field are very much familiar with the complicated and problematic course which this field has followed. According to Hunt and Dodge (2000), despite these obstacles, at the present, there is the consideration of leadership as being a “mature field” because of the developments that have been realized in the field even if this development hasn’t been attained in the absence of remarkable increasing pains. Rindova & Starbuck (1997) point out that the leadership field is not a new field of study and it came up during the old times and scholars in such early nations as Greece, China, Egypt, and India among others presented writings concerning the field. However, it was not until the 20th century thereon that systematic study in the field came into existence.

Leadership is not one of its kinds in its challenging progression to development. Looking at the entrepreneurship field, Hitt and Ireland (2000) point out that this field is a younger one and is not as old as the leadership field. It is in its early development stages as pointed out by Aldrich and Baker (1997) and it is at the present, regarded as a field that is in a considerable growth state (Busenitz et al, 2003).

In the same way as the course that the scholars in the leadership field faced, the entrepreneurship scholars are also fighting with issues that are associated with an area of study that is in its initial development periods. Cogliser and Bringham (2004) point out that; whereas the fields of leadership and entrepreneurship may have their differences, there is much they have in common and they may depend on each other based on the experiences they share. This paper is going to explore both the leadership and entrepreneurship fields and later, it is going to be established that future exploration of leadership and entrepreneurship should move away from what he/she is, towards what he/she does.

Exploration of Leadership and entrepreneurship

According to Cogliser and Bringham (2004) the initial stage in the exploration of a research field, which involves introducing the concept and explaining it, is marked by efforts to set up authenticity for the research field. The focus of research in the field is basically on the definition of the domain as well as its importance and usefulness for elucidating organizational trends to enlighten the readership on these matters (Reichers & Schneider, 1990).

Hunt and Dodge (2000) point out that the field of leadership has a larger number of models as compared to any other field that is under the behavioral sciences. Studies in the leadership field started during ancient civilizations (Bass, 1997). However, it was from the start of the twentieth century that there has been a systematic study in the leadership field. Moving hand in hand with a large number of contemporary leadership models is the huge number of meanings for the concept.

Bass (1990) points out that the early scholars in the field of leadership used the term “leadership” in different ways depending on what purpose they wanted it to serve, and in most cases, they did not give its clear meaning or definition within their particular construct domain. In considering this construct Yukl (2002) points out that it has well been labeled in several ways which include “power, authority, management, administration, control, and supervision as well as being defined about traits, behaviors, influence, interaction patterns, role relationships, and occupation of an administrative setting” (p.2).

Consequently, as it was observed by Janda (1990), “leadership” played a role as an unclear and vague term, including a broad range of settings having unconnected connotations, difficult predictions, and causing vagueness in definition. The complicated and disjointed status of the field stood at a level which made Miner (1975) to comment that, himself being among other scholars did not know what they wanted to know and that the leadership concept itself had lived longer than its worth.

The field of entrepreneurship has gone through the same fate of a new field that does not have a combined knowledge which is supported by the established theories in the field of study of social sciences (Cogliser & Bringham, 2004). According to Shane and Venkataraman (2000), they observed that the term entrepreneurship has turn out to be an expansive brand under which an assortment of research is accommodated. Aldrich and Baker (1997) have considered this term as, to quote their own words, “a multidisciplinary jigsaw characterized by accumulative fragmental in a chaotic pre-paradigmatic state of development” (p.396).

Looking for authenticity and distinctiveness has partially resulted from three “organization sciences” from which there has been coming up of entrepreneurship. The three are; sociology, ecology as well as economics (Vecchio, 2003). From a variety of these domains, there has been the development of two dominant viewpoints on entrepreneurship. One of the viewpoints takes the supply side and the other is the demand side. Considering the supply side, this side looks at the people who have the appropriate qualifications to take up the roles that need to be taken. On the other hand, the demand side approach looks at how many roles are supposed to be filled as well as the nature of these roles (Thormton, 1999).

The initial attempt to carry out a systematic study of leadership was the “trait approach” which peaked in the course of the 1920s up to the 1950s and saw a revival in the course of the 1990s. According to House and Aditya (1997), at that point, the domain started to set up its authenticity among the social sciences. The main attention of this was on the kind of characteristics that gave a distinction between those who are leaders and those who are not and the extent of the distinction (House & Aditya, 1997). Among the skills which were explored in the course of these studies, as pointed out by Bass (1990) included social and interpersonal skills. Others were the administrative skills as well as communicative skills and the intellectual expertise.

Looking at the entrepreneurship field, according to Cogliser & Bringham (2004), the studies on traits put focus on the identification of some specific “personality variables” which would give a distinction between entrepreneurs and other groups and which were reputed to give direction to the setting up of new organizations. The examples of those variables that were looked at in these kinds of studies were such variables as the need for accomplishment and the tendency for risk-taking among variables (Cogliser & Bringham, 2004).

Both the leadership and entrepreneurship fields experienced challenges looking wholly at “personality characteristics” among other individual differences for forecasting the rising of the entrepreneur or leader. The “trait approach” to leadership faced challenges from scholars and among these scholars was Stogdill (1948) whose critical review posed a question regarding how universal the traits in the leadership researches were. This review involved the launching of the initial big crisis in the leadership field and at the same time offering the driving force to move leadership attention, as pointed out by Antonakis, et al (2004), from who a leader is to what a leader does.

A large number of the “behavioral theories” that were set up beginning from the 1950s up to the 1980s had their attention on two classes of leader behavior. These classes were initiating and consideration (Antonakis, et al, 2004). These researchers, Antonakis, et al (2004), further observed that whereas there was a big effort to keenly consider the link between the leader behaviors and the resultant leadership efficiency, outcomes went on being weak or open to doubt. Therefore, leadership experienced its next or second-largest crisis (Antonakis, et al, 2004).

Comparable to the pivotal piece of Stogdill (1948), Cogliser & Bringham, (2004) states that entrepreneurship had an understandable delineation point from the trait move to the behavioral move. In an analysis carried out by Gartner (1985) in the field, it was concluded that disparities that can be traced among those who are entrepreneurs as well their business undertakings are as immense as the disparities between those who are entrepreneurs and those who are not and between the firms that have just been set up and those that have been in operation for a longer time.

This scholar as well called for a basic move away from individual trait standpoints and go in the direction of a behavioral approach for the study of entrepreneurship. Gartner (1988) went ahead to give a proposal that “future exploration of the entrepreneur should move away from what he/she is toward what he/she does” (Gartner, 1988, p.19). More reviews that were carried out ensured reinforcement of the need to take up a “behavioral approach”(Low & MacMillan, 1988). This was a well-seen move away from asking the question about who an entrepreneur is.

According to Herron & Robinson (1993), just considering the demographic features as well as demographic traits as a means to forecast entrepreneurial behavior has been chiefly dropped and there has been opting for more productive research opportunities. The consequence that has come out of this is however that, large numbers of scholars entirely left out the individual entrepreneur (Cogliser & Bringham, 2004). The fear of bringing entrepreneurship dimensions together and being acknowledged as a “traits researcher” remains in the field at the present (Cogliser & Bringham, 2004, p.782).

In an attempt to realize reconciliation in the findings which were revealed in the course of the behavioral leadership study era, the researchers in the leadership field shifted towards the exploration of the context under which there was the occurrence of the leadership concept. According to Antonakis, et al (2004), there was the domination of the “contingency theories” in the leadership writings all through the 1970s and this stretched into the 1980s. However, as it is pointed out by Scriesheim and Kerr (1977), the contingency theories were as well exposed to measurement and theoretical limitations that served as obstacles to the usefulness they had for active managers and for promoting an orderly flow of research. Just like in the development of leadership, entrepreneurship started to shift in the direction beyond putting focus only on the individual or only on the environment.


The leadership phenomenon has been studied beginning form the ancient days but it was not until the twentieth century that there was systematic study in this field. Currently, there is the consideration of leadership as being a developed field even if this development has not been realized without remarkable ever-increasing pains. The first researchers in the field of leadership “pulled” this term from the ordinary vocabulary and utilized it to go with the specific purposes they had, and in most cases its definition to be clear within their explicit construct domain. On the other hand, the entrepreneurship field, in relative terms, is less mature than the leadership field. It is in the premature development stages when looked at from the conceptual and methodological perspective and it is at the present day, taken to be in an important growth or evolving state.

The leadership, as well as the entrepreneurship fields, encountered challenges looking entirely at traits characteristics among other individual variations for forecasting coming up of the entrepreneur or leader. The trait move to considering leadership faced challenges from scholars and among these scholars was Stogdill (1948) whose critical analysis carried out the launching of the initial big crisis in leadership field and at the same time offering the driving force to shift the attention on the leadership of what a leader is to what activities he carries out. In conclusion, the “future exploration of the leader and entrepreneur should move away from what he/she is toward what he/she does as suggested by (Gartner, 1988). More reviews that have been carried out made sure that there is reinforcement of the need to take up a “behavioral approach”. This was a well-seen move away from asking the question about who a leader or an entrepreneur is.


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