Systematic Review of Authentic Leadership Effects on Patient, Nurse, and System Outcomes.

Abstract

Background: Authentic leadership in nursing is associated with positive nurse outcomes globally. However, the last published systematic review, in 2018, showed no evidence from the United States and little evidence of effect on patient or health system outcomes.

Objectives: To systematically review, appraise, and synthesize evidence focused on the effect of authentic leadership on nurse, patient, and system outcomes in acute care hospitals in the U.S.

Methods: A search of six databases for quantitative, peer-reviewed research focused on authentic leadership in nursing. Studies with registered nurses in any role conducted in acute care hospitals and published in English between 2004 and 2025 were included. Studies with non-registered nurse participants were excluded. Quality appraisal was conducted using Joanna Briggs Institute tools. Results were narratively synthesized, as heterogeneity in study instruments and methodologies rendered meta-analysis unsuitable.

Results: The final sample consisted of primarily descriptive cross-sectional surveys published between 2017 and 2025. Most sample sizes were < 200, with only two including >500 participants. Five different scales measured authentic leadership. All studies focused on nursing outcomes. Three studies showed to have a negative predictive relationship between authentic leadership and burnout, with a small to moderate effect size. Two studies showed authentic leadership predicted compassion satisfaction with small to moderate effect sizes. The final sample had moderate risks of bias.

Discussion: Evidence suggests authentic leadership may have a favorable effect on burnout and compassion satisfaction among U.S. nurses in acute care settings. This finding aligns with nationwide reports of nurse burnout and diminished well-being. No evidence is presented that links authentic leadership to patient or system outcomes. For nursing faculty and practice leaders, this limited evidence base poses a challenge in developing evidence-informed curricula and leadership programs. To address this critical gap, nurse scientists should prioritize research examining the effect of authentic leadership on nurse, patient, and system outcomes in U.S. health care settings.