Date of Award

Spring 5-15-2026

Degree Type

Dissertation

Degree Name

PhD Nursing

Department

Nursing

Advisor

Bonnie Sturm, Ed.D, R.N.

Committee Member

Kristi Stinton, PhD, RN, APN, PNAP

Committee Member

Pamela Foley, Ph.D.

Keywords

submissiveness to authority, moral disengagement, psychological power distance, healthcare leadership, ethics, obedience to authority

Abstract

Background: Understanding how senior healthcare executives respond to authority is critical in complex health systems where ethical decision-making, hierarchy, and organizational culture intersect. This study explored the relationships among moral disengagement, submissiveness to authority, and psychological power distance (PPD) in U.S. healthcare executives, as well as the influence of selected demographic and professional covariates.

Methods: A descriptive correlational design was used with a non-probability sample of senior healthcare executives (N = 98). Participants completed a demographic questionnaire and three validated instruments: the Submissiveness to Authority Scale (SOAS), the Moral Disengagement through Displacement of Responsibility Questionnaire (MDDR), and the Psychological Power Distance Scale (PPD). Data were analyzed using IBM SPSS® Statistics 30.0. Analyses included descriptive statistics, bivariate testing (t-tests, ANOVA, Pearson correlations), and multivariate regression modeling.

Results: Participants demonstrated moderate levels of submissiveness to authority (M = 39, SD = 9.3), lower than those reported in earlier validation research involving student populations. Contrary to expectations, moral disengagement was not significantly related to submissiveness to authority, suggesting that mechanisms such as diffusion or displacement of responsibility may function differently in executive-level decision-making or may operate collectively rather than individually. Psychological power distance did not moderate the relationship between moral disengagement and submissiveness; however, it showed a significant direct association with submissiveness (r = .285, p = .004) and emerged as a significant predictor in regression analysis (p = .045), indicating that individually held beliefs about hierarchy and authority meaningfully influence obedience behaviors. Several covariates were significant. Younger executives reported greater submissiveness to authority (r = −.233, p = .021). Professional licensure was associated with differences in obedience, with registered nurse–licensed executives differing significantly from unlicensed executives. Educational attainment also demonstrated a strong effect: master’s-prepared executives reported higher obedience scores than doctorally prepared executives (p = .007), supporting literature linking advanced education with reduced authoritarian tendencies.

Conclusions: Findings suggest that hierarchical values and professional socialization, rather than moral disengagement alone, shape executives’ responses to authority. Age, licensure, and education appear to influence willingness to question directives, highlighting the importance of fostering psychologically safe organizational cultures that encourage ethical voice across leadership levels. Further research should examine all mechanisms of moral disengagement and consider group-level dynamics in executive decision-making.

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