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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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Eskici, G. T., Kasap, E. U., & Gümüş, E. (2023) · Nursing Open · doi:10.1002/nop2.1701 · Cited by 11
“According to Cummings et al. (2018), employee- oriented leadership behaviour is associated with better outcomes for nurses regarding their work environment, perceptions of work and performance and more importantly, their health and well- being.”
BackgroundInfluentialBackman, A., Lindkvist, M., Lövheim, H., Sjögren, K., & Edvardsson, D. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16781 · Cited by 11
Patient satisfaction – results of cluster analysis of finnish patients
Nurmeksela, A., Kulmala, M., & Kvist, T. A. (2023) · BMC Health Services Research · doi:10.1186/s12913-023-09625-y · Cited by 11
“Nursing management has been shown to both directly and indirectly affect patient outcomes and satisfaction [23, 24]; for example, nurses’ job satisfaction improves patient satisfaction with care [25].”
BackgroundKesti, R., Kanste, O. I., Konttila, J., & Oikarinen, A. (2023) · Nursing Open · doi:10.1002/nop2.1896 · Cited by 11
Wang, X., Shao, J., Weng, A., Lian, J., Weng, F., Fang, Q., & Hu, Y. (2024) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s458235 · Cited by 11
“45,46 By focusing on nurses’ physical and logistical requirements while providing mental health care, ensuring fundamental needs—comprising physical, safety, and psychological well-being—are met becomes crucial in mitigating burnout, enhancing work efficiency, and bolstering job satisfaction.”
Yu-Wen, L. I. N., Ni, C., Hsu, S.-F., Tsay, S., & Tung, H. (2024) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000617 · Cited by 11
Impact of Nurse Manager’s Attributes on Multi-Cultural Nursing Teams: A Scoping Review
Teixeira, G. M., Lucas, P. R. M. B., & Gaspar, F. (2024) · Nursing Reports · doi:10.3390/nursrep14030125 · Cited by 11
“Additionally, these insights may provide guidelines for recruiting and selecting candidates for nursing management positions that are capable of effectively managing diversity in order to promote healthy work environments.”
BackgroundLundin, K., Engström, M., Skytt, B., Strömberg, A., & Silén, M. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11945-6 · Cited by 15
Morvati, D., Solbakken, R., Vaag, J. R., & Hilli, Y. (2025) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2025.2460255 · Cited by 11
“…have highlighted the influence of nurse leaders on the nursing work environment, particularly the significant relationship between nursing leaders’ leadership style and nurses’ health, job satisfaction, and well-being (Cummings et al., 2018; Kohnen et al., 2024; Niinihuhta & Häggman-Laitila, 2022).”
Abu-Qutaish, R., Alosta, M. R., Shosha, G. M. A., Oweidat, I. A., & Nashwan, A. J. (2025) · BMC Nursing · doi:10.1186/s12912-025-03518-7 · Cited by 11
Kim, S., & Jeong, S. H. (2020) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.20205 · Cited by 11
Predictors of Nursing Home Nurses' Willingness to Report Medication Near-Misses
Farag, A., Vogelsmeier, A., Knox, K., Perkhounkova, Y., & Burant, C. J. (2020) · Journal of Gerontological Nursing · doi:10.3928/00989134-20200303-03 · Cited by 11
Public Opinion Leadership in Nursing Practice: A Rogerian Concept Analysis
van Wijk, M., Lalleman, P., Cummings, G. G., & Engel, J. (2022) · Policy Politics & Nursing Practice · doi:10.1177/15271544211071099 · Cited by 11
“In line with other literature, we defined nurse leaders broadly in order to include both formal and informal roles and positions, in and outside the healthcare organization (see for example Cummings et al., 2018 or Sundean et al., 2021).”
MethodSelf-citationFeistritzer, N. R., Jackson, G., Scott, C., & Willis, P. (2022) · Nursing Administration Quarterly · doi:10.1097/naq.0000000000000519 · Cited by 11
An Empirical Study of Principals' Leadership Styles with Faculty Commitment
Thanh, N. H., Văn, Q. N., & Tuyết, N. T. (2022) · Emerging Science Journal · doi:10.28991/esj-2022-06-03-013 · Cited by 15
Inclusive Behaviors: Keys for Creating Empowering Practice Cultures
Parchment, J. (2023) · Nurse Leader · doi:10.1016/j.mnl.2023.01.011 · Cited by 10
Aikins, D. A., Poku, C. A., Donkor, E. S., & Naab, F. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282251 · Cited by 10
“With the moderate correlation between job satisfaction and facets of the work environment, previous research work by Klopper et al [43], Cummings et al [44] and Dhamija, Gupta and Bag [45] reported similar findings.”
ResultNursing leadership style and error management culture: a scoping review
Moraca, E., Zaghini, F., Fiorini, J., & Sili, A. (2024) · Leadership in health services · doi:10.1108/lhs-12-2023-0099 · Cited by 14
Roth, C., Breckner, A., Krug, K., Mahler, C., Wensing, M., & Berger, S. J. (2025) · BMC Nursing · doi:10.1186/s12912-025-02875-7 · Cited by 10
“Cummings et al. [22] conducted a systematic review and reported a strong link between leadership and management behaviours and various nurse outcomes, such as productivity and effectiveness, as well as job satisfaction and retention.”
Jiaqing, H., Tian, Y., Mimi, Z., Jiaxin, Y., Stephano, E. E., Yang, M., & Li, Y. (2025) · BMC Nursing · doi:10.1186/s12912-025-03006-y · Cited by 10
Tlhako, N., Coetzee, S. K., Ajanaku, O. J., & Fourie, E. (2025) · PLoS ONE · doi:10.1371/journal.pone.0323620 · Cited by 10
“It is well established from systematic reviews on nurse leadership [12,13] that leadership, management, and support of nurses have an impact on nurse, patient, and system outcomes.”
InfluentialSebire, S. Y., Brown, J., Malewezi, E., & Tume, L. N. (2025) · Journal of Nursing Management · doi:10.1155/jonm/2155376 · Cited by 15
ALFadhalah, T., & Elamir, H. (2021) · Leadership in health services · doi:10.1108/lhs-07-2021-0062 · Cited by 10
Leadership competencies of first-line nurse managers: a quantitative study
Paarima, Y., Kwashie, A. A., Asamani, J. A., & Ofei, A. M. A. (2021) · Leadership in health services · doi:10.1108/lhs-05-2021-0047 · Cited by 10
Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis
Jeong, S., & Jeong, S. H. (2022) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.22022 · Cited by 12
Hauser, C., Stahl, J., Simon, M., Valenta, S., Favez, L., & Zúñiga, F. (2023) · Journal of Advanced Nursing · doi:10.1111/jan.15704 · Cited by 9
Rosengren, K., & Friberg, M. (2024) · BMC Nursing · doi:10.1186/s12912-024-01732-3 · Cited by 9
“Moreover, research [4, 5, 29, 30] show that managers affect RNs working environment, and why the significant of leadership for good work environments is stressed, such as relationship-oriented shared leadership [11].”
BackgroundGagnon, J.-F., Fernet, C., Austin, S., & Drouin‐Rousseau, S. (2024) · Journal of Nursing Management · doi:10.1155/2024/8883038 · Cited by 24
“Among work organization factors of interest, transformational leadership which refers to particular behaviors and practices engaged in by leaders that improve overall performance and outcomes [10] has been shown to play a key role in nurses’ turnover intention [11, 12].”
InfluentialNurmeksela, A., Schavoronkoff, K., & Jokiniemi, K. S. (2025) · Journal of Nursing Management · doi:10.1155/jonm/9980485 · Cited by 19
“Several previous studies have shown the positive infuence of nurse leaders’ relational leadership styles, such as trans-formational leadership, on nursing, patient, and organizational outcomes [17, 19, 27, 28, 41, 42].”
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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