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Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review
Abstract
BACKGROUND Leadership is critical in building quality work environments, implementing new models of care, and bringing health and wellbeing to a strained nursing workforce. However, the nature of leadership style, how leadership should be enacted, and its associated outcomes requires further research and understanding. We aimed to examine the relationships between various styles of leadership and outcomes for the nursing workforce and their work environments. METHODS The search strategy of this systematic review included 10 electronic databases. Published, quantitative studies that examined the correlations between leadership behaviours and nursing outcomes were included. Quality assessments, data extractions and analysis were completed on all included studies by independent reviewers. RESULTS A total of 50,941 titles and abstracts were screened resulting in 129 included studies. Using content analysis, 121 outcomes were grouped into six categories: 1) staff satisfaction with job factors, 2) staff relationships with work, 3) staff health & wellbeing, 4) relations among staff, 5) organizational environment factors and 6) productivity & effectiveness. Our analysis illuminated patterns between relational and task focused leadership styles and their outcomes for nurses and nursing work environments. For example, 52 studies reported that relational leadership styles were associated with higher nurse job satisfaction, whereas 16 studies found that task-focused leadership styles were associated with lower nurse job satisfaction. Similar trends were found for each category of outcomes. CONCLUSIONS The findings of this systematic review provide strong support for the employment of relational leadership styles to promote positive nursing workforce outcomes and related organizational outcomes. Leadership focused solely on task completion is insufficient to achieve optimum outcomes for the nursing workforce. Relational leadership practices need to be encouraged and supported by individuals and organizations to enhance nursing job satisfaction, retention, work environment factors and individual productivity within healthcare settings.
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“The Quality Assessment and Validity Tool for Correlation Studies [28] was used to evaluate the quality of the 50 chosen articles.”
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Köksal, K., & Mert, İ. S. (2023) · International Nursing Review · doi:10.1111/inr.12841 · Cited by 31
Lui, J. N. M., Andres, E. B., & Johnston, J. M. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104675 · Cited by 34
Hagerman, H., Engström, M., Wadensten, B., & Skytt, B. (2019) · Journal of Nursing Management · doi:10.1111/jonm.12793 · Cited by 27
“Regarding their managerial position, managers have described having significant influence on their sub‐ ordinates' work conditions and well‐being (Cummings et al., 2018; Holm & Severinsson, 2014) as well as on the quality of care (Skytt, Hagerman, Strömberg, & Engström, 2015) and patient safety…”
BackgroundChristoffersen, L., Teigen, J., & Rønningstad, C. (2020) · Midwifery · doi:10.1016/j.midw.2020.102669 · Cited by 27
Leader empowering behaviour: relationships with nurse and patient outcomes
Cziraki, K., Wong, C., Kerr, M., & Finegan, J. (2020) · Leadership in Health Services · doi:10.1108/lhs-04-2020-0019 · Cited by 27
Self-citationThe evolution of oncology nursing: Leading the path to change.
Cummings, G. G., Lee, S., & Tate, K. (2018) · PubMed Central · Cited by 27
Self-citationCompassionate leadership in palliative and end-of-life care: a focus group study
Hewison, A., Sawbridge, Y., & Tooley, L. (2019) · Leadership in Health Services · doi:10.1108/lhs-09-2018-0044 · Cited by 26
Leadership Development in Undergraduate Nursing Students: A Scoping Review
Costa, P., Sousa, J. P., do Nascimento, T. F. R., Cruchinho, P. J. M., Nunes, E., Gaspar, F., & Lucas, P. R. M. B. (2025) · Nursing Reports · doi:10.3390/nursrep15050160 · Cited by 38
“Other systematic reviews have also found that nurses’ relational leadership styles are mediated by their ability to mobilise resources and achieve goals through access to information, support, and opportunities [23] and are also associated with higher levels of job satisfaction among staff [5].”
Haddad, M. E., Wilkinson, G., Thompson, L. A., Faithfull‐Byrne, A., & Moss, C. (2019) · Journal of Nursing Management · doi:10.1111/jonm.12860 · Cited by 26
Sjølie, B. M., Hartviksen, T. A., & Bondas, T. E. (2020) · BMC Health Services Research · doi:10.1186/s12913-020-4918-z · Cited by 26
Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey
Hooge, L. E. D. B.-D., van Os‐Medendorp, H., & Hafsteinsdøttir, T. B. (2021) · Journal of research in nursing · doi:10.1177/1744987120976176 · Cited by 26
van Dongen, L. J. C., & Hafsteinsdøttir, T. B. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.16168 · Cited by 26
“Systematic reviews have provided robust evidence that relational oriented leadership style, including transformational leadership, is linked to improved patient, workforce and organisation outcomes when compared to task- focussed leadership styles (Cummings et al., 2018; Wong et al., 2013).”
BackgroundNursing leadership and management in home care: A qualitative scoping review
Jordal, K., Vibeke, S., & Tønnessen, S. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13872 · Cited by 26
Palvimo, T., Vauhkonen, A., & Hult, M. (2023) · Journal of Nursing Management · doi:10.1155/2023/4289450 · Cited by 38
“A major determinant in work-related health outcomes in nurses is leadership, and the favourable efects of positive leadership styles are well known [34–36].”
Kida, R., Togari, T., Yumoto, Y., & Ogata, Y. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13174 · Cited by 25
Duignan, M., Drennan, J., & Carthy, V. J. C. M. (2020) · Journal of Nursing Management · doi:10.1111/jonm.13189 · Cited by 27
Leadership styles' influence on ICU nurses' quality of professional life: A cross‐sectional study
Cosentino, C., Luca, E. D., Sulla, F., Uccelli, S., Sarli, L., & Artioli, G. (2021) · Nursing in Critical Care · doi:10.1111/nicc.12738 · Cited by 25
What are the Barriers to Effective Nurse Leadership? A Review
Hughes, V. (2018) · ATHENS JOURNAL OF HEALTH & MEDICAL SCIENCES · doi:10.30958/ajh.5-1-1 · Cited by 25
Taylor, C., Maben, J., Jagosh, J., Carrieri, D., Briscoe, S., Klepacz, N. A., & Mattick, K. L. (2024) · BMJ Quality & Safety · doi:10.1136/bmjqs-2023-016468 · Cited by 25
“Managers having a relational leadership style, 153 listening and offering kindness and spaces to be heard can reinforce that staff are valued and their experiences are valid and recognised, and help staff to recover and feel less alone 154 (CMO25).”
Shuman, C. J., & Costa, D. K. (2020) · American Journal of Critical Care · doi:10.4037/ajcc2020421 · Cited by 24
Zappalà, S., Toscano, F., Polevaya, M. V., & Kamneva, E. V. (2020) · Journal of Nursing Scholarship · doi:10.1111/jnu.12615 · Cited by 24
Oti, N. O. O., de Villiers, M., Adejumo, P. O., Okumu, R., Maliti, B., Elkateb, N., & Hammad, N. (2021) · ecancermedicalscience · doi:10.3332/ecancer.2021.1209 · Cited by 24
Metadata
- Authors
- Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E.
- Affiliations
- University of Alberta (CA)
- Western University (CA)
- Corresponding author
- Cummings, Greta G.
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 85
- Pages
- 19-60
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W4233451756
- Semantic Scholar
- abb240e891ac6787579d92c4e1d6d3fdda213ec1
- Cited by
- 637
- References
- 378
- Citations by year
- 2026: 132 · 2025: 122 · 2024: 104 · 2023: 78 · 2022: 75 · 2021: 52 · 2020: 35 · 2019: 21 · 2018: 12
- FWCI
- 5.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Nursing Studies (publishedVersion)
- Funders
- University of Arizona (1 RO1-NU00908)
- Topics
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Nursing › Leadership and Management › Healthcare Education and Workforce Issues
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Education, Practice, and Leadership
- Keywords
- leadership styles, relational leadership, nursing workforce, nursing work environment, nursing satisfaction, nurse retention, nurse well-being, staff relationships, organizational context, nursing productivity
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