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This study aims to make visible the dynamic nature of leader–member exchange (LMX) in the changing realm of health-care leadership.

The qualitative study used an open questionnaire, which was distributed amongst nursing staff and managers at a Finnish public university hospital.

The participants described partly LMX theory, but the leader-member relationship was also influenced by the organizational culture and the existing management practices. Nursing staff were found to have a more variable and dynamic role in the LMX relationship than has previously been reported. The research therefore provided novel information for the field of health-care research.

The presented research was limited by the content of the data, as the collected single narratives were rather short; however, the fact that a large number of narratives were collected from diverse participants strengthened the ability to reliably answer the research questions.

Although the participants described partly LMX theory, the leader–member relationship is also influenced by the organizational culture and existing management practices; the finding that nurses have more variable roles in LMX relationships in the health-care context was new insight in this field. Therefore, the presented findings can help decision-makers change the current, perhaps antiquated, leadership practices at health-care organizations.

This study provides new insight into the field of LMX research in terms of the important role of nursing staff, the organizational factors that influence the LMX relationship and the dynamic nature of LMX relationships.

The purpose of this study is to address the construction of trust in leader member exchange (LMX) relationships as a multidimensional phenomenon and identify the importance of emotional and collective factors contributing to this phenomenon.

Ten health care professionals (five leaders and five members) were interviewed to subject to qualitative thematic analysis.

Four main themes in the data were identified (work roles, collectivity, interaction and participation) and linked to two main elements of LMX trust relations: core and contextual. The results extend understanding of the construction and maintenance of trust in LMX relationships, indicating that it is a more complex and socially constructed phenomenon than previously described.

Despite identified limitations of the study (the small amount of empirical material, interpretive research method and purposive sampling of participants), the findings reveal that constructing trust in LMX relationships is more multidimensional than generally portrayed in traditional LMX theory and its three-stage continuum. This study suggests that a broader perspective should be adopted in LMX research, treating it not only as a collective phenomenon but also considering leaders and members as emotional individuals.

Understanding the multidimensional nature of LMX relationships is helpful for developing interpersonal relationships in organizations and leadership practices through recognition of the importance of the transparency, practices and adequacy of mutual interaction. The results presented here may contribute to such understanding and help leaders to relate to members as both subjective individuals and parts of a complex social network. The results may also increase members' awareness of possible ways that they can promote the development of good LMX relationships in organizations.

The novelty of the study relates to the identification of the collective, emotional and multidimensional nature of LMX relationships.