Nurse Management and Leadership Practices in Hospitals: A Systematic Review
DOI:
https://doi.org/10.37287/ijghr.v8i3.1424Keywords:
hospital, nurse management, nursing leadership, nursing outcomes, systematic reviewAbstract
Nurse management and leadership play a critical role in shaping nurses’ work environments, patient safety, and organizational performance in hospital settings. In recent years, there has been a growing shift from traditional hierarchical management toward more relational and clinically oriented leadership practices. However, empirical evidence regarding dominant leadership styles, associated outcomes, and remaining research gaps remains dispersed across the literature. This systematic review aimed to synthesize existing evidence on nurse management and leadership practices in hospital settings, with a focus on dominant leadership styles, reported outcomes, and identified research gaps. A systematic review was conducted following the PRISMA 2020 guidelines. Literature searches were performed in PubMed/MEDLINE, Scopus, and CINAHL databases. A total of 524 articles were initially identified. After removal of duplicates and screening of titles and abstracts, 45 articles were assessed for full-text eligibility. Ten studies met all inclusion criteria and were included in the final synthesis. Data were analyzed using a narrative thematic approach. The synthesis revealed three main themes. First, transformational leadership emerged as the most frequently examined leadership style in nurse management, with increasing attention to clinical leadership among bedside nurses. Second, leadership practices were associated with nurse-related outcomes (work engagement, reduced burnout, and job performance), patient-related outcomes (quality of care, patient safety, and satisfaction), and organizational outcomes (innovative work behavior and reduced counterproductive behaviors). Third, several research gaps were identified, including the predominance of cross-sectional designs, reliance on self-reported measures, limited multicultural perspectives, and insufficient evidence on the long-term impact of leadership during and after healthcare crises such as the COVID-19 pandemic. Evidence from this systematic review indicates that relational and transformational leadership practices are consistently associated with positive outcomes for nurses, patients, and healthcare organizations in hospital settings. Strengthening leadership development and advancing longitudinal and intervention-based research are essential to better understand causal mechanisms and support sustainable improvements in nursing management and leadership.
References
Abou Ramadan, A., & Eid, W. (2020). Toxic Leadership: conflict management style and organizational commitment among intensive care nursing staff. Evid-Based Nurs Res, 2.
Alharbi, A., Rasmussen, P., & Magarey, J. (2021). Clinical nurse managers’ leadership practices in Saudi Arabian hospitals: A descriptive cross-sectional study. Journal of Nursing Management, 29(6), 1454–1464. https://doi.org/10.1111/jonm.13302
Alharbi, S. M., & Almansour, A. M. (2025). Leadership behaviours and practices assessment among nurse managers in riyadh second health cluster. BMC Nursing, 24(1), 969. https://doi.org/10.1186/s12912-025-03618-4
Alharthi, N. (2020). Clinical reflection and leadership in efficient management of patients in the Intensive Care Unit. Journal of Nursing Research and Practice, 4(5), 1–4.
Azzellino, G., Aitella, E., Ginaldi, L., & De Martinis, M. (2025). Barriers and Nursing Strategies in Oncology Care for LGBTQIA+ People: A Scoping Review. Cancers, 17(7). https://doi.org/10.3390/cancers17071146
Bush, S., Michalek, D., & Francis, L. (2020). Perceived Leadership Styles, Outcomes of Leadership, and Self-Efficacy Among Nurse Leaders:: A Hospital-Based Survey to Inform Leadership Development at a US Regional Medical Center. Nurse Leader. https://doi.org/10.1016/j.mnl.2020.07.010
Conroy, N., Patton, D., Moore, Z., O’Connor, T., Nugent, L., & Derwin, R. (2023). The Relationship between Transformational Leadership and Staff Nurse Retention in Hospital Settings: A Systematic Review. Journal of Nursing Management, 2023(1), 9577200. https://doi.org/https://doi.org/10.1155/2023/9577200
Crawford, G., Burns, S. K., Chih, H. J., Hunt, K., Tilley, P. J. M., Hallett, J., Coleman, K., & Smith, S. (2015). Mental health first aid training for nursing students: A protocol for a pragmatic randomised controlled trial in a large university. BMC Psychiatry, 15(1). https://doi.org/10.1186/s12888-015-0403-3
den Breejen-de Hooge, L. E., van Os-Medendorp, H., & Hafsteinsdóttir, T. B. (2021). Is leadership of nurses associated with nurse-reported quality of care? A cross-sectional survey. Journal of Research in Nursing, 26(1–2), 118–132. https://doi.org/10.1177/1744987120976176
Ghafourifard, M., Zamanzadeh, V., Valizadeh, L., & Rahmani, A. (2022). Compassionate Nursing Care Model: Results from a grounded theory study. Nursing Ethics, 29(3), 621–635. https://doi.org/10.1177/09697330211051005
González García, A., Bermejo-Martínez, D., López-Alonso, A. I., Trevissón-Redondo, B., Martín-Vázquez, C., & Pérez-González, S. (2025). Impact of ChatGPT usage on nursing students education: A cross-sectional study. Heliyon, 11(1). https://doi.org/10.1016/j.heliyon.2024.e41559
Hamada, H., Ninohei, M., Yamaji, N., & Ota, E. (2024). Effects of Interventions for Menstrual Health and Hygiene Management for Adolescent Girls: A Systematic Review and Meta-analysis. Pacific Rim International Journal of Nursing Research, 28(2), 356–376. https://doi.org/10.60099/prijnr.2024.265202
Hommel, A., Magnéli, M., Samuelsson, B., Schildmeijer, K., Sjöstrand, D., Göransson, K. E., & Unbeck, M. (2020). Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool. International Journal of Nursing Studies, 102, 103473. https://doi.org/https://doi.org/10.1016/j.ijnurstu.2019.103473
Huerta-González, S., Caro-Alonso, P. Á., Rodríguez-Martín, B., Castillo-Sarmiento, C. A., Pedrera-Zamorano, J. D., Chimpén-López, C., Rico-Martín, S., & López-Espuela, F. (2024). Nurses’ perceptions of the performance of nurse managers and senior hospital management during the COVID-19 pandemic. BMC Nursing, 23(1), 455. https://doi.org/10.1186/s12912-024-02123-4
Jefferies, K., Martin-Misener, R., Murphy, G. T., Gahagan, J., & Bernard, W. T. (2022). African Nova Scotian nurses’ perceptions and experiences of leadership: a qualitative study informed by Black feminist theory. CMAJ : Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 194(42), E1437–E1447. https://doi.org/10.1503/cmaj.220019
Kamaryati, N. P., Putu Darma Suyasa, I. G., Putu Dina Susanti, N. L., Ratih Comala Dewi, N. M., Aries Susanti, N. P., & Yudi Wahyu, I. M. (2024). Leadership in Nursing: Styles, Challenges, and Barriers. Babali Nursing Research, 5(4), 631–649. https://doi.org/10.37363/bnr.2024.54393
Kwame, A., & Petrucka, P. M. (2024). Effective nursing leadership as a catalyst for person-centered care and positive nursing-patient interactions: evidence from a public Ghanaian hospital. Discover Health Systems, 3(1), 50. https://doi.org/10.1007/s44250-024-00095-5
Martinez Rogers, N. E., Zamora, H., & Ornelas, D. (2021). Teaching Baccalaureate Nursing Students to Practice in Primary Care Settings. The Journal of Nursing Education, 60(3), 129–135. https://doi.org/10.3928/01484834-20210222-02
McCarthy, C., Boniol, M., Daniels, K., Cometto, G., Diallo, K., & Deen Lawani, A. (2020). State of the world’s nursing 2020: investing in education, jobs and leadership. World Health Organization.
Mramel, M., El Alaoui, M., Janati-Idrissi, R., & El Atmani, Z. (2025). Predictors and Levels of High-Risk/Emergency Management Competence among Newly Qualified Midwives in Morocco: A Cross-Sectional Study. Pacific Rim International Journal of Nursing Research, 29(1), 108–121. https://doi.org/10.60099/prijnr.2025.270039
Mushy, S. E., Mkoka, D. A., Lukumay, G. G., Massae, A. F., Rohloff, C. T., Mgopa, L. R., Mwakawanga, D. L., Kohli, N., Ross, M. W., Mkonyi, E., Trent, M., Athumani, K., Kulasingam, S., & Rosser, B. R. S. (2024). The need for and acceptability of a cancer training course for medical and nursing students in Tanzania: a convergent mixed methods study. BMC Medical Education, 24(1), 614. https://doi.org/10.1186/s12909-024-05497-w
Nurmeksela, A., Schavoronkof, K., & Jokiniemi, K. (2025). The Impact of Nurse Managers ’ Transformational Leadership on Nurses ’ Work Engagement : A Cross-Sectional Study. 2025. https://doi.org/10.1155/jonm/9980485
O’ Keeffe, A., O’ Grady, S., Cronin, F., Dolan, C., O’ Hea, A., O’ Shea, K. L., & Naughton, C. (2020). Evaluation of an emergency department falls pathway for older people: A patient chart review. International Emergency Nursing, 51, 100869. https://doi.org/https://doi.org/10.1016/j.ienj.2020.100869
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372, 1–11. https://doi.org/10.1136/bmj.n71
Pakizekho, S., & Barkhordari-Sharifabad, M. (2022). The relationship between ethical leadership, conscientiousness, and moral courage from nurses’ perspective. BMC Nursing, 21(1), 164. https://doi.org/10.1186/s12912-022-00941-y
Pepin, J., & Brault, I. (2025). The Exercise of Nurses ’ Clinical Leadership in Hospital Care Units : A Qualitative Multiple Case Study. 1452–1464. https://doi.org/10.1111/jocn.17468
Ramadhan Chairun, R., Isabela Silalahi, M., & Lestari Nasution, S. (2024). Analysis Head Nurses’ Leadership Styles to Staff Inpatient Nurses’ Job Performance Royal Prima Hospital. International Journal of Health and Pharmaceutical (IJHP), 4(4 SE-Articles), 634–644. https://doi.org/10.51601/ijhp.v4i4.226
Rhee, H., Grape, A., Tumiel-Berhalter, L., Wicks, M., Sloand, E., & Butz, A. (2020). Fidelity of a peer-led asthma self-management intervention and its attention control in a multisite study of urban adolescents. Research in Nursing & Health, 43(2), 195–205. https://doi.org/10.1002/nur.22001
Russell, R. G., White, J., Karns, A., Rodriguez, K., Jeffries, P. R., & Sengstack, P. (2025). Toward amplifying the good in nursing education: A quality improvement study on implementing artificial intelligence-based assistants in a learning system. Nursing Outlook, 73(5). https://doi.org/10.1016/j.outlook.2025.102483
Schlicht, L., Wendsche, J., Melzer, M., Tschetsche, L., & Rösler, U. (2025). Digital technologies in nursing: An umbrella review. International Journal of Nursing Studies, 161(November 2024). https://doi.org/10.1016/j.ijnurstu.2024.104950
Seljemo, C., Viksveen, P., & Ree, E. (2020). The role of transformational leadership, job demands and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study. BMC Health Services Research, 20(1), 799. https://doi.org/10.1186/s12913-020-05671-y
Välimäki, M. A., Lantta, T., Hipp, K., Varpula, J., Liu, G., & Tang, Y. (2021). Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol. BMJ Open, 11. https://doi.org/10.1136/bmjopen-2021-055356
WHO. (2020). State of the world’s nursing 2020: investing in education, jobs and leadership. https://www.who.int/publications-detail/nursing-report-2020
Wongso, E. S., Tahjoo, A., & Nofierni, N. (2024). Competency, Motivation, and Supervision Technique Strong Predict to Completeness of Nursing Documentation. International Journal of Nursing and Health Services (IJNHS), 7(5), 164–172. https://doi.org/10.35654/ijnhs.v7i5.800
Xue, X., Tao, J., Li, Y., Zhang, G., Wang, S., Xu, C., & Moreira, P. (2025). Impact of clinical leadership on frontline nurses ’ quality of care : work engagement as mediator role.
Yang, L., Ling, D., Ye, L., & Zeng, M. (2020). Psychological nursing intervention on anxiety and depression in patients with urinary incontinence after radical prostatectomy: A randomized controlled study protocol. Medicine, 99(48), e23127–e23127. https://doi.org/10.1097/MD.0000000000023127
Yeneget, M. G., Negussie, B. B., Beyene, T., & Gizaw, A. B. (2025). Nurses ’ Perception of Leadership Practices and the Factors In fl uencing These Practices of Their Managers. https://doi.org/10.1177/23779608251390307
Zaghini, F., Fiorini, J., Piredda, M., Fida, R., & Sili, A. (2020a). International Journal of Nursing Studies The relationship between nurse managers ’ leadership style and patients ’ perception of the quality of the care provided by nurses : Cross sectional survey. 101. https://doi.org/10.1016/j.ijnurstu.2019.103446
Zaghini, F., Fiorini, J., Piredda, M., Fida, R., & Sili, A. (2020b). The relationship between nurse managers’ leadership style and patients’ perception of the quality of the care provided by nurses: cross sectional survey. Int J Nurs Stud, 101. https://doi.org/10.1016/j.ijnurstu.2019.103446
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
