*Result*: The Influence of Nursing Leadership Styles on Medication Safety: A Mixed-Methods Systematic Review.
Title:
The Influence of Nursing Leadership Styles on Medication Safety: A Mixed-Methods Systematic Review.
Authors:
Dirik HF; Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey., Theiakouli C; Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece., Efstathiou N; Department of Nursing and Midwifery, University of Birmingham, Edgbaston, Birmingham, UK.
Source:
International nursing review [Int Nurs Rev] 2026 Mar; Vol. 73 (1), pp. e70166.
Publication Type:
Journal Article; Systematic Review
Language:
English
Journal Info:
Publisher: Blackwell Science Ltd Country of Publication: England NLM ID: 7808754 Publication Model: Print Cited Medium: Internet ISSN: 1466-7657 (Electronic) Linking ISSN: 00208132 NLM ISO Abbreviation: Int Nurs Rev Subsets: MEDLINE
Imprint Name(s):
Publication: Oxford, UK : Blackwell Science Ltd.
Original Publication: Geneva, International Council of Nurses.
Original Publication: Geneva, International Council of Nurses.
MeSH Terms:
References:
Aij, K. H., and M. Teunissen. 2017. “Lean Leadership Attributes: A Systematic Review of the Literature.” Journal of Health Organization and Management 31, no. 7–8: 713–729. https://doi.org/10.1108/JHOM‐12‐2016‐0245.
Ajzen, I. 1991. “The Theory of Planned Behaviour.” Organisational Behaviour and Human Decision Processes 50, no. 2: 179–211. https://doi.org/10.1016/0749‐5978(91)90020‐T.
Al‐Oweidat, I. A., A. Saleh, A. H. Khalifeh, et al. 2023. “Nurses' perceptions of the Influence of Leadership Behaviours and Organisational Culture on Patient Safety Incident Reporting Practices.” Nursing Management 30, no. 7: e2088. https://doi.org/10.7748/nm.2023.e2088.
Al‐Rjoub, S., A. Alsharawneh, M. J. Alhawajreh, and E. H. Othman. 2024. “Exploring the Impact of Transformational and Transactional Style of Leadership on Nursing Care Performance and Patient Outcomes.” Journal of Health Care Leadership 16: 557–568. https://doi.org/10.2147/JHL.S496266.
Anderson, M. H., and P. Y. T. Sun. 2017. “Reviewing Leadership Styles: Overlaps and the Need for a New ‘Full‐Range’ theory.” International Journal of Management Reviews 19, no. 1: 76–96. https://doi.org/10.1111/ijmr.12082.
Anderson, M. H., and P. Y. T. Sun. 2024. “Re‐Envisioning a Hierarchy of Leadership Behaviours Using Insights From the Psychological Literature on Personality Traits.” Journal of Management Studies 61, no. 4: 1165–1191. https://doi.org/10.1111/joms.12922.
Barkhordari‐Sharifabad, M., M. Mirjalili, and N.‐S. Mirjalili. 2020. “Ethical Leadership, Nursing Error and Error Reporting From the Nurses' Perspective.” Nursing Ethics 27, no. 2: 609–620. https://doi.org/10.1177/0969733019858706.
Barrachina, A., and V. M. González‐Chordá. 2020. “Error Reporting and the Performance of Nursing Management: A Game‐Theoretic Study.” IMA Journal of Management Mathematics 31, no. 4: 445–468. https://doi.org/10.1093/imaman/dpz019.
Browne, F., B. Hannigan, and J. Harden. 2021. “A Realist Evaluation of a Safe Medication Administration Education Programme.” Nurse Education Today 97: 104685. https://doi.org/10.1016/j.nedt.2020.104685.
Bryant, S., and L. Yoder. 2021. “Implementing the Lean Management System to Influence Unfinished Nursing Care.” MEDSURG Nursing 30, no. 3: 181–217. https://doi.org/10.62116/msj.2021.30.3.181.
Critical Appraisal Skills Programme (CASP). 2024. CASP Cohort Study Checklist. https://casp‐uk.net/casp‐tools‐checklists/cohort‐study‐checklist/.
Dirik, H. F., and S. Seren Intepeler. 2024. “An Authentic Leadership Training Programme to Increase Nurse Empowerment and Patient Safety: A Quasi‐Experimental Study.” Journal of Advanced Nursing 80, no. 4: 1417–1428. https://doi.org/10.1111/jan.15926.
Farag, A., M. Blegen, A. Gedney‐Lose, D. Lose, and Y. Perkhounkova. 2017a. “Voluntary Medication Error Reporting by ED Nurses: Examining the Association With Work Environment and Social Capital.” Journal of Emergency Nursing 43, no. 3: 246–254. https://doi.org/10.1016/j.jen.2016.10.015.
Farag, A., S. Tullai McGuinness, M. K. Anthony, C. Burant et al. 2017b. “Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?” Journal of Nursing Administration 47, no. 1: 8–15. https://doi.org/10.1097/NNA.0000000000000430.
Farag, A. A., and M. K. Anthony. 2015. “Examining the Relationship Among Ambulatory Surgical Settings Work Environment, Nurses' characteristics, and Medication Errors Reporting.” Journal of Perianesthesia Nursing 30, no. 6: 492–503. https://doi.org/10.1016/j.jopan.2014.11.014.
Farag, A. A., D. Lose, and A. Gedney Lose. 2019. “Nurses' Safety Motivation: Examining Predictors of Nurses' Willingness to Report Medication Errors.” Western Journal of Nursing Research 41, no. 7: 954–972. https://doi.org/10.1177/0193945918815462.
Ferreira, T. D. M., G. R. de Mesquita, G. C. de Melo, et al. 2022. “The Influence of Nursing Leadership Styles on the Outcomes of Patients, Professionals and Institutions: An Integrative Review.” Journal of Nursing Management 30, no. 4: 936–953. https://doi.org/10.1111/jonm.13592.
Hamdan, M., A. H. Jaaffar, O. Khraisat, M. R. Issa, and M. Jarrar. 2024. “The Association of Transformational Leadership on Safety Practices Among Nurses: The Mediating Role of Patient Safety Culture.” Risk Management and Health Care Policy 17: 1687–1700. https://doi.org/10.2147/RMHP.S458505.
Hempel, S., P. G. Shekelle, J. L. Liu, et al. 2015. “Development of the Quality Improvement Minimum Quality Criteria Set (QI‐MQCS): A Tool for Critical Appraisal of Quality Improvement Intervention Publications.” BMJ Quality & Safety 24, no. 12: 796–804. https://doi.org/10.1136/bmjqs‐2014‐003151.
Hong, Q. N., P. Pluye, S. Fàbregues, et al. 2018. Mixed Methods Appraisal Tool (MMAT), Version 2018: User Guide. https://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria‐manual_2018‐08‐01_ENG.pdf.
Huang, C.‐H., H.‐H. Wu, Y.‐C. Lee, and X. Li. 2024. “The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.” Risk Management and Health Care Policy 17: 513–523. https://doi.org/10.2147/RMHP.S446651.
Hult, M., A. Terkamo‐Moisio, P. Kaakinen, et al. 2023. “Relationships Between Nursing Leadership and Organisational, Staff and Patient Outcomes: A Systematic Review of Reviews.” Nursing Open 10, no. 9: 5920–5936. https://doi.org/10.1002/nop2.1876.
Kim, M. S., J. H. Seok, and B. M. Kim. 2020. “Mediating Role of the Perceived Benefits of Using a Medication Safety System in the Relationship Between Transformational Leadership and the Medication‐Error Management Climate.” Journal of Research in Nursing 25, no. 1: 22–34. https://doi.org/10.1177/1744987118824621.
Kowalski, M. O., C. Basile, E. Bersick, D. A. Cole, D. E. McClure, and S. H. Weaver. 2020. “What Do Nurses Need to Practice Effectively in the Hospital Environment? An Integrative Review With Implications for Nurse Leaders.” Worldviews on Evidence‐Based Nursing 17, no. 1: 60–70. https://doi.org/10.1111/wvn.12401.
Labrague, L. J. 2021. “Influence of Nurse Managers' Toxic Leadership Behaviours on Nurse‐Reported Adverse Events and Quality of Care.” Journal of Nursing Management 29, no. 4: 855–863. https://doi.org/10.1111/jonm.13228.
Lappalainen, M., M. Härkänen, and T. Kvist. 2020. “The Relationship Between Nurse Manager's Transformational Leadership Style and Medication Safety.” Scandinavian Journal of Caring Sciences 34, no. 2: 357–369. https://doi.org/10.1111/scs.12737.
Lizarondo, L., C. Stern, J. Carrier, et al. 2024. “Chapter 8: Mixed Methods Systematic Reviews.” In JBI Manual for Evidence Synthesis, edited by E. Aromataris, C. Lockwood, K. Porritt, B. Pilla, and Z. Jordan. JBI. https://doi.org/10.46658/JBIMES‐24‐07.
Mendes, L., and G. França. 2025. “Lean Thinking and Risk Management in Health Care Organisations: A Systematic Literature Review and Research Agenda.” International Journal of Quality & Reliability Management 42, no. 3: 851–892. https://doi.org/10.1108/IJQRM‐06‐2023‐0210.
Milosevic, I., S. Maric, and D. Lončar. 2020. “Defeating the Toxic Boss: The Nature of Toxic Leadership and the Role of Followers.” Journal of Leadership & Organizational Studies 27, no. 2: 117–137. https://doi.org/10.1177/1548051819833374.
Mohiuddin, S., and K. Mohteshamuddin. 2020. “Combination Model for Sustainable Change by Utilizing Kotter's Change Model and the Hersey & Blanchard's Leadership Model for Improving Medication Errors Reporting.” Journal of Medical & Allied Sciences 10, no. 1: 25–32. https://doi.org/10.5455/jmas.76372.
Moraca, E., F. Zaghini, J. Fiorini, and A. Sili. 2025. “Errors in Clinical Practice and Organisational Constraints: The Role of Leadership in Improving Patients' Safety.” Safety 11, no. 2: 57. https://doi.org/10.3390/safety11020057.
National Coordinating Council for Medication Error Reporting and Prevention. 2025. About Medication Errors. https://www.nccmerp.org/about‐medication‐errors.
Nurmeksela, A., S. Mikkonen, J. Kinnunen, and T. Kvist. 2021. “Relationships Between Nurse Managers' Work Activities, Nurses' Job Satisfaction, Patient Satisfaction, and Medication Errors at the Unit Level: A Correlational Study.” BMC Health Services Research 21, no. 1: 296. https://doi.org/10.1186/s12913‐021‐06288‐5.
Page, M. J., J. E. McKenzie, P. M. Bossuyt, et al. 2021. “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews.” Bmj 372: n71. https://doi.org/10.1136/bmj.n71.
Popay, J., H. Roberts, A. Sowden, et al. 2006. Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. ESRC Methods Programme.
Richards, A. 2020. “Exploring the Benefits and Limitations of Transactional Leadership in Health Care.” Nursing Standard 35, no. 12: 46–50. https://doi.org/10.7748/ns.2020.e11593.
Seljemo, C., P. Viksveen, and E. Ree. 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, no. 1: 799. https://doi.org/10.1186/s12913‐020‐05671‐y.
Sfantou, D. F., A. Laliotis, A. E. Patelarou, D. Sifaki Pistolla, M. Matalliotakis, and E. Patelarou. 2017. “Importance of Leadership Style towards Quality of Care Measures in Health Care Settings: A Systematic Review.” Healthcare 5, no. 4: 73. https://doi.org/10.3390/healthcare5040073.
Singh, P. K., S. Singh, V. Kumari, and M. Tiwari. 2024. “Navigating Health Care Leadership: Theories, Challenges, and Practical Insights for the Future.” Journal of Postgraduate Medicine 70, no. 4: 232–241. https://doi.org/10.4103/jpgm.jpgm_533_24.
Smith‐Love, J. 2022. “Reducing near Miss Medication Events Using an Evidence‐Based Approach.” Journal of Nursing Care Quality 37, no. 4: 327–333. https://doi.org/10.1097/NCQ.0000000000000630.
Stern, C., L. Lizarondo, J. Carrier, et al. 2020. “Methodological Guidance for the Conduct of Mixed Methods Systematic Reviews.” JBI Evidence Synthesis 18, no. 10: 2108–2118. https://doi.org/10.11124/JBISRIR‐D‐19‐00169.
van Elp, B., O. Roemeling, and K. H. Aij. 2022. “Lean Leadership: Towards Continuous Improvement Capability in Health Care.” Health Services Management Research 35, no. 1: 7–15. https://doi.org/10.1177/09514848211001688.
Wang, M., and J. Dewing. 2021. “Exploring Mediating Effects Between Nursing Leadership and Patient Safety from a Person‐Centred Perspective: A Literature Review.” Journal of Nursing Management 29, no. 5: 878–889. https://doi.org/10.1111/jonm.13226.
Wang, X., Y. Liu, Z. Peng, et al. 2024. “Situational Leadership Theory in Nursing Management: A Scoping Review.” BMC Nursing 23, no. 1: 930. https://doi.org/10.1186/s12912‐024‐02582‐9.
World Health Organisation. 2017. Medication Without Harm. World Health Organisation. https://www.who.int/initiatives/medication‐without‐harm.
World Health Organisation 2019. 10 Facts on Patient Safety. https://www.who.int/news‐room/photo‐story/detail/10‐facts‐on‐patient‐safety.
World Health Organisation. 2024. Global Burden of Preventable Medication‐Related Harm in Health Care: A Systematic Review. https://www.who.int/publications/i/item/9789240088887.
Wu, Y., S. R. Awang, T. Ahmad, and C. You. 2024. “A Systematic Review of Leadership Styles in Health Care Sector: Insights and Future Directions.” Geriatric Nursing 59: 48–59. https://doi.org/10.1016/j.gerinurse.2024.06.033.
Ajzen, I. 1991. “The Theory of Planned Behaviour.” Organisational Behaviour and Human Decision Processes 50, no. 2: 179–211. https://doi.org/10.1016/0749‐5978(91)90020‐T.
Al‐Oweidat, I. A., A. Saleh, A. H. Khalifeh, et al. 2023. “Nurses' perceptions of the Influence of Leadership Behaviours and Organisational Culture on Patient Safety Incident Reporting Practices.” Nursing Management 30, no. 7: e2088. https://doi.org/10.7748/nm.2023.e2088.
Al‐Rjoub, S., A. Alsharawneh, M. J. Alhawajreh, and E. H. Othman. 2024. “Exploring the Impact of Transformational and Transactional Style of Leadership on Nursing Care Performance and Patient Outcomes.” Journal of Health Care Leadership 16: 557–568. https://doi.org/10.2147/JHL.S496266.
Anderson, M. H., and P. Y. T. Sun. 2017. “Reviewing Leadership Styles: Overlaps and the Need for a New ‘Full‐Range’ theory.” International Journal of Management Reviews 19, no. 1: 76–96. https://doi.org/10.1111/ijmr.12082.
Anderson, M. H., and P. Y. T. Sun. 2024. “Re‐Envisioning a Hierarchy of Leadership Behaviours Using Insights From the Psychological Literature on Personality Traits.” Journal of Management Studies 61, no. 4: 1165–1191. https://doi.org/10.1111/joms.12922.
Barkhordari‐Sharifabad, M., M. Mirjalili, and N.‐S. Mirjalili. 2020. “Ethical Leadership, Nursing Error and Error Reporting From the Nurses' Perspective.” Nursing Ethics 27, no. 2: 609–620. https://doi.org/10.1177/0969733019858706.
Barrachina, A., and V. M. González‐Chordá. 2020. “Error Reporting and the Performance of Nursing Management: A Game‐Theoretic Study.” IMA Journal of Management Mathematics 31, no. 4: 445–468. https://doi.org/10.1093/imaman/dpz019.
Browne, F., B. Hannigan, and J. Harden. 2021. “A Realist Evaluation of a Safe Medication Administration Education Programme.” Nurse Education Today 97: 104685. https://doi.org/10.1016/j.nedt.2020.104685.
Bryant, S., and L. Yoder. 2021. “Implementing the Lean Management System to Influence Unfinished Nursing Care.” MEDSURG Nursing 30, no. 3: 181–217. https://doi.org/10.62116/msj.2021.30.3.181.
Critical Appraisal Skills Programme (CASP). 2024. CASP Cohort Study Checklist. https://casp‐uk.net/casp‐tools‐checklists/cohort‐study‐checklist/.
Dirik, H. F., and S. Seren Intepeler. 2024. “An Authentic Leadership Training Programme to Increase Nurse Empowerment and Patient Safety: A Quasi‐Experimental Study.” Journal of Advanced Nursing 80, no. 4: 1417–1428. https://doi.org/10.1111/jan.15926.
Farag, A., M. Blegen, A. Gedney‐Lose, D. Lose, and Y. Perkhounkova. 2017a. “Voluntary Medication Error Reporting by ED Nurses: Examining the Association With Work Environment and Social Capital.” Journal of Emergency Nursing 43, no. 3: 246–254. https://doi.org/10.1016/j.jen.2016.10.015.
Farag, A., S. Tullai McGuinness, M. K. Anthony, C. Burant et al. 2017b. “Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?” Journal of Nursing Administration 47, no. 1: 8–15. https://doi.org/10.1097/NNA.0000000000000430.
Farag, A. A., and M. K. Anthony. 2015. “Examining the Relationship Among Ambulatory Surgical Settings Work Environment, Nurses' characteristics, and Medication Errors Reporting.” Journal of Perianesthesia Nursing 30, no. 6: 492–503. https://doi.org/10.1016/j.jopan.2014.11.014.
Farag, A. A., D. Lose, and A. Gedney Lose. 2019. “Nurses' Safety Motivation: Examining Predictors of Nurses' Willingness to Report Medication Errors.” Western Journal of Nursing Research 41, no. 7: 954–972. https://doi.org/10.1177/0193945918815462.
Ferreira, T. D. M., G. R. de Mesquita, G. C. de Melo, et al. 2022. “The Influence of Nursing Leadership Styles on the Outcomes of Patients, Professionals and Institutions: An Integrative Review.” Journal of Nursing Management 30, no. 4: 936–953. https://doi.org/10.1111/jonm.13592.
Hamdan, M., A. H. Jaaffar, O. Khraisat, M. R. Issa, and M. Jarrar. 2024. “The Association of Transformational Leadership on Safety Practices Among Nurses: The Mediating Role of Patient Safety Culture.” Risk Management and Health Care Policy 17: 1687–1700. https://doi.org/10.2147/RMHP.S458505.
Hempel, S., P. G. Shekelle, J. L. Liu, et al. 2015. “Development of the Quality Improvement Minimum Quality Criteria Set (QI‐MQCS): A Tool for Critical Appraisal of Quality Improvement Intervention Publications.” BMJ Quality & Safety 24, no. 12: 796–804. https://doi.org/10.1136/bmjqs‐2014‐003151.
Hong, Q. N., P. Pluye, S. Fàbregues, et al. 2018. Mixed Methods Appraisal Tool (MMAT), Version 2018: User Guide. https://mixedmethodsappraisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMAT_2018_criteria‐manual_2018‐08‐01_ENG.pdf.
Huang, C.‐H., H.‐H. Wu, Y.‐C. Lee, and X. Li. 2024. “The Critical Role of Leadership in Patient Safety Culture: A Mediation Analysis of Management Influence on Safety Factors.” Risk Management and Health Care Policy 17: 513–523. https://doi.org/10.2147/RMHP.S446651.
Hult, M., A. Terkamo‐Moisio, P. Kaakinen, et al. 2023. “Relationships Between Nursing Leadership and Organisational, Staff and Patient Outcomes: A Systematic Review of Reviews.” Nursing Open 10, no. 9: 5920–5936. https://doi.org/10.1002/nop2.1876.
Kim, M. S., J. H. Seok, and B. M. Kim. 2020. “Mediating Role of the Perceived Benefits of Using a Medication Safety System in the Relationship Between Transformational Leadership and the Medication‐Error Management Climate.” Journal of Research in Nursing 25, no. 1: 22–34. https://doi.org/10.1177/1744987118824621.
Kowalski, M. O., C. Basile, E. Bersick, D. A. Cole, D. E. McClure, and S. H. Weaver. 2020. “What Do Nurses Need to Practice Effectively in the Hospital Environment? An Integrative Review With Implications for Nurse Leaders.” Worldviews on Evidence‐Based Nursing 17, no. 1: 60–70. https://doi.org/10.1111/wvn.12401.
Labrague, L. J. 2021. “Influence of Nurse Managers' Toxic Leadership Behaviours on Nurse‐Reported Adverse Events and Quality of Care.” Journal of Nursing Management 29, no. 4: 855–863. https://doi.org/10.1111/jonm.13228.
Lappalainen, M., M. Härkänen, and T. Kvist. 2020. “The Relationship Between Nurse Manager's Transformational Leadership Style and Medication Safety.” Scandinavian Journal of Caring Sciences 34, no. 2: 357–369. https://doi.org/10.1111/scs.12737.
Lizarondo, L., C. Stern, J. Carrier, et al. 2024. “Chapter 8: Mixed Methods Systematic Reviews.” In JBI Manual for Evidence Synthesis, edited by E. Aromataris, C. Lockwood, K. Porritt, B. Pilla, and Z. Jordan. JBI. https://doi.org/10.46658/JBIMES‐24‐07.
Mendes, L., and G. França. 2025. “Lean Thinking and Risk Management in Health Care Organisations: A Systematic Literature Review and Research Agenda.” International Journal of Quality & Reliability Management 42, no. 3: 851–892. https://doi.org/10.1108/IJQRM‐06‐2023‐0210.
Milosevic, I., S. Maric, and D. Lončar. 2020. “Defeating the Toxic Boss: The Nature of Toxic Leadership and the Role of Followers.” Journal of Leadership & Organizational Studies 27, no. 2: 117–137. https://doi.org/10.1177/1548051819833374.
Mohiuddin, S., and K. Mohteshamuddin. 2020. “Combination Model for Sustainable Change by Utilizing Kotter's Change Model and the Hersey & Blanchard's Leadership Model for Improving Medication Errors Reporting.” Journal of Medical & Allied Sciences 10, no. 1: 25–32. https://doi.org/10.5455/jmas.76372.
Moraca, E., F. Zaghini, J. Fiorini, and A. Sili. 2025. “Errors in Clinical Practice and Organisational Constraints: The Role of Leadership in Improving Patients' Safety.” Safety 11, no. 2: 57. https://doi.org/10.3390/safety11020057.
National Coordinating Council for Medication Error Reporting and Prevention. 2025. About Medication Errors. https://www.nccmerp.org/about‐medication‐errors.
Nurmeksela, A., S. Mikkonen, J. Kinnunen, and T. Kvist. 2021. “Relationships Between Nurse Managers' Work Activities, Nurses' Job Satisfaction, Patient Satisfaction, and Medication Errors at the Unit Level: A Correlational Study.” BMC Health Services Research 21, no. 1: 296. https://doi.org/10.1186/s12913‐021‐06288‐5.
Page, M. J., J. E. McKenzie, P. M. Bossuyt, et al. 2021. “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews.” Bmj 372: n71. https://doi.org/10.1136/bmj.n71.
Popay, J., H. Roberts, A. Sowden, et al. 2006. Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. ESRC Methods Programme.
Richards, A. 2020. “Exploring the Benefits and Limitations of Transactional Leadership in Health Care.” Nursing Standard 35, no. 12: 46–50. https://doi.org/10.7748/ns.2020.e11593.
Seljemo, C., P. Viksveen, and E. Ree. 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, no. 1: 799. https://doi.org/10.1186/s12913‐020‐05671‐y.
Sfantou, D. F., A. Laliotis, A. E. Patelarou, D. Sifaki Pistolla, M. Matalliotakis, and E. Patelarou. 2017. “Importance of Leadership Style towards Quality of Care Measures in Health Care Settings: A Systematic Review.” Healthcare 5, no. 4: 73. https://doi.org/10.3390/healthcare5040073.
Singh, P. K., S. Singh, V. Kumari, and M. Tiwari. 2024. “Navigating Health Care Leadership: Theories, Challenges, and Practical Insights for the Future.” Journal of Postgraduate Medicine 70, no. 4: 232–241. https://doi.org/10.4103/jpgm.jpgm_533_24.
Smith‐Love, J. 2022. “Reducing near Miss Medication Events Using an Evidence‐Based Approach.” Journal of Nursing Care Quality 37, no. 4: 327–333. https://doi.org/10.1097/NCQ.0000000000000630.
Stern, C., L. Lizarondo, J. Carrier, et al. 2020. “Methodological Guidance for the Conduct of Mixed Methods Systematic Reviews.” JBI Evidence Synthesis 18, no. 10: 2108–2118. https://doi.org/10.11124/JBISRIR‐D‐19‐00169.
van Elp, B., O. Roemeling, and K. H. Aij. 2022. “Lean Leadership: Towards Continuous Improvement Capability in Health Care.” Health Services Management Research 35, no. 1: 7–15. https://doi.org/10.1177/09514848211001688.
Wang, M., and J. Dewing. 2021. “Exploring Mediating Effects Between Nursing Leadership and Patient Safety from a Person‐Centred Perspective: A Literature Review.” Journal of Nursing Management 29, no. 5: 878–889. https://doi.org/10.1111/jonm.13226.
Wang, X., Y. Liu, Z. Peng, et al. 2024. “Situational Leadership Theory in Nursing Management: A Scoping Review.” BMC Nursing 23, no. 1: 930. https://doi.org/10.1186/s12912‐024‐02582‐9.
World Health Organisation. 2017. Medication Without Harm. World Health Organisation. https://www.who.int/initiatives/medication‐without‐harm.
World Health Organisation 2019. 10 Facts on Patient Safety. https://www.who.int/news‐room/photo‐story/detail/10‐facts‐on‐patient‐safety.
World Health Organisation. 2024. Global Burden of Preventable Medication‐Related Harm in Health Care: A Systematic Review. https://www.who.int/publications/i/item/9789240088887.
Wu, Y., S. R. Awang, T. Ahmad, and C. You. 2024. “A Systematic Review of Leadership Styles in Health Care Sector: Insights and Future Directions.” Geriatric Nursing 59: 48–59. https://doi.org/10.1016/j.gerinurse.2024.06.033.
Contributed Indexing:
Keywords: Leadership; medication errors; nursing; systematic review
Entry Date(s):
Date Created: 20260223 Date Completed: 20260223 Latest Revision: 20260225
Update Code:
20260225
PubMed Central ID:
PMC12927690
DOI:
10.1111/inr.70166
PMID:
41729137
Database:
MEDLINE
*Further Information*
*Aim: To synthesise evidence on the impact of nursing leadership styles on medication errors.
Background: Leadership plays a critical role in medication safety by shaping staff behaviour, promoting adherence to clinical guidelines and fostering a safety-oriented culture. However, the effects of specific leadership styles on medication safety have not yet been comprehensively synthesised.
Methods: The Joanna Briggs Institute convergent segregated approach for mixed-method systematic reviews was employed and reported in accordance with PRISMA guidelines. Searches were conducted in MEDLINE, CINAHL, Scopus, PubMed, Web of Science, EMBASE, PsycINFO and Google Scholar, encompassing literature published from January 2014 to April 2025.
Results: The review includes 15 papers: 11 cross-sectional, 2 quality improvement, 1 quasi-experimental and 1 mixed-methods study. Transformational (n = 11) and ethical leadership styles were associated with enhanced medication safety, as evidenced by increased error reporting and greater adherence to medication protocols. Situational leadership was linked to gradual improvements in self-reporting behaviours. In contrast, passive-avoidant and toxic leadership styles correlated with higher rates of medication errors and decreased willingness to report errors. The effects of transactional leadership (n = 5) were mixed and appeared to be influenced by contextual factors.
Discussion: Synthesising both consistent and divergent findings clarified the complex dynamics through which leadership can mitigate or exacerbate medication errors, and offered guidance for the development of innovative and integrated leadership approaches.
Conclusion: Transformational, ethical and situational leadership styles contribute to improved medication safety, whereas passive-avoidant and toxic leadership styles lead to increased medication errors.
Implications for Nursing and Nursing Policy: This review highlights the relevance of leadership approaches associated with safety-oriented behaviours. Understanding the effects of different leadership styles will inform and support decision-making, enabling nurse leaders to implement more effective strategies to reduce medication-related risks. Investment in leadership development, particularly programmes based on transformational and ethical principles, has the potential to strengthen safe medication practices.
Prospero Registration: This systematic review's protocol was registered in PROSPERO (registration number CRD42023380426).
(© 2026 The Author(s). International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)*