Background: Toxic Leadership (TL) in nursing represents a significant and pervasive challenge in healthcare systems worldwide, with profound implications for both professional well-being and organizational outcomes. Aim: This review systematically examines the prevalence, characteristics, and multifaceted 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, organizational dynamics, and nurses’ individual experiences. Results: Key findings reveal that TL significantly correlates with decreased job satisfaction, increased emotional exhaustion (EE), and higher turnover intentions, ultimately compromising patient safety (PS) and the quality of the healthcare system. TL imposes significant economic burdens, weakens patient care quality, and intensifies 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. Conclusion: These insights underscore the urgent requirement for targeted interventions at individual, organizational, and systemic levels to mitigate the adverse effects of TL.
References
[1]
Webster, V., Brough, P. and Daly, K. (2016) Fight, Flight or Freeze: Common Responses for Follower Coping with Toxic Leadership. Stress and Health, 32, 346–354. https://doi.org/10.1002/smi.2626
[2]
Ahmed, A.K., Atta, M.H.R., El-Monshed, A.H. and Mohamed, A.I. (2024) The Effect of Toxic Leadership on Workplace Deviance: The Mediating Effect of Emotional Exhaustion, and the Moderating Effect of Organizational Cynicism. BMC Nursing, 23, Article No. 669. https://doi.org/10.1186/s12912-024-02308-x
[3]
Padilla, A., Hogan, R. and Kaiser, R.B. (2007) The Toxic Triangle: Destructive Leaders, Susceptible Followers, and Conducive Environments. The Leadership Quarterly, 18, 176-194. https://doi.org/10.1016/j.leaqua.2007.03.001
[4]
Spence Laschinger, H.K., Wong, C.A. and Grau, A.L. (2012) The Influence of Authentic Leadership on Newly Graduated Nurses’ Experiences of Workplace Bullying, Burnout and Retention Outcomes: A Cross-Sectional Study. International Journal of Nursing Studies, 49, 1266-1276. https://doi.org/10.1016/j.ijnurstu.2012.05.012
[5]
Hutchinson, M. and Jackson, D. (2013) Hostile Clinician Behaviours in the Nursing Work Environment and Implications for Patient Care: A Mixed-Methods Systematic Review. BMC Nursing, 12, Article No. 25. https://doi.org/10.1186/1472-6955-12-25
[6]
Labrague, L.J. (2023) Toxic Leadership and Its Relationship with Outcomes on the Nursing Workforce and Patient Safety: A Systematic Review. Leadership in Health Services, 37, 192-214. https://doi.org/10.1108/lhs-06-2023-0047
[7]
Diaz, M. (2024) Impact of Toxic Leadership on the Mental Health of Employees in Texas State Agencies. Master’s Thesis, Walden University.
[8]
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al. (2021) Updating Guidance for Reporting Systematic Reviews: Development of the PRISMA 2020 Statement. Journal of Clinical Epidemiology, 134, 103-112. https://doi.org/10.1016/j.jclinepi.2021.02.003
[9]
Cooke, A., Smith, D. and Booth, A. (2012) The Benefits of a Systematic Search Strategy When Conducting Qualitative Evidence Synthesis; the Spider Tool. Qualitative Health Research, 22, 1435-1443. https://doi.org/10.1177/1049732312452938
[10]
Joanna Briggs Institute (2024) JBI Critical Appraisal Tools. https://jbi.global/critical-appraisal-tools
[11]
Maclean, F., Carin-Levy, G., Hunter, H., Malcolmson, L. and Locke, E. (2012) The Usefulness of the Person-Environment-Occupation Model in an Acute Physical Health Care Setting. British Journal of Occupational Therapy, 75, 555-562. https://doi.org/10.4276/030802212x13548955545530
[12]
Salvagioni, D.A.J., Melanda, F.N., Mesas, A.E., González, A.D., Gabani, F.L. and Andrade, S.M.D. (2017) Physical, Psychological and Occupational Consequences of Job Burnout: A Systematic Review of Prospective Studies. PLOS ONE, 12, e0185781. https://doi.org/10.1371/journal.pone.0185781
[13]
Rosenstein, A.H. and O’Daniel, M. (2008) A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety. The Joint Commission Journal on Quality and Patient Safety, 34, 464-471. https://doi.org/10.1016/s1553-7250(08)34058-6
[14]
Hamzah, K.D. (2023) The Effect of Toxic Leadership on Deviant Work Behavior: The Mediating Role of Employee Cynicism. Texas Journal of Multidisciplinary Studies, 18, 92-107.
[15]
Alsadaan, N. and Alqahtani, M. (2024) Toxic Leadership in Emergency Nurses: Assessing Abusive Supervision and Its Team-Level Impacts on Conflict Management and Organizational Commitment. Journal of Nursing Management, 2024, Article ID: 4271602. https://doi.org/10.1155/2024/4271602
[16]
Guo, X., Li, X., Wang, Y., Wang, Y., Jin, H., Xiao, F., et al. (2023) Status and Influencing Factors of Nurses’ Perception of Toxic Leadership Behavior: A Cross-Sectional Study. Journal of Nursing Management, 2023, Article ID: 7711237. https://doi.org/10.1155/2023/7711237
[17]
Guo, X., Xiong, L., Wang, Y., Li, X., Wang, Y., Xiao, F., et al. (2022) Chinese Nurses’ Perceptions on Toxic Leadership Behaviours of Nurse Managers: A Qualitative Study. Journal of Nursing Management, 30, 3256-3263. https://doi.org/10.1111/jonm.13758
[18]
Özkan, A., Çamlica, T. and Kartal, H. (2022) An Analysis of the Effect of Nurse Managers’ Toxic Leadership Behaviours on Nurses’ Perceptions of Professional Values: A Cross-Sectional Survey. Journal of Nursing Management, 30, 973-980. https://doi.org/10.1111/jonm.13597
[19]
Labrague, L.J., Nwafor, C.E. and Tsaras, K. (2020) Influence of Toxic and Transformational Leadership Practices on Nurses’ Job Satisfaction, Job Stress, Absenteeism and Turnover Intention: A Cross-Sectional Study. Journal of Nursing Management, 28, 1104-1113. https://doi.org/10.1111/jonm.13053
[20]
Ofei, A.M.A., Paarima, Y., Barnes, T. and Poku, C.A. (2022) Toxic Leadership Behaviour of Nurse Managers on Perceived Job Satisfaction and Productivity of Nursing Workforce in Sub-Saharan Ghana: A Multi-Centre Cross-Sectional Study. Journal of Nursing Management, 30, 2733-2742. https://doi.org/10.1111/jonm.13741
[21]
Labrague, L.J. (2020) Influence of Nurse Managers’ Toxic Leadership Behaviours on Nurse-Reported Adverse Events and Quality of Care. Journal of Nursing Management, 29, 855-863. https://doi.org/10.1111/jonm.13228
[22]
Hossny, E.K., Alotaibi, H.S., Mahmoud, A.M., Elcokany, N.M., Seweid, M.M., Aldhafeeri, N.A., et al. (2023) Influence of Nurses’ Perception of Organizational Climate and Toxic Leadership Behaviors on Intent to Stay: A Descriptive Comparative Study. International Journal of Nursing Studies Advances, 5, Article ID: 100147. https://doi.org/10.1016/j.ijnsa.2023.100147
[23]
Labrague, L.J. (2024) Linking Toxic Leadership with Work Satisfaction and Psychological Distress in Emergency Nurses: The Mediating Role of Work-Family Conflict. Journal of Emergency Nursing, 50, 670-678. https://doi.org/10.1016/j.jen.2023.11.008
[24]
Celebi Cakiroglu, O. and Tuncer Unver, G. (2023) Toxic Leadership, Mental Well-Being and Work Engagement among Nurses: A Scale Adaptation Study and Structural Equation Model Approach. Journal of Health Organization and Management, 38, 49-69. https://doi.org/10.1108/jhom-10-2022-0291
[25]
Farghaly Abdelaliem, S.M. and Abou Zeid, M.A.G. (2023) The Relationship between Toxic Leadership and Organizational Performance: The Mediating Effect of Nurses’ Silence. BMC Nursing, 22, Article No. 4. https://doi.org/10.1186/s12912-022-01167-8
[26]
Türkmen Keskin, S. and Özduyan Kiliç, M. (2023) Investigation of the Relationship between Nurses’ Perception of Toxic Leadership and Their Organizational Trust Levels and Turnover Intentions. Journal of Advanced Nursing, 80, 1859-1867. https://doi.org/10.1111/jan.15951
[27]
Nonehkaran, E.A., Mozaffari, N., Iranpour, S. and Soola, A.H. (2023) Identifying the Predictors of Turnover Intention Based on Nurse Managers’ Toxic Leadership Behaviors among Nurses in Iran: A Cross-Sectional Correlational Study. BMC Health Services Research, 23, Article No. 1201. https://doi.org/ https://doi.org/10.1186/s12913-023-10046-0
[28]
Sedikides, C. and Campbell, W.K. (2017) Narcissistic Force Meets Systemic Resistance: The Energy Clash Model. Perspectives on Psychological Science, 12, 400-421. https://doi.org/10.1177/1745691617692105
[29]
Tepper, B.J. (2000) Consequences of Abusive Supervision. Academy of Management Journal, 43, 178-190. https://doi.org/ https://doi.org/10.5465/1556375
[30]
Boomer, C.A. and McCormack, B. (2010) Creating the Conditions for Growth: A Collaborative Practice Development Programme for Clinical Nurse Leaders. Journal of Nursing Management, 18, 633-644. https://doi.org/10.1111/j.1365-2834.2010.01143.x
[31]
Robert, V. and Vandenberghe, C. (2022) Laissez-faire Leadership and Employee Well-Being: The Contribution of Perceived Supervisor Organizational Status. European Journal of Work and Organizational Psychology, 31, 940-957. https://doi.org/10.1080/1359432x.2022.2081074
[32]
O’Donovan, R., De Brún, A. and McAuliffe, E. (2021) Healthcare Professionals Experience of Psychological Safety, Voice, and Silence. Frontiers in Psychology, 12, Article 626689. https://doi.org/10.3389/fpsyg.2021.626689
[33]
Schaufeli, W.B., Leiter, M.P. and Maslach, C. (2009) Burnout: 35 Years of Research and Practice. Career Development International, 14, 204-220. https://doi.org/10.1108/13620430910966406
[34]
House, R.J., Dorfman, P.W., Javidan, M., Hanges, P.J. and de Luque, M.F.S. (2014) Strategic Leadership across Cultures: The GLOBE Study of CEO Leadership Behavior and Effectiveness in 24 Countries. SAGE Publications, Ltd. https://doi.org/10.4135/9781506374581
[35]
Woo, C.H. and Kim, C. (2020) Impact of Workplace Incivility on Compassion Competence of Korean Nurses: Moderating Effect of Psychological Capital. Journal of Nursing Management, 28, 682-689. https://doi.org/10.1111/jonm.12982
[36]
Duchscher, J.E.B. (2009) Transition Shock: The Initial Stage of Role Adaptation for Newly Graduated Registered Nurses. Journal of Advanced Nursing, 65, 1103-1113. https://doi.org/10.1111/j.1365-2648.2008.04898.x
[37]
Glover, Z.E. and McClain, W.L. (2025) Mitigating Toxic Leaders through the Experiences of Employees: A Qualitative Narrative Inquiry. Journal of Leadership, Accountability and Ethics, 22, 1-31. https://doi.org/10.33423/jlae.v22i2.7625
[38]
Al-Bashtawy, M. (2013) Workplace Violence against Nurses in Emergency Departments Injordan. International Nursing Review, 60, 550-555. https://doi.org/10.1111/inr.12059
[39]
Zaghmout, B. (2024) Unmasking Toxic Leadership: Identifying, Addressing, and Preventing Destructive Leadership Behaviours in Modern Organizations. Open Journal of Leadership, 13, 244-265. https://doi.org/10.4236/ojl.2024.133015
[40]
Goldman, A. (2009) Destructive Leaders and Dysfunctional Organizations: A Therapeutic Approach. Cambridge University Press. https://doi.org/10.1017/cbo9780511805097
[41]
Chandranathan, P. (2024) Entrepreneurial Leadership and Transformational Leadership: A Historical-Comparative Conceptual Analysis. Journal of Management History. https://doi.org/10.1108/jmh-10-2023-0109
[42]
Arifin, Y. (2024) The Role of Leadership in Mitigating Toxic Workplace Culture: A Critical Examination of Effective Interventions. The Journal of Academic Science, 1, 389-397. https://doi.org/10.59613/3zy62r39