Transformational leadership and nursing outcomes: A systematic review of job satisfaction and productivity in global healthcare settings

Abstract

Background and objective: Transformational leadership significantly influences nursing outcomes, yet evidence synthesis across diverse healthcare contexts remains limited. To systematically examine the relationship between transformational leadership and nursing job satisfaction and productivity across global healthcare settings.

Methods: A total of 48,590 titles and abstracts were screened, with 134 full-text articles reviewed, resulting in 22 included studies. Using content analysis, Following PRISMA 2020 guidelines, we searched five databases (PubMed, Scopus, Web of Science, CINAHL, Google Scholar) for studies published 2016-2024. Quantitative studies examining transformational leadership effects on nursing job satisfaction and productivity were included. Quality assessment used the NIH Quality Assessment Tool. Using narrative synthesis, patterns and recurring themes were systematically identified and categorized across studies.

Results: Twenty-two studies from 11 countries (n = 4,847 nurses) met inclusion criteria. All studies demonstrated fair methodological quality. Transformational leadership showed consistent positive associations with job satisfaction (correlation range: 0.43-0.94; 17/20 studies statistically significant) and productivity (13/15 studies significant). Regional variations emerged, with stronger effects in hierarchical healthcare systems. Three key patterns were identified: job satisfaction determinants, productivity factors, and leadership-outcome relationships.

Conclusions: Transformational leadership consistently enhances nursing job satisfaction and productivity across diverse contexts, with effect magnitude varying by cultural and organizational factors. Healthcare organizations should prioritize transformational leadership development programs for nurse managers.

Keywords

Job satisfaction / Nurses / Productivity / Systematic review / Transformational leadership

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