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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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“Flexible and contemporary leadership models, such as resonant and authentic, contribute to worker and patient satisfaction (Cummings et al. 2018) and to health system performance by improving quality and efficiency through supporting positive perceptions of the safety climate (Wong, Cummings, and…”
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Olinover, M., Gidron, M., Yarmolovsky, J., Lipschits, O., & Geva, R. (2022) · Journal of Leadership & Organizational Studies · doi:10.1177/15480518221117886 · Cited by 6
“These findings deepen the notion of congruency that effective implementation of individual characteristics relevant to leadership depends on the relevant training context (Bonner, 2010; Cummings et al., 2018).”
Backgroundvan der Cingel, M., Andela, R., & Barf, H. (2023) · Science Talks · doi:10.1016/j.sctalk.2023.100127 · Cited by 4
Leadership Styles: Work Stress, Related Outcomes and Health
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Mobarak, H. S., Ahmed, F. R., Al‐Yateem, N., Bani‐Issa, W., Alhosani, M. I., & AbuRuz, M. E. (2023) · The Open Nursing Journal · doi:10.2174/0118744346281502231031102549 · Cited by 4
Mir, M. M., Khan, A., & Abbas, Q. (2020) · Etikonomi · doi:10.15408/etk.v19i1.11264 · Cited by 8
Clinical leadership during the Covid-19 pandemic: a scoping review
Chuku, H., Williams, S., & Best, S. (2024) · Journal of Health Organization and Management · doi:10.1108/jhom-05-2024-0205 · Cited by 4
Registered nurses and what may constitute their leadership in the home healthcare context
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“Although the amount of literature on nurses’ leadership has significantly increased in recent years, research mainly focuses on hospitals and nursing homes [14].”
Matandela, M., Chisale, G. L., & Matahela, V. E. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1634563 · Cited by 3
When Creativity Meets Technology: A Systematic Review of Digital Creativity in the Workplace
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Golfenshtein, N., Drach‐Zahavy, A., Sperling, D., Fleishman, T. T., Hirschfeld, M. J., Wagner, N., & Srulovici, E. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105289 · Cited by 3
Alanazi, A. K., Traynor, M., McFetridge, L., McKeaveney, C., & Clarke, S. A. (2026) · Journal of Nursing Management · doi:10.1155/jonm/7518764 · Cited by 3
Webster, J., Sanders, K., Cardiff, S., & Manley, K. (2022) · Nursing Older People · doi:10.7748/nop.2022.e1377 · Cited by 3
The Relationship between the new Leadership Styles and Nursing Productivity
Aly, S. M., Alghabbashi, M. T., Alhusyeni, N. M., & Alkhaybary, M. M. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22165836 · Cited by 3
Lateef, T. O., & Ameen, C. A. H. (2023) · Qalaai Zanist Scientific Journal · doi:10.25212/lfu.qzj.8.2.51 · Cited by 3
Diaczun, T., & Miller, M. K. (2023) · International Nursing Review · doi:10.1111/inr.12891 · Cited by 3
Ünal, A., Yıldırım, N., & Öncel, S. (2025) · International Journal of Nursing Practice · doi:10.1111/ijn.13324 · Cited by 3
Enablers and inhibitors of nursing and midwifery leadership in Pacific Island collectivist cultures
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Sullivan, D., Frazer, C., Lopez, L., & Frazer, E. A. (2025) · Journal of Pediatric Surgical Nursing · doi:10.1177/23320249251314112 · Cited by 3
“In today ’ s rapidly changing healthcare landscape, where constant challenges and disruptions are the norm, nurse leaders envision the future and build the systems and environments necessary to realize that vision (Cummings et al., 2018).”
Hess, F., Klußmann, A., Harth, V., & Mache, S. (2025) · BMC Palliative Care · doi:10.1186/s12904-025-01721-6 · Cited by 3
“A healthy and supportive work environment has been demonstrated to have a positive impact on employees, as well as on the quality of patient care [19, 20].”
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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