Toxic Leadership in Nursing: A Systematic Review of Its Professional and Organizational Challenges

Abstract

Background: Toxic Leadership (TL) in nursing represents a significant and pervasive challenge in healthcare systems worldwide, with profound implica-tions for both professional well-being and organizational outcomes. Aim: This review systematically examines the prevalence, characteristics, and multifac-eted impacts of TL behaviors in nursing across diverse healthcare contexts. Method: Drawing on 15 empirical studies conducted between 2020 and 2024, involving 7910 nurses, the review employs the PEO (Population, Exposure, Outcome) framework to explore the complex interplay between TL, organiza-tional dynamics, and nurses’ individual experiences. Results: Key findings re-veal that TL significantly correlates with decreased job satisfaction, increased emotional exhaustion (EE), and higher turnover intentions, ultimately com-promising patient safety (PS) and the quality of the healthcare system. TL imposes significant economic burdens, weakens patient care quality, and in-tensifies workforce instability and organizational inefficiency. The review also highlights the mediating roles of EE and organizational cynicism, as well as the buffering effects of professional resilience and advanced education. Con-clusion: These insights underscore the urgent requirement for targeted inter-ventions at individual, organizational, and systemic levels to mitigate the ad-verse effects of TL.