The participants regarded staff reliance, and thus obedience,
as necessary in order to achieve goals:
I became an educational supervisor . . . I had to assure
the head nurses so that they could trust me. I had to show
them my capacities so that they know that I amqualified,
therefore care . . . what I say. In this way, I could achieve
my goals (S 2).
Having information enabled the participants to convince
top managers, as well as subordinators:
If a manager tries to influence working conditions, such
as wages, then our information enables us to resist and
convince him/her (S 3).
Moreover, legal authority provided the participants with a
great authority to behave assertively:
When we do not find a medical intern, we tell the senior
resident “either to find the intern or to cure the patient
yourself”. A nurse, even as [the] emergency unit incharge,
cannot speak this way. I, as a supervisor, can do
so.We need a more powerful one (S 1).
Psychology
This category explains the use of psychology as various treatment
styles that are appropriate to the situation. It includes
“the analysis of the staff members’ mood” and “understanding
the staff”. For example, the following comments were
made:
Once you confront an employee who is not in a good
mood and naturally resists what you say, if you know
him/her psychologically, you try to calm him/her and
solve his/her problem rather than giving him/her orders
(S 3).
[The] head nurse and her assistant should know each
other retrospectively. If not, some challenges between
them will be unavoidable. Similar challenges have . . .
occurred before (HN 6).
Internal relationship between the executive
agents components
Besides the main path of the model, there are internal relationships
among the executive agents’ categories.
The components of learning assertiveness, self-learning,
and developmental factors could impact the bravery development
factors:
. . . as I was the elder child in my family, my father gave
me more responsibility. It increased my selfconfidence
. . . (M 2).
When Mr N notices braveness in my speech, he inductively
becomes brave. He tries to imitate me to speak
against others (S 2).
Not only did the supportive factors directly influence assertive
behavior but they also affected the bravery development
factors:
Daring is related to [the] top managers’ support . . . this
is an encouragement for leaders.That is, if a leader does
his/her best, [the] top managers support him/her (HN 5).
Relationship between the religious beliefs and the
executive agents
The study’s participants considered religious beliefs as a
daring factor:
. . . that the leaders believe in Islamic management is
another requirement for daring . . . this is a divine management
which God is satisfied with. The leadership
should be like this. I prefer it (M 1).
Religious beliefs persuaded learning:
You need to have plans to achieve ideological goals. To
do so, accruing information and awareness plays an
important role in managerial behaviors, etc. (HN 6).
Some religious recommendations could influence the
supportive factors. For example, truth could influence staff
reliance:
. . . [the] truth causes reliance. If they trust you, they
cooperate with you (HN 3).
However, developmental factors, such as social and family
training, could affect one’s religious and ethical beliefs:
My mother limited our contacts with others. She
believed that we should not be in touch with those who
do not worship God. She emphasized . . . religious and
ideological issues . . . (S 1).
DISCUSSION
This grounded theory study demonstrated how assertive
behaviors are shaped in some Iranian nursing leaders.The first
theme was task generation, which induced a set of tasks for
the participants. The participants were directed to assertive
behaviors to carry out the target tasks. In a study by Khomeiran
et al. (2006), the participants pointed out that taking some
degree of responsibility had given them the opportunity to
acquire some important skills, such as assertiveness.
The results of this study indicated that the ETGs were
related to job characteristics and job status and they automatically
induced responsibilities for the participants who
needed to be assertive to carry out these responsibilities. In
a study by Timmins and McCabe (2005b), the respondents
cited their responsibility to patients as a primary facilitator of
their assertive behavior. Clearly, from these practicing clinicians’
perspective, assertiveness was a requirement of good
quality patient care. Therefore, the results of Timmins and
McCabe (2005b) and Khomeiran et al. (2006) are confirmed
by the present study’s results.
The interesting point in this study was that some of the
ITG-related tasks were imposed on the participants internally.
Such tasks internally enforced them to carry out the
external tasks in accordance with ethics and religious criteria.
For example, they should take care of patients so carefully