Nurse job satisfaction reflects how nurses experience their work, including working conditions, expectations and the suitability of the work environment. It is linked with stress, burnout, turnover, care quality, patient safety and nursing shortages. A recent meta-analysis published in BMC Nursing assessed the relationship between leadership and job satisfaction in nurses, using data from 57 eligible studies identified through seven databases. The protocol was registered in PROSPERO and reporting followed PRISMA 2020. The results point to a moderate positive relationship between leadership and nurse job satisfaction. However, the strength of that relationship changes according to leadership style, national development level, year of data collection, care setting and methodological quality.
A Clear but Variable Link
The pooled result shows that better leadership is associated with higher job satisfaction among nurses. The relationship is moderate, positive and statistically significant. Sensitivity analysis also supports the stability of the result after a small number of outlier or overly influential datasets were removed. After their exclusion, the relationship remained positive and became slightly stronger.
The evidence covered publications from 1993 to 2024. Transformational leadership was the most frequently examined style, followed by transactional, authentic and toxic leadership. Several tools were used to measure leadership, with the Multifactor Leadership Questionnaire appearing most often. Nurse job satisfaction was also measured in different ways, covering areas such as overall satisfaction, working conditions, job characteristics, leadership and organisational support.
The results varied widely across the evidence base. Differences in sample size, measurement tools, setting and context help explain why leadership appears more strongly linked with job satisfaction in some cases than in others. This variation makes the moderator findings especially important, as they show which leadership and workplace factors shape the relationship most clearly.
Relational Leadership Shows the Strongest Benefits
Leadership style is the strongest moderator in the relationship between leadership and nurse job satisfaction. Transformational leadership shows the strongest positive association. Transactional, authentic and ethical leadership also show positive and significant associations with job satisfaction.
Toxic leadership shows a significant negative relationship with job satisfaction. Passive-avoidant and releasing leadership also move in a negative direction, although their associations are weaker and not statistically significant. The overall pattern is clear: leadership styles built around support, relationships and constructive behaviour align with higher satisfaction, while harmful or avoidant styles align with lower satisfaction.
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A broader grouping gives the same message. Relationship-oriented leadership includes transformational, transactional, authentic, ethical, distributed, compassionate, benevolent, relational, resonant and clinical leadership. This group shows a strong positive association with job satisfaction. Task-oriented leadership includes passive, laissez-faire, releasing, toxic and narcissistic leadership. This group shows a negative association.
For nurse managers, the results point towards leadership behaviours that build trust, communication, empowerment and collaboration. Leadership development therefore needs to focus not only on tasks and formal authority but also on the everyday behaviours that shape nurses’ experience of work.
Workplace and Country Context Matter
Country alone does not significantly explain differences in the relationship between leadership and job satisfaction. However, national development level does matter. Developed countries show a stronger and statistically significant association, while developing countries show a smaller and non-significant association. The factors named in relation to this difference include economic stability, resource adequacy, participatory organisational cultures, hierarchical structures, limited leadership training and resource constraints.
Timing also changes the strength of the relationship. Data collected before 2020 show a stronger positive association between leadership and job satisfaction. Data collected from 2020 onwards show a weaker but still positive and significant association. Increased workload, uncertainty, burnout, digitalisation, workforce shortages and rising job demands are all named as factors that may have affected the relationship.
Setting also influences the results. Hospital settings show a significant moderate association, while non-hospital settings show a stronger association. Non-hospital settings include primary care centres, nursing homes and long-term care facilities. In these settings, closer communication, support and compassion may be more visible. In larger hospitals, hierarchy, bureaucracy and heavy workloads may reduce the perceived effect of leadership on individual job satisfaction.
Leadership remains an important factor in nurse job satisfaction, but its impact is not uniform. Relational and people-oriented styles show the clearest positive associations, while toxic and task-oriented styles show negative associations. National development level, time period, setting and methodological quality also influence the strength of the relationship. For healthcare organisations, leadership development that supports trust, empowerment, collaboration and communication offers the clearest route towards improving nurses’ working experience and professional fulfilment.
Source: BMC Nursing
Image Credit: iStock
References:
Ozen TA & Kantek F (2026) Relationship between leadership and job satisfaction in nurses: a meta-analysis and moderator analysis. BMC Nurs: In Press.
