The Impact of Toxic Leadership on Nurse Retention: A Scoping Review.

Abstract

Background/Objectives: Toxic leadership has arisen as a matter of serious concern within the nursing profession, with growing evidence linking it to diminished job satisfaction, ineffective conflict management, and weakened organizational commitment. These effects not only compromise nurse retention but also threaten the quality of patient care and overall healthcare outcomes. This scoping review aimed to examine the impact of toxic nursing leadership on staff retention by synthesizing evidence from existing literature and a broad range of published studies. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, CINAHL and Science Direct databases yielding 1356 articles. Of these, 18 met the predefined inclusion criteria. The scoping review followed the six-stage methodological framework proposed by Arksey and O'Malley. Thematic analysis identified two core categories: (a) key dimensions shaping perceptions of toxic leadership and (b) the impact of toxic leadership on nursing staff retention. Results: The findings reveal that toxic leadership contributes to organizational silence, emotional exhaustion, diminished psychological safety, and low professional commitment. Such behaviors not only jeopardize nurse engagement and productivity but also negatively affect patient safety and care quality. In contrast, leadership styles such as transformational and transactional leadership are associated with higher job satisfaction, reduced burnout, and improved retention outcomes. Conclusions: This review underscores the need for healthcare organizations to identify and address toxic leadership behaviors promptly. By promoting supportive and ethical leadership styles, institutions can foster a healthier workplace, improve nurse retention, and ultimately enhance the quality of care. The study offers practical implications for healthcare administrators, emphasizing leadership development.