Positive and Negative Leadership Styles and Burnout among Nurses: A Systematic Review and Meta-Analysis

Abstract

Although burnout among nurses carries serious consequences for staff well-being, patient safety, and the quality of care delivered, leadership remains one of the few organizational factors that can realistically be changed. This review sought to quantitatively synthesize the available evidence linking both supportive and harmful leadership styles to burnout among nurses. We systematically searched PubMed, ScienceDirect, and CINAHL/EBSCO for quantitative, English-language studies published from 2016 through 2026. Of the 47 studies retained for the review (protocol pre-registered as PROSPERO CRD420261430556), 33 provided correlation-based effect sizes suitable for the random-effects meta-analyses. Positive leadership was significantly associated with lower burnout (25 studies, n = 10,308; r = −0.294, 95% CI [−0.355, −0.231], p < 0.001), while negative leadership was significantly associated with higher burnout (8 studies, n = 5,437; r = 0.531, 95% CI [0.356, 0.669], p < 0.001). Positive leadership was linked to lower overall burnout, emotional exhaustion, and depersonalization; negative leadership showed its strongest documented association with emotional exhaustion (r = 0.552, 95% CI [0.317, 0.723]). Constructive styles (authentic, transformational, servant, ethical, empowering leadership) were linked to favourable outcomes, whereas destructive styles (toxic, despotic, authoritarian, exploitative, passive leadership) were linked to poorer outcomes. These findings support investment in constructive leadership development alongside efforts to curb harmful supervisory practices, though the substantial heterogeneity and predominantly observational nature of the evidence base warrant caution. To our knowledge, this review is the first to jointly pool correlations for both supportive and harmful leadership against multiple burnout dimensions in the nursing literature.