Researchers and prominent healthcare leaders worldwide have called for programs that will

benefit the nursing population. For illustration, Johnson and Brown (2019) underlined that
training sessions on nurse leadership development significantly boost nurses' confidence and
competency, thereby enhancing patient outcomes. This is due to the fact that these programs
provide nurses with the opportunity to be recognised and acknowledged for their significant
contributions to the healthcare system. Healthcare organisations can use nurses as a valuable
resource because they have the information, skills, and empathy to make fundamental
changes if they invest in their leadership potential. These programs enrich the quality of
nursing and improve the entire healthcare system (Henshall et al.,2022). This literature
review examines

various studies and theories to determine the impact of nurse leadership development on the
quality of care it provides.

Leadership development programs have been established to help strengthen current leaders'
capabilities while supporting nurses who aspire to take on management and decision-making
roles within the healthcare environment (Spiva et al., 2020). These programs aim to enhance
leadership abilities, foster a more collaborative healthcare team, promote critical thinking and
teamwork, and advocate for a more patient-centred approach in healthcare environments.
Nurse leadership programs also instruct nurses on the effective management of resources, the
proper leading of teams, and the implementation of methods that have been demonstrated to
be effective (Niki et al., 2021). For example, Zaranko et al. (2022) showed that leadership
programs lead to a 15% increase in nurse job satisfaction, which correlates with better patient
care and reduced turnover rates. Furthermore, a mixed methods systematic review by
Välimäki et al. (2024) demonstrated that nurses' performance, organisational results and
clinical outcomes are improved by evidence-based nursing leadership. These initiatives
prepare nurse leaders with the necessary knowledge and abilities to assist healthcare
institutions in achieving success (Niki et al., 2021). This literature review will explore the
relationship between leadership development and healthcare outcomes and how they impact
each other.

2|Page
2.2. Strategies for Developing Nurse Leadership

. Formal Education and Training.

Formal education and training provide the basis for developing nursing leadership, which
impacts healthcare outcomes substantially. Nurses acquire consequential leadership skills
through structured educational programs, including critical thinking, decision-making, and
effective communication. These programs often use evidence-based practices to confirm that
nurse leaders have the most up-to-date information and skills to lead healthcare teams
effectively. For instance, leadership courses and advanced nursing administration or
healthcare management degrees deliver theoretical and practical insights into organisational
behaviour, strategic planning, and resource management. As a result, it enables a deeper
understanding of the complexities within healthcare systems, helps nurse leaders to navigate
challenges and drives improvements in patient care quality (Välimäki et al., 2024).

Enhancing nursing leadership necessitates ongoing training, including workshops, seminars,

and continuing professional development (CPD) courses. These programs offer hands-on
experience and opportunities for skill refinement, focusing on specific leadership
competencies such as conflict resolution, team building, and change management. By
engaging in these training activities, nurse leaders can apply theoretical knowledge in real-
world scenarios, improving their ability to lead diverse teams and implement effective
healthcare strategies. More importantly, ongoing training ensures that nurse leaders remain
current with evolving healthcare trends and technologies, a key factor in maintaining high
patient care and safety standards. This continuous learning keeps them informed and prepared
for the challenges of the healthcare field (Mlambo et al., 2021).

The impact of formal education and training on nursing leadership extends to measurable
improvements in healthcare outcomes. Studies have shown that well-trained nurse leaders
contribute to better patient satisfaction, reduced medical errors, and enhanced overall care
quality (Curtis et al., 2011). Effective leadership fosters a positive work environment,
increasing staff morale and retention, further contributing to consistent and high-quality
patient care. Besides, nurse leaders well-versed in evidence-based practices can implement
policies and procedures that promote patient safety and optimise resource utilisation,
ultimately leading to more efficient and effective healthcare delivery (Kelly at el., 2014).

3|Page
Formal education and training are merely the commencement of the process of developing
nursing leaders capable of significantly impacting healthcare outcomes. These educational
programs ensure that nurse leaders possess the necessary skills and knowledge to address the
requirements of contemporary healthcare environments, effect positive change, and elevate
the quality of patient care (Mlambo et al., 2021).

. Mentorship and Coaching.

Mentorship and mentoring are essential for developing nursing leadership, which enormously
affects healthcare delivery. Mentorship involves experienced nurses guiding less experienced
colleagues and fostering a supportive environment where knowledge, skills, and professional
values are shared. This interrelation helps mentees navigate challenging clinical situations,
enhances decision-making, and builds confidence. Influential mentors act as role models,
demonstrating best practices and ethical standards which mentees can emulate. This process
not only improves the performance of nurses but also motivates them to continue their
education and advance in their careers within healthcare organisations. (Drake, 2021).

Conversely, coaching emphasises improving particular skills and competencies by employing

controlled, goal-oriented interactions. Coaches work with nurse leaders to identify areas for
improvement, set achievable goals, and develop strategies to overcome challenges. This
tailored method helps nurse leaders hone their leadership styles, enhance their
communication abilities, and create a more cooperative atmosphere (Hoover at. el, 2020 ). In
their research, Hu et al. (2024) show that leaders' efficacy, staff members' contentment, and
team performance may be much influenced by coaching. Coaching guarantees nurse leaders
are ready for the hectic and often demanding work environment by attending to their both
personal and professional development needs.

The impact of mentorship and coaching on healthcare outcomes is profound, as effective

nurse leadership is associated with better staff prolonged stay rate within the organisation,
enhanced client satisfaction, and higher quality of patient care. Leaders who have undergone
mentorship and coaching are more likely to implement evidence-based practices, advocate for
patient safety, and create a positive workforce that reduces burnout and turnover among
nursing employees. This leads to the development of more durable and efficient healthcare
delivery systems, enhancing patient outcomes (Välimäki et al., 2024). Thus, a strong and
competent nursing workforce able to satisfy the changing needs of the healthcare sector

4|Page
depends on including mentoring and coaching within nurse leadership development
programs. (Drake, 2021).

. On-the-job training.

Nursing leadership is developed mainly through job training, which provides nurses with the
mandatory resources and expertise to manage and lead healthcare teams in a professional
way. Nurses can enhance their communication skills and decision-making abilities and
navigate complex healthcare scenarios by enrolling in structured training sessions at the
workplace. These types of sessions usually include mentoring, simulation exercises, and
administrative seminars that help leaders learn and improve their use of leadership strategies
in the workforce. They also help leaders believe in their management skills, which are
essential for leading teams, resolving conflicts, and using evidence-based practices.
(Välimäki et al., 2024).

The impact of job training on nursing leadership extends beyond individual development; it
significantly influences healthcare outcomes. Effectual nurse leaders are crucial for fostering
an appropriate work environment and enhancing staff satisfaction and retention. This positive
environment is linked to improved patient care quality, as motivated and well-supported
nursing staff are likelier to deliver high-quality, patient-centred care. Furthermore, trained
nurse leaders are more capable of implementing and maintaining quality improvement
initiatives, resulting in improved clinical outcomes, increased patient safety, and reduced
medical errors (Välimäki et al., 2021). An article by Major (2019)from Nursing
Standard discussed the importance of effective leadership for nurses and healthcare
organisations. It outlined various methods for developing leadership skills, including formal
education, mentorship programs, and on-the-job training. The paper underlined the
importance of these training courses in raising leadership qualities and boosting healthcare
results.

Furthermore, job training in nursing leadership helps address nurse leaders' challenges, such
as resource constraints, staff shortages, and the need for continuous adaptation to healthcare
innovations. By providing nurses with the tools and strategies to overcome these barriers,
training programs ensure that nurse leaders can maintain high standards of care even in the
face of adversity. This resilience is essential for preserving healthcare delivery and enduring
enhancements in patient outcomes. The systematic development of nursing leadership

5|Page
through job training is critical in enhancing healthcare systems' effectiveness. (Välimäki et
al., 2024).

. Workshops and Seminars.

Nursing leadership is growing out of seminars and workshops. They give medical
professionals a disciplined road towards learning, skill improvement, and professional
growth. Through engaging seminars, case studies, and hands-on internships, participants can
gain a pragmatic understanding of leadership theses and apply them in daily situations.
Moreover, seminars often bring together experts and practitioners from various fields,
fostering a collaborative learning culture. This exposure to diverse perspectives and
experiences can broaden a nurse leader’s understanding of different leadership styles and
strategies (Zhang et al., 2024). A study by Välimäki et al. (2024) shows that these
multidisciplinary learning opportunities can improve critical thinking and problem-solving
abilities, which are crucial for excellent management in medical environments. Likewise, it
demonstrated that seminars that emphasise evidence-based leadership practices can enhance
the health facility's performance by promoting the application of study findings in practical
situations.

6|Page
 The results chapter in a systematic literature review research paper is where t
he findings from the included studies are presented in a clear and structured
manner. This chapter typically includes:
1. Summary of Findings: A concise summary of the main results from the inclu
ded studies, addressing the primary research question and any secondary qu
estions1. This helps to provide an overview of the key findings.
2. Presentation of Data: The results are often presented using tables, graphs, a
nd charts to visually illustrate the data1. This makes it easier for readers to un
derstand and interpret the findings.
3. Statistical Analysis: If applicable, the results chapter includes statistical anal
yses of the data, such as measures of effect size, confidence intervals, and p-
values. This helps to quantify the results and assess their significance.
4. Subgroup Analyses: If the review includes subgroup analyses (e.g., based o
n different populations, interventions, or outcomes), these are presented to sh
ow how the results vary across different subgroups.
5. Synthesis of Results: The results from individual studies are synthesized to
provide an overall picture of the evidence. This may include narrative synthesi
s, meta-analysis, or other methods of combining data.
6. Discussion of Heterogeneity: Any heterogeneity (variability) among the stud
y results is discussed, including potential reasons for differences in findings an
d their implications for the overall conclusions.

7Quality of Evidence: The quality of the evidence is assessed and reporte

d, often using tools like GRADE (Grading of Recommendations Assessme
nt, Development, and Evaluation) to evaluate the certainty of the evidence.
8Implications for Practice and Research: The results chapter may also d
iscuss the practical implications of the findings for clinical practice, policy, o
r future research.

By presenting the results in a systematic and transparent manner, the results

chapter helps readers understand the evidence base, draw meaningful conclu
sions, and identify areas for further research.

7|Page
4. Results
4.1 search outcomes
Initially, 400 articles were retrieved from various electronic databases, and searching for 2
more journals manually yielded a total of 402 articles. 200 articles were screened for titles
and abstracts after removing 202 duplicates. Based on the title and abstract assessment, 100
articles were excluded, and another 100 were selected for full-text reviews; upon reviewing
the full-text articles, 80 articles excluded failed to meet the inclusion criteria. Finally, 20
articles were deemed eligible for quality assessment. Fifteen articles did not meet quality
criteria and were excluded as well, resulting in 5 articles that are included in this review.

8|Page
 4.2 study characteristics

Table 2 Studies included in the systematic review

Author Title Year Journal Relevance to the research Outcomes of metrics and
questions results

Hughes A qualitative 2022 Nursing This research is highly relevant The objective was to identify
et al. descriptive study Open because it demonstrates the the personal strategies nurse
of effective impact of personal methods leaders from small island
leadership and and cultural factors on the countries in Europe employ to
leadership development of nurse leaders. succeed as leaders. The
development By acquiring knowledge about outcome measures contained
strategies used by these topics, leadership themes of leadership,
nurse leaders in development programs can be communication, processes, and
European island tailored to accommodate better relationships. The data
countries. the requirements of nurse indicated that the nurse leaders'
leaders from diverse cultural strategies and plans could be
backgrounds. Eventually, this categorised into four primary
will result in improved patient themes and twelve subthemes.
care and higher organisational The Leadership Model's five
performance. The study's transformational leadership
emphasis on transformational techniques were shown to be
leadership practices effective by these results. The
consistently enhances patient research demonstrated that the
outcomes by instructing nurses "nurse leader" position was a
on becoming effective leaders. cultural identity shared by all
islands, despite the ongoing
discussion regarding cultural
island identity.

De Kok Nurse Leadership 2023 Nursing This study is highly relevant, During this study, the
et al Development: A management as it provides valuable insights researchers sought to
Qualitative Study into the characteristics of a determine the extent to which
of the Dutch nursing leader. The research nurses believed that the Dutch
Excellent Care provides healthcare Excellent Care Program had
Program organisations with practical facilitated their development as
suggestions for implementing leaders and improved their
programs that can enhance the work environments. The
quality of care, employee outcome measures contained
retention, and job satisfaction themes of leadership,
by identifying the primary interaction, and relations. The
processes that facilitate the findings indicated that there
development of leaders. The are four primary factors that
results demonstrate the critical contribute to the development
importance of providing nurses of leaders: (1) nurses'

9|Page
 with the necessary resources to responsibility for their own
facilitate their professional learning and skills, (2) the
development and establish a enhancement of nursing
supportive work environment governance through the
that encourages innovation and reinforcement of organisational
continuous improvement. structures, (3) the challenge of
the status quo through projects
that enhance quality, (4) and
the increased awareness of the
supportive role of the nurse
manager among nurses.
Conner Band 5 Nurses’ 2023 Nursing The study is highly relevant. The objective of the
et al. Leadership management It demonstrates band 5 investigation was to ascertain
Development as a nurses' challenges and the perspectives of band 5 staff
Current Care thoughts on developing their nurses regarding leadership
Priority in and leadership development, as
leadership skills. Healthcare
England: A well as any issues they
organisations can facilitate observed and potential
Qualitative Study leadership development by solutions for future reference.
of Perceptions, developing interventions Three primary themes emerged
Barriers, and customised to the barriers from the results: fostering
Ways Forward and facilitators they leadership development,
encounter. This will providing individuals with
ultimately result in improved opportunities to lead, and
patient care and describing leadership. The
organisational performance. research demonstrated that the
The study underscores the frequency and quality of
leadership development for
significance of providing
band 5 nurses are highly
nurses with formal and variable. Additionally,
informal training to assist facilitators and barriers were
them in acquiring the identified.
necessary leadership skills.

Roekel Nurses in the 2021 BMC Nursing The study is highly relevant The investigation employed
et al. lead: a qualitative as it demonstrates the thematic analysis to examine
study on the critical nature of nurses' the evolution of various
development of development of leadership nursing positions through
distinct nursing small-change experiments. The
skills to enhance patient
roles in daily research determined that
nursing practice
outcomes. The research implementing small-change
posits that nurses can more experiments resulted in
effectively align policy developing novel nursing
initiatives with daily nursing positions that incorporated
practices by promoting nurses' invisible work and
personal leadership and facilitated their professional
professionalisation. development. This approach
Ultimately, this will enhance enabled nurses to convert
the calibre of patient care. national laws into hospital
regulations, thereby enhancing
the quality of care by
establishing a connection
between the hospital's
resources and patients'
requirements.

10 | P a g e
Curry et Leadership 2020 BMJ open The research is highly The study's primary objective
al. development in relevant since it discusses was to determine whether and
complex health the significance of how the skills and knowledge
systems: a leadership development that participants acquired
qualitative study. during the leadership
programs in healthcare
development program were
settings and their potential to utilised and preserved over
enhance patient quality, time, as well as whether the
safety, and clinical program's impact varied as
outcomes. The research participants advanced in their
demonstrates that the long- professions. The research
term impact of leadership identified three primary themes
development on healthcare that consistently emerged: (1)
systems can be beneficial by Specific components of the
concentrating on utilising program had an apparent effect
skills and competencies over on professional development at
various levels; (2) the
time. The results are
integration of a professional
particularly advantageous to network and practical tools
nursing leadership facilitated the discovery of
development, as they fresh methods to resolving
demonstrate the value of system-wide issues, and (3)
continuing to learn and participants expressed a sense
deploy practical tools and of ongoing and expanding
professional networks to learning as the complexity of
address complex healthcare their work increased.
issues.

4.3 theoretical framework

Hughes et al. (2022) used the exemplary leadership model in their study. This model shows
five main things that successful leaders undertake: they guide, set a shared goal, evaluate the
process, and give others the power to take action or make a decision. The study examines
how these practices manifest in the unique cultural contexts of European island countries and
their impact on nursing leadership development. Conversely, De Kok et al. (2023) work on a
different model, employing the servant leadership theory in their study. This method focuses
on the leader's part in serving their team and other healthcare workers to develop their skills
by encouraging a culture of continuous improvement, collaboration, and prioritising the
patient. The research demonstrates the critical importance of providing support and authority
to nurse leaders to enable them to make a positive change in healthcare delivery by
concentrating on the principles of servant leadership.

11 | P a g e
Conner et al. (2023) employ a framework grounded in transformational leadership theory.
This framework aims to provide band 5 nurses with the required tools and motivation to
enhance their leadership abilities. The goal of transformational leadership is to create strong,
visionary leaders who can inspire their teams and make positive improvements in healthcare
settings. The ultimate goal of the study is to identify the factors that facilitate and impede
leadership development in order to encourage the implementation of effective leadership
strategies that enhance organisational outcomes and patient care.

Roekel et al. (2021) in BMC Nursing utilises a role theory framework. This theoretical
approach examines how nurses develop distinct roles through daily practice and the influence
of organisational and policy contexts on these roles. The study highlights the importance of
clear role definitions and role flexibility in enhancing nursing leadership and improving
healthcare outcomes. Thus, healthcare settings could improve the quality of care, efficiency,
and coordination by establishing defined roles for nurses.

Curry et al. (2020) implement the complexity leadership theory. This framework recognises
that healthcare systems are evolving and interconnected, mandating adaptive leadership to
respond to these obstacles. The research investigates the extent to which leadership
development programs may provide healthcare professionals with the necessary skills to
navigate complex and rapidly evolving environments. The study underscores the value of
continuous learning and adaptation in order to enhance healthcare outcomes by emphasising
the importance of deploying and maintaining leadership skills.

4.4 Measures of healthcare outcomes.

The five qualitative studies used a single or combination of instruments in each study to
measure factors affecting healthcare outcomes. All five studies
employed qualitative descriptive methods and thematic analysis; however, three of them used
the semi-structured interview as a study instrument, and the other two studies combined the
semi-structured interviews with the focus group observation. Seven factors affecting
healthcare outcomes found in the studies include empowerment and motivation of nurses,
continuous learning and professional development, supportive organisational structures, role
clarity and flexibility, collaborative and inclusive environment, cultural context and focus on
patient-centred care.

12 | P a g e
All five studies discussed the importance of empowering nurses through leadership
development to enhance their confidence and skills. The studies identified that empowering
these nurses through targeted leadership programs improves job satisfaction and retention
rates. When nurses feel supported and valued, they are more likely to remain in their roles,
reducing turnover costs and enhancing financial efficiency. Improved leadership skills also
translate to better patient care, thereby boosting patient satisfaction. In addition, continuous
learning is a recurrent theme. All five studies underscore the need for ongoing education and
professional development to maintain and enhance leadership competencies. Effective
leadership leads to better decision-making, improved team dynamics, and higher-quality
patient care, boosting patient satisfaction. Retaining skilled nurse leaders who can navigate
complex environments also enhances financial efficiency by reducing the costs associated
with turnover and poor management.

Three studies highlight the need for supportive organisational structures and policies to
facilitate leadership development. This includes providing access to training programs,
mentoring opportunities, and resources supporting professional growth and enhancing
healthcare outcomes. Nevertheless, two studies mentioned the importance of clear definition
and flexibility in nursing roles. These studies emphasised that leadership development
enables nurses to navigate their roles better and improve coordination and efficiency in
patient care. This clarity and flexibility increase job satisfaction and retention rates as nurses
feel more competent and less stressed. Further, improved role clarity and efficiency
contribute to financial savings by reducing errors and improving patient outcomes, directly
enhancing patient satisfaction.

Two studies underscore the significance of considering cultural contexts when implementing
leadership development programs. They suggest that understanding and integrating cultural
nuances can foster a culture of continuous improvement, leading to better healthcare
outcomes. Three studies also underline that fostering a collaborative and inclusive work
environment is essential, and leadership development programs should promote teamwork,
open communication, and inclusivity to create a supportive and productive workplace.

Finally, three studies consider focusing on patient-centred care, one of the factors affecting
healthcare outcomes; they argue that the essence of leadership is managing complex
healthcare environments, including fostering patient-centred care. They conclude that leaders

13 | P a g e
who prioritise patient needs can widely improve the quality of care and patient satisfaction.

6. Discussion
6.1. Interpretation of Findings
6.2. Implications for Nursing Practice and Policy
6.3. Strengths and Limitations of the Study

14 | P a g e
 References

Conner, T., Parkinson, M. and Thompson, J. (2023), “Band 5 Nurses’ Leadership

Development as a Current Care Priority in England: A Qualitative Study of

Perceptions, Barriers, and Ways Forward”, Journal of Nursing Management, Vol.

2023, pp. 1–11, doi: 10.1155/2023/3145908.

Van Schothorst–van Roekel, J., Weggelaar-Jansen, A.M.J.W.M., Hilders, C.C.G.J.M., De

Bont, A.A. and Wallenburg, I. (2021), “Nurses in the lead: a qualitative study on the

development of distinct nursing roles in daily nursing practice”, BMC Nursing, Vol.

20 No. 1, doi: 10.1186/s12912-021-00613-3.

Curry, L.A., Ayedun, A.A., Cherlin, E.J., Allen, N.H. and Linnander, E.L. (2020),

“Leadership development in complex health systems: a qualitative study”, BMJ Open,

Vol. 10 No. 4, p. e035797, doi: 10.1136/bmjopen-2019-035797.

Hughes, V., Wright, R., Taylor, J., Petchler, C. and Ling, C. (2022), “A qualitative

descriptive study of effective leadership and leadership development strategies used

15 | P a g e
 by nurse leaders in European island countries”, Nursing Open, Vol. 10 No. 2, pp.

1071–1082, doi: 10.1002/nop2.1374.

De Kok, E., Janssen-Beentjes, K., Lalleman, P., Schoonhoven, L. and Weggelaar, A.M.

(2023b), “Nurse Leadership Development: A Qualitative Study of the Dutch

Excellent Care Program”, Journal of Nursing Management, Vol. 2023, pp. 1–11, doi:

10.1155/2023/2368500.

16 | P a g e