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Mod Care J. In Press(In Press):e130402.
Published online 2023 January 19.
https://doi.org/10.5812/modernc-130402.
Review Article
Exploring Different Aspects of Nursing Leadership: An Integrative
Review of Qualitative Studies
Ana Luiza Ferreira Aydogdu 1, *
1Department of Nursing, Istanbul Health and Technology University,Istanbul, Turkey
*Corresponding author: Department of Nursing, Istanbul Health and Technology University, Istanbul, Turkey. Email: ana.luiza@istun.edu.tr
Received 2022 July 31; Revised 2022 October 11; Accepted 2022 November 20.
Abstract
Context: Leadership is the process of influencing people to achieve common goals. In all nurses’ roles, leadership is emphasized
since nurse leaders’ attitudes influence nurses’ job satisfaction and retention and, consequently, the quality of care.
Objective: This study aimed to explore the scientific literature concerning different aspects of leadership in nursing.
Methods: This is an integrative review of qualitative studies in which four electronic databases (Medline, PubMed, Scopus, and
Google Scholar) were searched. Articles published in the last ten years (2013 - 2022) were searched by titles using the descriptors
"qualitative," "leadership," and "nursing" linked by the Boolean Operator AND. The search carried out in July 2022 was not limited by
the publication language. A total of 63 studies were identified, and 11 original primary research articles were included. The quality
of articles was assessed using the Critical Appraisal Skills Program (CASP). Qualitative content analysis was performed to analyze the
obtained data.
Results: The results were organized into three categories: (1) the importance of nursing leadership and leaders’ roles; (2) ethical
leadership; and (3) nursing leadership education. Personal characteristics of nurse leaders and leadership skills were indicated as
factors influencing staff nurses’ attitudes and reflecting on the quality of care. Training in nursing leadership since the early years
of nursing education is essential for future nursing leaders.
Conclusions: Nurse leaders influence other team members and patients; consequently, nursing leadership impacts the quality of
care. Therefore, training on leadership should be addressed in nursing schools in undergraduate and postgraduate courses and
health institutions through continuing education.
Keywords: Ethical Leadership, Leadership, Leadership Training, Nursing
1. Context
Leadership is the process of influencing people to
achieve common goals (1). In other words, leadership is a
process of social influence in which leaders use interper-
sonal behaviors to motivate their followers to do their best
for the group to achieve its goals (2). Nursing leadership
is increasingly discussed in the literature, as it directly in-
fluences nurses’ job satisfaction and retention and, con-
sequently, the quality of care (3-6). When nurses are sat-
isfied with their leaders, they are more motivated; on the
other hand, under toxic leadership, nurses tend to be frus-
trated with the profession, which increases turnover inten-
tion (5) and decreases the quality of care (3). It must be
emphasized that nursing turnover has economic and non-
economic consequences, threatening the safety of patients
and nurses and thus interfering with the success of health
institutions (3,7). Nurse leaders, therefore, have important
roles in motivating their teams and developing a safe work
environment (8).
Nurses perform functions related to care, education,
research, and management (9,10). However, caring is the
basic talent of nurses, and all other functions they perform
aim to make care increasingly efficient and effective (9).
Many factors can affect the quality of care, including nurs-
ing leadership (3). Leadership is emphasized in all nurses’
roles (4,8,11). Nurses can adopt several different leader-
ship styles when leading their teams. Democratic, auto-
cratic, authentic, servant, transactional, and transforma-
tional leadership are among these different styles (1). How-
ever, in the nursing field, transformational leadership is
one of the most discussed styles (1,12,13), and in many stud-
ies, it is pointed out as the style preferred by nurses (5,12)
because transformational leaders seek to motivate, inspire
and empower their followers so that they too gain leader-
ship competence (1,11).
While leading, nurses must adopt ethical attitudes,
which will be reflected in team members; leaders must,
Copyright © 2023, Modern Care Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International
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properly cited.
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Aydogdu ALF
therefore, be role models for others (14). Ethical leaders are
fair and honest; they respect others and lead by example
(15). Nurses’ ethical behaviors and leadership competence
are pivotal to creating a favorable work environment for
quality and safe patient care (3,16).
Although leadership is a skill that improves over
time, nursing students must receive leadership education
through creative and innovative methods (17), as leader-
ship knowledge will be necessary when providing care,
managing the nursing team, training other nurses, and de-
veloping research in the field of nursing (9).
The healthcare system is constantly changing, and
nurses, who are critical to the success of the healthcare in-
dustry, play various roles in which they must exercise lead-
ership. Nurse leaders are scientists, educators, and care-
givers who inspire their followers (18). Understanding that
leadership is important in all nurse functions, the need to
explore the last ten years of scientific literature on the dif-
ferent aspects of leadership in nursing was identified. It
was determined that learning about nurses’ experiences
would be appropriate to better explore the different di-
mensions of nursing leadership; therefore, only qualita-
tive studies were selected. Qualitative approaches are used
to analyze the lived experience of individuals (19).
2. Objective
This study aimed to explore the scientific literature
concerning different aspects of leadership in nursing.
3. Methods
3.1. Design
The Whittemore and Knafl (20) framework were used
to carry out this integrative review of qualitative studies;
first, the problem was identified, then the literature was
searched, then data was evaluated and analyzed, and fi-
nally, the results were presented. Qualitative studies ad-
dress a specific event, process, or phenomenon experi-
enced by individuals (19,21); thus, selecting qualitative
studies was considered more appropriate for identifying
different aspects of nursing leadership.
3.2. Search Strategy
The search for original primary qualitative research
articles on nursing leadership published in the last ten
years (2013 - 2022) was carried out in July 2022. The arti-
cles were searched by titles using the descriptors “qualita-
tive,” “leadership,” and “nursing” linked by the Boolean op-
erator AND. The search was conducted on Google Scholar,
Medline, PubMed, and Scopus. These databases were cho-
sen due to the ease of access and because they include
many publications (22-24). Although the search was not
limited by the publication language, the descriptors used
for searches were written in English.
3.3. Inclusion and Exclusion Criteria
Original primary qualitative research articles report-
ing nursing leadership, with full texts available on the In-
ternet, were included. Studies that did not address nursing
leadership and non-qualitative studies were excluded.
3.4. Data Extraction
Sixty-three studies were found through the four elec-
tronic databases, 40 duplicate articles were excluded, and
the result decreased to 23. Abstracts were screened for the
remaining articles, and 12 articles were excluded for not
matching the objective of the study. A total of 11 articles
were read in full and were included in the quality assess-
ment. The research flowchart is shown in Figure 1.
3.5. Quality Assessment
The quality of the studies was evaluated through the
Critical Appraisal Skills Program (CASP) (25). The CASP is
used to evaluate qualitative studies through 10 main ques-
tions. These questions assess the clearness of the study,
the suitability of the methodology, the participants’ se-
lection process, the data collection methods, the relation-
ship between researcher and participants, ethical consid-
erations, the rigor of data analysis, the presentation of re-
sults, and the importance of the study (25). The questions
were rated as “yes” (2 points), “unclear” (1 point), or “no”
(0 points). The selected articles scored between 16 and 20
points. The most common weaknesses found in the arti-
cles were unclear information about the relationship be-
tween researchers and participants and a lack of justifi-
cation for choosing the qualitative approach. No articles
were excluded based on critical assessment; all 11 evaluated
articles were included in this review (Table 1).
3.6. Data Analysis
A form containing the following headings: au-
thors/year of publication, country, journal, sample,
type of study, data collection, main findings, and limi-
tations were used to extract general information from
the included articles. Important information is shown
in the quality assessment (Table 1) and summary table
(Table 2). Data were analyzed through qualitative content
analysis, which is used in integrative reviews to share new
information based on synthesizing results from previous
original studies (37). The included articles were read
several times; information was compared, and similar in-
formation was coded and organized by categories. Codes
identified through data comparison were presented in
2 Mod Care J. In Press(In Press):e130402.
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Aydogdu ALF
Google Scholar: 24
Medline: 13
Pubmed: 14
Scopus: 12
(n = 63)
Duplicated articles removed
(n = 40)
Articles analyzed by titles
and abstracts
(n = 23)
Excluded articles:
•For not being qualitative primary research: 10
•For addressing another theme: 2
(n = 12)
Full-text articles
assessed for eligibility
(n = 11)
Full-text articles
excluded
(n = 0)
Records screened
using CASP
(n = 11)
Articles excluded
(n = 0)
Included articles
(n = 11)
IdentificationScreeningEligibilityIncluded
Figure 1. Research flowchart
three categories: (1) the Importance of nursing leadership
and leaders’ roles; (2) ethical leadership; and (3) nursing
leadership education.
4. Results
Although the search for studies was not limited by the
publication language, all the articles included in this re-
view were published in English. The 11 selected studies
are from ten different journals. Four studies (36.36%) were
published in 2017. The samples were very varied; studies
were conducted with nurses, nurse leaders, nurse educa-
tors, nurse researchers, and nursing students. Nine stud-
ies (81.82%) were phenomenological. The number of partic-
ipants varied from 10 to 55 individuals. Studies were con-
ducted in Iran (n = 3), Canada (n = 2), Australia (n = 1), Jor-
dan (n = 1), South Korea (n = 1), the Netherlands (n = 1),
the United Kingdom (n = 1), and one study was conducted
with nurse leaders from four different countries: Australia,
Canada, England, and Sweden. In six studies, the majority
of participants were female (26,27,29-32); in one study, all
participants were female (34); in three studies, gender was
not mentioned (33,35,36); and in one study the majority of
participants (57,14%) were male (28).
A total of four studies had the main objective related
to ethical nursing leadership (27 -29,35), three articles
Mod Care J. In Press(In Press):e130402. 3
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Table1. Evaluation of the Quality of Articles According to the Critical Appraisal Skills Programme (CASP) a
Reference
Questions aQuality
Score
1 2 3 4 5 6 7 8 9 10
Bahlman-van Ooijen et al. (26),
2022
Y Y Y Y Y Y Y Y Y Y 20 = 100
Barkhordari-Sharifabad et al.
(27), 2018
Y Y Y U Y U Y Y Y Y 18= 0.90
Barkhordari-Sharifabad et al.
(28), 2017
Y Y U U Y N Y Y Y Y 16= 0.80
Barkhordari-Sharifabad et al.
(29), 2018
Y Y U U Y N Y Y Y Y 16 = 0.80
Démeh and Rosengren (30), 2015 Y Y Y Y Y N Y Y Y Y 18= 0.90
Ha and Pepin (31), 2017 Y Y Y Y Y U Y Y Y Y 19 = 0.95
Ha and Pepin (32), 2018 Y Y Y Y Y N Y Y Y Y 18 = 0.90
Harvey et al. (33), 2019 Y Y Y Y Y U Y Y Y Y 19 = 0.95
Kim et al. (34), 2022 Y Y Y Y Y N Y Y Y Y 18 = 0.90
Mannix et al. (35), 2015 Y Y U Y Y N Y Y Y Y 17 = 0.85
Tinkler and Robinson (36), 2020 Y Y Y Y Y U Y Y Y Y 19 = 0.95
aCritical Appraisal Skills Programme (CASP) checklist is a 10-question tool used to evaluate qualitative studies (CASP,2018).
Table2. Summary of the Characteristics and Findings of the Included Studies
Authors/Yearof
Publication
Countries Journal Sample Type of Study/Data
Collection
Main Findings Limitations
Bahlman-van Ooijen et
al. (26), 2022
Netherlands Journal of Advanced
Nursing
Twelvenurses Ethnography/Semi-
structured
interviews
Findings were presented into six main themes
related to leadership, patient participation and
preferences, relationships, task-focused nursing, and
role modeling.
Data saturation was not
mentioned.
Barkhordari-Sharifabad
et al. (27), 2018
Iran Journal of Medical Ethics
and History of Medicine
Fourteen nurse managers
and educators
Phenomenological/Semi-
structured
interviews
Three main themes emerged: ethical, cultural, and
managerial problems.
Unclear information
about the recruitment of
participants; and the
relationship
researcher-participants
Barkhordari-Shariabad
et al. (28), 2017
Iran Electronic Physician Fourteennurse managers
and nursing instructors
Phenomenological/
Semi-structured
interviews
Twomain themes emerged: leader as mentor and
professional insight
The choice of method was
not clearly justified;
Unclear participants’
recruitment; Lack of
information regarding
the researcher-participant
relationship
Barkhordari-Sharifabad
et al. (29), 2018
Iran Nursing Ethics Fourteen nursing faculty
members and nurse
managers
Phenomenological/Semi-
structured
interviews
Findings were presented in two main themes related
to satisfaction and productivity.
Does not clearly justify the
choice of method; Unclear
participants’
recruitment; Lack of
information regarding
the researcher-participant
relationship
Démeh and Rosengren
(30), 2015
Jordan Nurse Education Today Twentynursing students Narrative/Written
narratives
Findings were presented under one main theme
related to clinical leadership and safety.
Data collection
procedure; Lack of
information regarding
the researcher-participant
relationship
Ha and Pepin (31), 2017 Canada NurseEducation Today Five undergraduate
nursing students, four
nursing educators, and
the principal investigator
Phenomenological/Documents
from team meetings, the
principal investigator’s
field notes, and a focus
group
Findings were presented under two main themes
related to collaboration and changes.
Potential bias since the
principal investigator was
also a participant
Ha and Pepin (32), 2018 Canada NurseEducation in
Practice
Twenty-threestudents
and six educators
Phenomenological/Semi-
structured interviews and
focus groups
Findings were presented under three themes: visual
examples, role models, and group discussions.
Data saturation was not
mentioned; Lack of
information regarding
the researcher-participant
relationship.
Harvey et al. (33), 2019 Australia,
Canada,
England, and
Sweden
International Journal of
Nursing Studies
Fifty-five nurses leaders Phenomenological/Semi-
structured
interviews
Three main themes emerged: different mechanisms
for evidence-based practice (EBP), roles shaped by
context, and challenges of leading EBP.
Unclear information
regarding the
researcher-participant
relationship
Kim et al. (34), 2022 SouthKorea Journal of Nursing
Management
Fifteen nurse leaders Phenomenological/Individual
interviews and focus
groups
Findings were presented under five main themes
related to nursing leadership: commitment and
abilities, and leadership education: importance,
difficulties, and strategies
Lack of information
regarding the
researcher-participant
relationship
Mannix et al. (35), 2015 Australia Journal of Clinical
Nursing
Twelvenurse leaders Phenomenological/Semi-
structured
interviews
Findings were presented according to three main
themes related to practice, ethical leadership, and
fair/just solutions.
The choice of method was
not clearly justified; Lack
of information regarding
the researcher-participant
relationship.
Tinkler and Robinson
(36), 2020
United
Kingdom
Journal of Research in
Nursing
Twenty-sevenClinical
Research Nurses
Phenomenological/Individual
interviews and focus
groups
Twomain themes emerged: self-leadership and
leadership culture
Unclear information
regarding the
researcher-participant
relationship
4 Mod Care J. In Press(In Press):e130402.
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had clinical nursing leadership as the main theme (30 -
32), one article aimed to identify nursing leadership behav-
iors that facilitate patients’ participation in care (26), one
article addressed nursing leadership education and prac-
tice (34), one article was about leadership and evidence-
based practices (33), and the remaining article was con-
ducted to explore the influence of individual and organi-
zational leadership on nursing research delivery (36). The
participants’ perceptions regarding the different aspects
of nursing leadership are present in the findings of all 11
studies. The findings of the present review were organized
into three categories: (1) the importance of nursing leader-
ship and leaders’ roles; (2) ethical leadership; and (3) nurs-
ing leadership education.
4.1. Importance of Nursing Leadership and Leaders’ Roles
According to the analyzed literature, nurse leaders are
supportive (30,34), passionate, committed (35), compe-
tent, reflective, enthusiastic, inspiring, and critical profes-
sionals (26) who are responsible for care in all its dimen-
sions(26,34), thus nurse leaders are always looking for new
knowledge and skills (26,28), and they are also mentors
and monitors who share knowledge and information (30,
33) and provide directions to other team members (33). The
role of nursing leaders in collecting data to create policies
and procedures and developing evidence-based practice
was also reported (33). In addition, the importance of pro-
viding feedback while leading the nursing team to ensure
the development of staff (33) and the success of the institu-
tion was identified (33,34). The studies emphasized that
nurse leaders are responsible for motivating their teams
(26,34), supervising nurses and nursing students, thus en-
suringpatient safety (26), and encouraging patients to play
an active role in the care process (26,30).
According to nurses, leadership is a skill acquired over
time through experience and analysis of different lead-
ership styles (26). It was emphasized that skills such as
problem-solving, interpersonal relationships, empathetic
communication, and organizational management are cru-
cial for nurse leaders (34). In addition, communication (26,
30) and training were important points in improving nurs-
ing leadership (26).
The importance of role models was addressed in two
different ways, as nurses need a role model when exer-
cising leadership (26), and they must also be role models
for other team members by adopting ethical leadership
(28,29,33). The importance of having a nursing leader-
ship model seems to be crucial since nurses and nursing
students pointed out this need during internships when
they were being trained in clinical nursing leadership (30).
It was reported that nurse leaders motivate staff nurses
through ethical behaviors (29). Therefore, nurse leaders’
attitudes influence the satisfaction and productivity of the
nursing team, consequently reflecting the quality of care
(26,29). As nurse leaders are important for caring in differ-
ent dimensions, they are crucial for promoting nursing as
a profession valued by society (26,29).
Studies emphasized the importance of leadership for
care, management, education, and research in the field of
nursing. According to the studies included in this review,
nursing leadership is essential in implementing evidence-
based practice (33). In addition, nurses’ attitudes as leaders
influence patients’ participation in the care process (26).
Ethical behaviors of nursing managers reflect on the sat-
isfaction of the nursing team and the quality of care since
nurses are more motivated in the presence of ethical lead-
ership (27-29,35). Therefore, the importance of teaching
leadership in nursing schools was emphasized (34), and
clinical leadership was identified as an important tool for
training competent nurses (30-32). Self-leadership and or-
ganizational leadership were pointed out as fundamental
factors for clinical research success in nursing (36).
4.2. Ethical Leadership
Ethical leadership was mentioned in several articles in-
cluded in this review (27-30,34,35). According to the sci-
entific literature, when adopting ethical leadership, nurse
leaders manage to achieve inner satisfaction while increas-
ing the satisfaction of staff nurses and patients (29) since
honesty, fairness, flexibility, and respect for other team
members lead to self-satisfaction (29), and when the nurs-
ing leader treats all team members equally, nurses are em-
powered (28,34,35), and work more satisfied, thus care is
positively affected (29). In other words, one of the impor-
tant roles of nursing leaders is to build ethical work envi-
ronments (30,34).
However, nurse managers may face barriers in adopt-
ing ethical leadership, as other team members may have
varied opinions regarding the leader’s attitudes; in addi-
tion, some leaders report that the team may try to take
advantage when faced with a more flexible and friendly
leader; thus, some leaders mentioned being bullied and
abused while seeking to lead ethically (27). Moreover, so-
cial culture (27) and organizational culture were pointed
out by nurse managers as obstacles to ethical leadership
(27,35). According to nursing leaders, negative societal
perceptions of the nursing profession, lack of organiza-
tional democracy (27), and some organizational policies
and procedures, such as restrictions on patient visits, can
undermine ethical leadership (35). In other words, per-
sonal attributes, previous experience, and also organiza-
tional rules will influence nurses’ attitudes (36). Thus,
nurse leaders may face dilemmas when defining what is
ethical and what is not, in addition to experiencing eth-
ical distress when forced to make decisions against their
ethical values (27,35). As conflicts between their beliefs
Mod Care J. In Press(In Press):e130402. 5
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Aydogdu ALF
and institutional values can represent obstacles to ethical
decision-making (27,35), nursing leaders should regularly
evaluate themselves and their attitudes (35). Ethical lead-
ership seems more complicated in health institutions than
in educational institutions, as many ethical dilemmas can
arise in clinical environments (27).
4.3. Nursing Leadership Education
The importance of nursing leadership education to re-
duce mistakes, introduce a nursing leadership model, and
improve competency was pointed out by nurse leaders
(34). In addition, three of the included studies in this re-
view analyzed students’ views of nursing leadership (30-
32). It was identified that nursing students might feel anx-
ious due to a lack of management knowledge, but they also
are eager to exercise leadership in the near future (30).
The importance of providing leadership training in the
early years of nursing education was pointed out (30-32), as
such training can make students learn about policies, reg-
ulations, and job descriptions (30), which develops their
visions of the nursing profession (30,32). A lack of knowl-
edge of clinical nursing leadership was noticed in some
students (32); the importance of clinical leadership to pro-
vide holistic care since it may fill gaps that still exist be-
tween theoretical and practical nursing education was em-
phasized (30,31,34). In addition, a lack of financial and in-
stitutional support was pointed out as an obstacle to nurs-
ing leadership education (34). Differences between gener-
ations were also reported as barriers to nursing leadership
education because professors can seek pedagogical meth-
ods that are not interesting for students who currently get
information from social media (34).
Studies highlighted that developing clinical nursing
leadership projects involving educators and students (31),
watching clinical nursing leadership videos, observing
role models, and developing group discussions can be use-
ful for students to learn clinical nursing leadership (32).
Also, Evidence-based programs should be developed in
undergraduate and postgraduate nursing courses, as the
knowledge acquired through such methods is essential for
future nursing leaders (33). Moreover, a study emphasized
that individual and organizational leadership are funda-
mental for research to be carried out in nursing, which will
ensure evidence-based care (36).
5. Discussion
This integrative review aimed to explore the scientific
literatureconcerning different nursingleadership aspects.
Through the studies included in this review, the impact of
leadership on different functions of nurses, such as care,
education, management, and research, was identified. The
included studies mentioned the importance of leadership
for nurses’ job satisfaction and quality of care. The charac-
teristics/skills of nursing leaders and the role of leaders as
sources of motivationand inspiration for thenursing team
were emphasized. Studies pointed out the importance of
ethical nursing leadership, and the difficulties leaders may
face in making ethical decisions. The need to teach lead-
ership through practical and theoretical classes for under-
graduate nursing students was also reported.
In the studies included in this review, commitment,
competence, passion, and also skills such as problem-
solving, interpersonal relationships, and empathetic com-
munication were identified as necessary features for nurs-
ing leaders. In addition, nursing leaders were seen as
mentors and monitors who should motivate other team
members. The literature on leadership mentions differ-
ent abilities, such as technical, conceptual, diagnostic, po-
litical, and human skills, when discussing the necessary
characteristics of leaders. However, human skills such as
understanding and motivating individuals and working
and communicating with different groups seem to be the
most necessary features for leaders (37). Nursing leader-
ship refers to various aspects of the nursing routine and
involves effective communication, coordination skills, and
interaction with other health professionals, hospital ad-
ministrators, and patients. Nurses organize, coordinate,
and control their team and care process (38). Studies iden-
tified that communicative, good listeners, well-informed,
and open individuals have more chances to succeed as
leaders (39,40). In a study conducted in 2020 with millen-
nial nurses, leaders were identified as mentors, monitors,
and coordinators who have important roles in nurses’ job
satisfaction and retention (41). It is difficult to determine
how much nursing leadership can influence the care pro-
cess, but it is known that nursing leaders need to create an
appropriate work environment and empower their follow-
ers, and these factors bring positive consequences for care
(4).
According to the studies selected for this review, nurs-
ing leaders are important for formulating policies and pro-
cedures that aim to guarantee the quality of care and, con-
sequently, the success of health institutions. A study car-
ried out in Spain (2013) pointed out the importance of de-
veloping leadership styles that lead to empowering nurses
and improving the health system’s efficiency and efficacy
(42). Nurses play a critical role in formulating health poli-
cies at different administrative levels, ranging from the or-
ganizational level to higher health system levels. Nurses
can use their leadership skills and attitudes to influence
others and be essential in decision-making that will re-
flect on the population’s well-being (43). In addition, nurse
leaders’ attitudes affect staff nurses’ job satisfaction; thus,
leadership styles influence healthcare quality indicators
(44). A study conducted in the Philippines (2021) reported
6 Mod Care J. In Press(In Press):e130402.
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Aydogdu ALF
how toxic leadership could negatively affect the quality of
care since it can lead to errors in drug administration and
increase infection rates and patient falls (3).
Ethical nursing leadership and the difficulties nurses
face while making ethical decisions in the clinical environ-
ment were emphasized in some of the studies included in
this review. Ethics in nursing leadership is discussed in sev-
eral studies (14,45). According to a study carried out in Iran
(2017), ethical leaders are sensitive to care, errors, commu-
nication, decision-making, and practice; thus, when adopt-
ing ethical leadership, nurses become role models to other
health team members (14). A study conducted in Egypt
(2021) also pointed out the importance of the ethical be-
havior of leaders to positively influence staff nurses (45).
A study from Turkey (2019) identified the relationship be-
tween ethical leadership and nurses’ job satisfaction (46).
After the emergence of the COVID-19 pandemic, the inter-
est in ethical nursing leadership became even more com-
mon (47-49). Nursing leadership must be conducted to
support and empower nurses and protect patients (50).
However, nurses face barriers that can make adopting an
effective leadership style challenging. According to a sys-
tematic review, budget, team diversity, workload, lack of
human resources, and policies related to patient safety
are some of the challenges that may affect nursing lead-
ership (51). In a study conducted in Norway (2022), nurse
leaders stated that personnel matters are the most energy-
intensive, as it is difficult to be fair and understanding
when there are staff shortages and excessive workloads
(52).
The importance of teaching leadership to nursing stu-
dents so that they become competent nurse leaders was
emphasized in this review. Nursing educators identify the
importance of addressing leadership from the early years
of undergraduate courses and that practical classes are es-
sential in training nurse leaders (53). A study carried out
in Brazil (2017) pointed to the importance of training nurs-
ing students in leadership and improving such knowledge
through postgraduate courses and continuing education
(54).
Different aspects of nursing leadership are widely dis-
cussed in the scientific literature. Leadership needs to be
exercised in all dimensions of nursing, so nursing man-
agers, frontline nurses, educators, and researchers must
use their leadership skills in favor of quality care (18,43).
Nurses have important roles in the health system, so nurs-
ing leadership occupies a decisive place in the health sec-
tor. Nursing leaders must make fair decisions and be role
models for their teams, as their attitudes affect the satis-
faction of nurses and the quality of care. Ethical attitudes
of nursing leaders are still important because they lead
to inner satisfaction. Nevertheless, there are many barri-
ers encountered by nurse leaders due to their characteris-
tics and experiences, and also those of their followers. In
addition, organizational policies and procedures can go
against leaders’ values, thus harming the decision-making
process. The need to train nursing students to be fair and
competent leaders is noteworthy. In addition, teaching
leadership in health institutions through continuing edu-
cation is an important measure to promote ethical nursing
leadership.
An important limitation of this study is that the search
was performed only on the titles of articles published in
the last ten years. In addition, important databases were
not searched, and relevant studies may not have been
found due to the search criteria. However, the included
studies enabled an important analysis of the importance
of nursing leadership for care, management, teaching, and
research.
5.1. Conclusion
Leadership is important in all roles performed by
nurses. Nurse leaders influence other team members and
patients; consequently, nursing leadership impacts the
quality of care. Thus, nursing leadership is pivotal in cre-
ating a safe environment for nurses and patients. In the re-
search area, individual and organizational leadership are
important to provide data for evidence-based care.
Administrators of educational and health institutions
must be attentive to nursing leadership, as training com-
petent nurse leaders are important for providing quality
care and, consequently, organizational success. Therefore,
training on leadership should be addressed in nursing
schools in undergraduate and postgraduate courses and
health institutions through continuing education.
Footnotes
Authors’ Contribution: Study concept and design, A. L.
F. A.; Acquisition of data, A. L. F. A.; Analysis and interpreta-
tion of data, A. L. F. A.; Drafting of the manuscript, A. L. F. A.;
Critical revision of the manuscript for important intellec-
tual content, A. L. F. A.; Statistical analysis, A. L. F. A.; Admin-
istrative, technical, and material support, A. L. F. A.; Study
supervision, A. L. F. A.
Conflict of Interests: The author declares that there is
no conflict of interest with respect to the research, author-
ship, and/or publication of this article.
Funding/Support: This research received no specific
grant from any funding agency in the public commercial
or not-for-profit sector.
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