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Systematic Review

Fostering Organizational and Professional Commitment Through Transformational Leadership in Nursing: A Systematic Review

by
Eleni Tsapnidou
1,*,
Georgios Katharakis
1,
Martha Kelesi-Stavropoulou
1,
Michael Rovithis
2,
Sofia Koukouli
3,
Evangelia Sigala
1,
Maria Moudatsou
3,
Dimitrios Papageorgiou
1 and
Areti Stavropoulou
1,4
1
Department of Nursing, School of Health, Faculty of Health and Care Sciences, University of West Attica, 12243 Egaleo, Greece
2
Department of Business Administration and Tourism, School of Management and Economics Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
3
Department of Social Work, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
4
Faculty of Health, Science, Social Care and Education, Kingston University, London KT1 2EE, UK
*
Author to whom correspondence should be addressed.
Hospitals 2025, 2(2), 10; https://doi.org/10.3390/hospitals2020010
Submission received: 18 March 2025 / Revised: 28 April 2025 / Accepted: 5 May 2025 / Published: 8 May 2025
Browse Figure
Versions Notes

Abstract

:
Effective nurse leadership increases nurses’ job satisfaction, performance, motivation, and empowerment. Ensuring nurses’ organizational and professional commitment is vital for addressing quality, sustainability, and cost-effectiveness challenges in a high-demanding healthcare environment. The aim of this study was to explore the impact of transformational leadership on nurses’ organizational and professional commitment. A systematic review was conducted using the Scopus, ScienceDirect, PubMed/Medline, Scilit.net, and Wiley Online Library databases. Original research studies published between 2016 and 2024 focusing exclusively on nurses’ professional and organizational commitment and transformational leadership were included. The indexing terms “nursing leadership”, “transformational leadership”, “professional/organizational commitment”, and “nursing” were used along with the Boolean operators AND, OR, and NOT. According to the findings, transformational leadership practices increase nurses’ organizational and professional commitment through vision sharing, motivation, career development, interpersonal communication, a positive working environment, and productive resources management. The healthcare policy makers should invest in organizing, supporting, and promoting relational leadership practices to retain their nursing workforce and obtain their organizational and professional commitment to ensure high care quality.

1. Introduction

Leadership is one of the most significant attributes that affect working conditions and consequently nurses’ and patients’ outcomes [1]. Nurse leaders play a pivotal role in empowering and motivating nurses, the shortage of whom has become a matter of global concern [2,3]. The aging workforce and the number of nurses intending to leave the profession or their organization have become critical issues to be addressed by healthcare policy makers and key stakeholders [4]. The COVID-19 crisis highlighted the importance of the nursing role in the healthcare system, but it also revealed a decline in nurses’ professional commitment as the pandemic altered their working conditions irreversibly [5,6]. Within this context, nurse managers appear to be key players who can provide a positive working environment through their leadership practices and influence thus the nurses’, patients’, and organizations’ outcomes [7]. Through effective and human capital-oriented leadership, nurse managers can ensure nurses’ job satisfaction and professional commitment and enhance staff retention, productivity, quality of care, and patient outcomes [8,9]. There are several different leadership practices which nurse managers can apply to achieve the above-mentioned goals. Transactional leadership focuses on reward and recognition, adopting a cognitive approach and offering only short-term commitment [10,11], whereas resonant leadership may also provide limited commitment through coaching using emotional intelligence [12]. The servant leadership style along with the authentic both require sincerity and provision and may build trust between nurses’ and their managers [13,14].
According to Bass [15], transformational leadership “occurs when leaders broaden and elevate the interests of their employees, when they generate awareness and acceptance of the purposes and mission of the group, and when they stir their employees to look beyond their own self-interest for the good of the group” (p. 21). It is among the most prevalent and effective leadership style in healthcare and has been positively correlated with high levels of job satisfaction, low turnover, and burnout levels. It is also related to evidence-based practice and has improved patient satisfaction with the perceived care [16,17,18,19,20,21]. Charismatic leaders are the ones that use their communication and influencing skills to motivate their staff to exceed their expectations and to achieve the organizational goals [16,22]. In contrast to the transactional leadership style, where the leader adopts a cognitive approach to ensure loyalty, transformational leadership invests in long-term relationships and, therefore, supports professional and organizational commitment [10,11,23].
Organizational commitment is defined by Meyer and Allen [24] as “a psychological state that (a) characterizes the employee’s relationship with the organization, and (b) has implications for the decision to continue or discontinue membership in the organization” (p. 67). Organizational commitment consists of the following three components: the affective component, which refers to the employees’ emotional attachment to organization; the continuance component, which refers to the costs of the employee leaving the organization; and the normative component, which refers to the employees’ feeling of obligation to remain in the organization [25]. The literature also reveals that, specifically for the nursing staff, organizational commitment is influenced by turnover intentions, motivation, job satisfaction, family encouragement, a conscious choice of the nursing profession, a supportive work environment, and nurses’ educational level [26,27]. Ensuring high levels of organizational commitment is vital for staff retainment, a reduction in absenteeism, improved job performance, and organizational goal achievement [28,29,30].
Professional commitment, also referred to as occupational commitment, is defined by Morrow and Wirth [31] as “a person’s belief in and acceptance of the values of his or her chosen occupation or line of work, and willingness to maintain membership in that occupation” (p. 40). Professional commitment within the healthcare sector may eventually lead to organizational success as it contributes to addressing the challenges of effective source allocation, productivity, performance, quality, and effectiveness [32]. Professional and organizational commitment are interrelated as the former refers to the willingness to stay in the profession and the latter to the intent to stay within the organization.
Studying nursing leadership and its impact on nurses’ organizational and professional commitment may provide insightful evidence to healthcare organizations, administrators, stakeholders, nurse leaders, and educators. Considering the current situation of the healthcare system worldwide, it is important to apply management practices that enhance nurses ‘organizational and professional commitment.
The evolving healthcare landscape presents increasing demands on healthcare systems, emphasizing the need for skilled professionals, efficient change-oriented leaders, and high-quality patient care. However, the ongoing technological advancements, financial recession, cultural diversities, and shortage of nurses pose significant challenges, making well-qualified staff retention a critical priority for healthcare organizations. To address these concerns, reduce dropouts, and ensure a stable and engaged workforce, it is important to study how transformational leadership can encourage nurses’ organizational and professional commitment. This study contributes to the existing body of knowledge by offering a comprehensive examination of how transformational leadership behaviors influence not only nurses’ allegiance to their employing organization (organizational commitment) but also their long-term dedication to the nursing profession itself (professional commitment). Unlike previous research that often addresses these forms of commitment in isolation, this study integrates both aspects, organizational and professional, providing a more holistic understanding of the motivational dynamics at play.

2. Aim and Research Questions

The aim of this study was to explore the impact of transformational nursing leadership on nurses’ organizational and professional commitment. More specifically, this study seeks to answer the following research question following the PIO framework (population, intervention, outcome) where the population is nurses, the intervention is transformational leadership, and the outcome is an enhancement of their organizational and professional commitment.
RQ1: What are the key factors that influence nurses’ organizational and professional commitment levels?
RQ2: How does the application of transformational leadership practices increase nurses’ organizational and professional commitment?

3. Materials and Methods

3.1. Design

The systematic review methodology adheres to a methodical process for identifying and analyzing relevant literature pertinent to a defined subject, employing predetermined criteria to comprehensively investigate, synthesize, and convey the results with the aim of addressing the research inquiries. Consequently, this research employed a systematic methodological framework for its examination that was conducted in November 2024 using the Scopus, ScienceDirect PubMed/Medline, Scilit.net, and Wiley Online Library databases. The indexing terms “nursing leadership”, “transformational leadership”, “professional/organizational commitment”, and “nursing” were used along with the Boolean operators AND, OR, and NOT, as shown in Table 1, in order to fulfill the research objectives.

3.2. Identifying Relevant Studies and Study Selection

The study selection process was reported using the prescribed guidelines from the preferred reporting items for systematic review and meta-analysis (PRISMA) flowchart [33]. This systematic review was registered on the Open Science Framework platform of systematic reviews on 20 March 2025 (DOI 10.17605/OSF.IO/9GPJ4).
The systematic review employed a rigorous study selection process, as illustrated by the PRISMA flowchart, to identify relevant literature on nursing leadership and organizational commitment. The search strategy involved a broad approach across multiple databases, including Wiley Online Library, Scopus, ScienceDirect, PubMed/Medline, and Scilit.net, yielding a substantial initial pool of 3272 records. After removing 3150 ineligible records due to duplication, automation tools, and other reasons, 322 records underwent title and abstract screening, with 105 being excluded. Full-text retrieval was sought for 217 reports, but 132 were not retrieved, leaving 85 reports for eligibility assessment. Ultimately, 68 reports were excluded for irrelevance to the research questions, resulting in a final inclusion of 17 studies. This selection process was guided by specific inclusion criteria, encompassing original research with qualitative, quantitative, or mixed methodologies focused exclusively on professional/organizational commitment and nursing/transformational leadership and published in English between 2016 and 2024. This rigorous approach, while ensuring the inclusion of pertinent studies, also reveals limitations such as the exclusion of non-English articles and the challenge of non-retrieved reports, which should be considered when interpreting the review’s findings.
The included research articles described ways that transformational leadership strategies have been shown to yield a beneficial influence on the organizational commitment of nurses. This influence is achieved through a variety of mechanisms, including sharing a compelling vision, motivating employees, facilitating career development, fostering effective interpersonal communication, cultivating a positive work environment, and efficiently managing resources. The diagram depicted in Figure 1 outlines the PRISMA format.

3.3. Data Extraction

The comprehensive exploration of the databases led to the identification of a considerable number of unique records. A substantial portion of the initial articles retrieved underwent processing with the aid of reference management software, specifically EndNote v. 20 [34]. In a meticulous manner, each article was individually scrutinized to detect and subsequently remove any duplicate entries. Upon discovering duplicate articles, an integration of records within EndNote was performed with the intention of amalgamating data to avoid redundancy. After a thorough screening process of titles and abstracts, a specific number of articles were deemed unqualified for further analysis. Subsequently, a meticulous examination of the entirety of the remaining studies was conducted. As a consequence, 17 articles were chosen that satisfied the predetermined criteria for inclusion.

3.4. Data Synthesis

The data synthesis phase of this systematic review was characterized by a meticulous and systematic process designed to compile and organize pertinent information extracted from the final selection of 17 studies. This process began after the rigorous study selection process, ensuring that only relevant and eligible studies contributed to the synthesis. To effectively manage and analyze the data, pertinent information derived from these chosen studies was then compiled into Microsoft Excel spreadsheets version 2021, a tool selected for its capacity to handle and structure diverse data types. The data extraction process was comprehensive, encompassing various attributes of each study to facilitate a thorough comparative analysis. These attributes included key bibliographic details such as the author(s) and publication year, which are essential for tracking the provenance of the research and identifying potential trends over time. Furthermore, information regarding the state in which each study was carried out was recorded, allowing for an exploration of contextual factors that might influence the findings. The research aims of each study were also extracted, providing a clear understanding of the specific objectives and hypotheses that guided the original investigations. To understand the scope and scale of the included research, the sample size of each study was documented. Critical methodological details, such as the study design employed (e.g., qualitative, quantitative, mixed-methods), were also captured to assess the methodological rigor and potential limitations of each study. Finally, the outcomes of each study, representing the key findings and results, were extracted to synthesize the evidence related to the research questions of the review. For transparency and to provide readers with a clear record of the studies included in the synthesis, the list of the 17 selected articles is provided in Table A1, located in Appendix A.

3.5. Quality Assessment

The methodological rigor of the studies incorporated in this analysis was meticulously evaluated utilizing the Joanna Briggs Institute (JBI) critical appraisal checklist for systematic reviews [35]. The selection of this tool was based on its appropriateness for scrutinizing the structure of the studies encompassed in the review. Two independent reviewers conducted a comprehensive assessment of each study to mitigate bias, with any disparities being resolved through deliberation and agreement. By adhering to the JBI checklist a structured evaluation of crucial components of each study’s methodological approach, such as the clarity of inclusion criteria, the depiction of study participants and environment, and the assessment of the accuracy and consistency of exposure and outcome measurements, as well as the identification and mitigation of confounding factors and the appropriateness of statistical techniques, was facilitated. The outcomes of this quality appraisal were subsequently taken into consideration during the synthesis of findings, enabling an assessment of the collective robustness of the outcomes and guiding the deductions drawn from the review.

4. Results

4.1. Overview of the Selected Studies

Table 2 presents an overview of the research characteristics for the 17 selected studies included in the systematic review. The studies had a global reach, with representation from most of the continents, notably with a concentration in Asia (64.7%) and Europe (23.5%) which the highest percentages, followed by the USA (5.9%) and Africa (5.9%). In terms of publication years, five of the studies (29.4%) were published between 2024 and 2018, five of the studies (29.4%) were published between 2019 and 2021, and the rest of them (41.2%) between 2021 and 2024. Methodologically, most of the studies used cross-sectional methods (12 out of 17), 2 of the studies employed descriptive or longitudinal approaches, and the rest of them utilized a mixed-method methodology.
As a result of the comprehensive research examined in the present systematic review, a significant array of perceived impacts, effects, and consequences has been delineated. To streamline the narrative synthesis, the findings were categorized into two main classifications according to whether the reported impact was related to (1) factors related to nurses’ organizational and professional commitment (5 studies) or (2) transformational leadership and organizational and professional commitment (12 studies).

4.2. Thematic Categories

4.2.1. Factors Related to Nurses’ Organizational and Professional Commitment

According to the findings of this study, nurses’ organizational and professional commitment are related to multiple factors. Duran et al. [36] carried out a study in three state hospitals in Turkey to investigate the factors affecting nurses’ professional commitment. A total of 389 nurses participated in this study and revealed that the intention to leave the profession, support from family, educational level, the supporting leadership style, and their job satisfaction levels were significantly related to nurses’ professional commitment.
Mon et al. [37] conducted a study in four general hospitals in the Republic of the Union of Myanmar, exploring nurses’ organizational commitment and relating the years of experience, level of education, position, perceived organizational support, and work–life balance with each one of the components of organizational commitment (affective, continuance, and normative commitment). With a sample of 234 nurses, this study underscored that the years of experience, position, perceived organizational support, and work–life balance were positively correlated with all three components of nurses’ organizational commitment. More specifically, years of experience, perceived organizational support, and work–life balance predicted all three components of nurses’ commitment, whereas nurses’ position was a predictor only for affective and normative commitment. On the other hand, the level of nurses’ education was the only predictor of the continuance commitment, stating that the provision of career development opportunities may also affect nurses’ organizational commitment to some extent.
Another study was conducted with 226 nurses from six public hospitals in Saudi Arabia to determine the relationship between managerial competence and organizational commitment. The study revealed a significant positive association between the two variables. Although the managerial competence and the organizational commitment were both found to be at a moderate level, this study highlighted the need for training in order to acquire managerial competence, establish good interpersonal relationships, provide organizational support, and promote teamwork as they have a significant positive relationship with organizational commitment among nurses [38].
Ming et al. [39] studied the relationship between nurses’ job satisfaction and their professional commitment. In the study, 150 registered nurses from selected private hospitals in Perak, Malaysia participated, and the findings showed moderate job satisfaction levels and a significant connection between job commitment and job satisfaction. The research suggested career advancement opportunities, promotion, and innovation as means to increase nurses’ job satisfaction and subsequently their professional commitment levels.
Su et al. [40] investigated Chinese nurses’ organizational commitment and analyzed the factors influencing it. In the research, 362 nurses from two hospitals participated and revealed high organizational commitment levels despite the COVID-19 pandemic and its impact on nurses’ physical and mental health. The work values and the professional practice environment were found to be significant predictors of organizational commitment. A sense of social responsibility, appreciation, and recognition along with work stability increased their loyalty to the organization. Participation in hospital affairs, supportive leadership, managerial competence, adequate human and material resources, and teamwork were also factors predicting nurses’ organizational commitment.

4.2.2. Transformational Leadership and Organizational and Professional Commitment

The review of the literature revealed a relationship between the transformational leadership style and nurses’ organizational and professional commitment. Nunes et al. [41] conducted their study in Lisbon, Portugal, with 408 nurses to investigate the influence of the quality of the relationship between them and their nurse leader and the level of their organizational commitment. The results of this study depicted a satisfactory relationship between nurses and their leader but low organizational commitment levels. The nurses appeared to have an ambiguous perspective towards their organizations. They were found to have a strong sense of affection, loyalty, and belonging and to simultaneously have feelings of unappreciation, dissatisfaction, and a lack of opportunities for personal growth. This study also revealed a positive correlation between the quality of leadership and nurses’ organizational commitment, suggesting that the establishment of the relationship between nurses and their leaders defines nurses’ organizational commitment levels. It also highlighted that certain relational leadership traits are vital, such as building trust relations, promoting teamwork, investing in training, providing career opportunities, and motivating the nurses to go above and beyond what is required, which can lead to them identifying with the organization and therefore increasing their organizational commitment.
Orgambidez and Almeida [42] in their research assessed the relationship between affective organizational commitment and work engagement and the support from the leader and coworkers. Three public hospitals participated in the research, with a total of 215 nursing professionals, and it was revealed that work engagement and supportive leadership were positively correlated with affective organizational commitment. Support from colleagues appeared also to be a predictor of organizational commitment, but not a significant one. This study suggests that nurse managers should be trained in relational leadership, which provides support, guidance, advice, and resources and encourages autonomy and decision making in order to increase the affective organizational commitment levels.
Graf et al. [43], in a sub-study of the Swiss Nursing Homes Human Resources Project (SHURP) in 2016, explored the relationships between the affective aspect of nurses’ organizational commitment levels and organizational, situational and healthcare personnel characteristics and outcomes. In this study, 5323 care personnel from 163 different nursing homes participated, revealing that leadership practices, job satisfaction, quality of care, and collaboration with the leader were positively correlated with nurses’ organizational commitment. Another significant result of this study was that it showed that outcomes significantly related to higher organizational commitment were low turnover rates, reduced health issues, and absenteeism. It highlights that leadership is the most important antecedent of affective organizational commitment and underlines the need for innovative leadership practices which aim at increasing job satisfaction, career development, training, group support, and participation in decision making.
Labrague et al. [44] contrasted the impact of toxic and transformational leadership practices on nurses’ organizational and professional commitment in a study which involved 770 registered nurses from 15 hospitals in central Philippines. The findings of this research underscored that toxic leaders may cause distress, absenteeism, and higher turnover rates and consequently low organizational and professional commitment. On the contrary, nurses who perceived their leaders as transformational demonstrated higher job satisfaction levels and lower turnover rates. This study also suggests that nurses’ retainment strategies should include relational leadership traits such as applying evidence-based-practice and providing training and career growth opportunities to enhance nurses’ organizational and professional commitment.
Another study in Saudi Arabia, where 219 nurses from two hospitals took part, investigated how transformational leadership and nurses’ organizational commitment are related. This research concluded that visionary leadership, especially inspirational motivation, had the greatest influence on nurses’ organizational commitment in comparison to the transactional and laissez-faire leadership style. Regarding commitment factors such as staff retention, a healthy working environment, and educational and career development opportunities, transformational leadership was the strongest contributor [45].
Geremias et al. [46] carried out a study in which 342 healthcare professionals were involved from different public and private hospitals located in three large cities in Angola. This research analyzed the relationship between psychological capital in its four dimensions (self-efficacy, hope, resilience, and optimism) and organizational commitments and its three components (normative, affective, and continuance), with the mediating role of transformational leadership. According to the findings of this research, psychological capital was positively correlated with normative and affective commitment but had a negative effect on continuance commitment. Perceived transformational leadership was positively related with psychological capital and affective commitment but negatively with continuance and normative commitment. This research advocates that this negative correlation is due to the fact that normative and continuance aspects of organizational commitment are linked to moral duty and the high costs of leaving and is therefore unrelated to the leader’s vision. The results of this research pointed out that the mediating role of the perceived transformational leadership is indirect but crucial in the relationship between psychological capital and affective commitment. To enhance nurses’ affective organizational commitment it is also suggested that leaders should provide inspirational motivation, intellectual stimulation, and share the vision.
A relevant study demonstrates that the establishment of supportive leadership practices from both leaders and colleagues ensures a well-rooted nursing workforce [47]. This longitudinal study was conducted over 12 months including 387 French-Canadian nurses and studied the effects of transformational leadership on professional commitment and the mediating role of autonomous motivation. The results demonstrate that supportive leadership and positive behaviors from colleagues are predictors of nurses’ autonomous motivation, which contributes to staff retainment. Coaching, mentoring, and investing in shared governance within the team were also found to promote a more supportive work environment and thus decrease nurses’ intentions to leave the profession. This study also suggests that healthcare organizations should apply change-oriented leadership to promote autonomous motivation to ensure sustainability and staff retainment.
Regarding the relationship between nurses’ organizational commitment and leadership in acute care setting, research was carried out in Taiwan in 2022 with a sample of 1205 nurses from the Taiwan Association of Nurse Practitioners. The results demonstrated that job satisfaction, organizational commitment, and leadership style were at a moderate level. Additionally, job satisfaction among the nurses was positively correlated with organizational commitment, idealized influence, and individual consideration styles and negatively correlated with high patient load. Overall, transformational leadership aspects were considered a major development factor for nurse practitioners’ organizational commitment due to them increasing their job satisfaction levels [48].
Iqbal et al. [49] conducted research in 2019, in Sargohda District, Pakistan, with a total sample of 299 nurses from both the public and the private sector. This study inspected the relationship between transformational leadership and nurses’ organizational commitment through the mediating effect of psychological empowerment. According to the findings of this study, visionary leaders can enhance organizational commitment through inspiration, innovation, and individual consideration. The research evidence advocates that psychologically empowered nurses, with more autonomy, resources, and a sense of appreciation and influence over their working environment, are more involved and attached to their organization. The study also suggests that nurses’ well-being should be regarded as a prerequisite to their organizational commitment.
Other research suggests that transformational leadership practices can increase nurses’ organizational commitment as they promote job satisfaction and a trusting relationship with nurse managers [50]. This study took place in a university hospital in Turkey and investigated the views and opinions of 153 nurses (17 nurse managers and 136 staff nurses) regarding their managers’ transformational leadership style and its effects on their organizational commitment and job satisfaction rates. According to the findings of the research, the managers’ transformational leadership self-assessment was more positive than the views of staff nurses about their leaders. The nurse managers also reported that the innovative leadership practices have a significant effect on the organizational commitment and job satisfaction level of the staff nurses. The staff nurses reported that they were more likely to follow and comply with a charismatic leader, highlighting the importance of transformational leadership for positive employee and patient outcomes. The results of this research suggest that transformational leadership practices enhance both job satisfaction and organizational commitment.
On the other hand, some evidence indicates that visionary leadership has a marginal effect on nurses’ commitment [51]. In a study that took place in Riyadh City, Saudi Arabia, with a sample of 332 nurses working in acute healthcare settings, most of them appeared to be moderately committed to their organization and mostly influenced by the normative and less by continuance and affective components of the organizational commitment. Other findings of this study argue that nurses perceived themselves to have moderate levels of psychological empowerment, an increased sense of meaningfulness, moderate self-worth and autonomy, and feelings of insignificance in their working environment. According to this research, the leaders who were perceived as transactional were more likely to earn nurses’ trust through their cognitive leadership behavior of organizational punishments and rewards. Those leaders were also found to delegate authority and responsibility to their subordinates and nurses appeared more empowered. In this study, transformational leadership had a moderate positive association with organizational commitment but was related to both continuance and normative aspects of it.
The level of the organizational commitment and related factors were also investigated in the primary healthcare sector in research that took place in Addis Ababa, Ethiopia, with a sample of 459 healthcare professionals from 12 different health centers. According to the findings of this study, significant predictors of organizational commitment were age, high job satisfaction levels, and perceived transformational leadership. The overall organizational commitment of the primary healthcare professionals in Addis Ababa was found to be low and it was recommended to administrations and health policy makers to adopt transformational leadership practices, maximize job satisfaction rates, and also attend to those under the age of 30 years old [52].

5. Discussion

This systematic review collected and analyzed data from 17 primary research studies worldwide concerning the impact of transformational leadership practices on nurses’ organizational and professional commitment. The included studies principally reported that transformational leadership ensures and promotes nurses’ organizational and professional commitment or paves the way towards it. Research data also revealed nurses’ needs and requirements to stay devoted and remain in an organization or in the profession [16,18,42,47,48,49,50,51,52,53,54,55,56]. Results of the present study demonstrate that nurses’ organizational and professional commitment levels depend on many factors such as leadership style, trust, organizational support, and job satisfaction [36,39,41,42,43]. These findings are in alignment with other studies which underlined the positive correlation between nurses’ organizational and professional commitment and their managers’ leadership style [53,54]. Other studies also revealed a positive correlation between trust in the leader [55,56] and nurses’ commitment levels. Further studies also showed the positive correlation between a supportive and empowering working environment [57] and organizational and professional commitment. Several other studies also focused on the effectiveness of the high job satisfaction rates [58,59], which reduce the intent to leave the profession and increase nurses’ professional commitment [32,60,61,62].
The transformational leadership style was found to positively correlate with nurses’ organizational commitment [49,50,51,52]. This was also reported in many other studies where visionary leadership practices were proved to be the most efficient strategy concerning the achievement of long-term goals related to nurses’ organizational and professional commitment [16,63]. However, the findings of a study which revealed a marginal correlation between transformational leadership practices and nurses’ organizational commitment [51] are not adequately supported in the relevant literature. Transformational leaders were found to provide better working conditions [18] by effectively managing the workload [1] and motivating the nurses to stay in the profession. They were also found to establish effective communication [59,64], facilitate a supportive environment, and thus increase organizational and professional commitment. On the other hand, negative leadership practices were found to cause excessive stress and anxiety [44] which may lead to physical and mental exhaustion, reduced organizational commitment and productivity [65], and increased turnover rates [66]. In addition to transformational leadership practices, it appears that certain personal characteristics of employees are essential for professional and organizational engagement. This study revealed a positive relationship between career development, personal growth, and organizational commitment. This is also supported by relevant literature which highlights that self-efficacy, personal growth, loyalty, and positive behaviors from the nursing workforce are prerequisites for professional and organizational commitment [56,67,68].

Limitations and Strengths

This systematic review provides further evidence about the interplay between transformational leadership and organizational and professional commitment in nursing. Its main strength is the analysis of the evidence reported by several countries worldwide, offering a broad perspective in the field under investigation. However, despite the extensive search and selection strategy, all relevant studies may not have been included due to the exclusion of studies written in a language other than English. A notable limitation of the present study is the geographical distribution of the included studies as the research evidence is predominantly drawn from Asia and Europe, while other regions such as the United States and Africa are not sufficiently represented. Another limitation of this study concerns with cultural aspects in the field of leadership, for example, the cultural differences that dictate various leadership styles and how these differences may impact various leadership approaches.

6. Conclusions

The results of the present study revealed a positive interaction between nurse managers’ transformational leadership practices and nurses’ organizational and professional commitment. For addressing the lack of nursing workforce in the continuously changing, complex, and multifaceted healthcare system it is suggested that healthcare administrations should invest in organizing, supporting, and promoting relational leadership practices. In this way they may ensure committed and sustainable nursing staff, high care quality, patient safety, reduce the turnover rates, and the relative costs that follow. Ultimately, the adoption of transformational leadership principles in nursing can lead to a more adaptive, engaged, and high-performing healthcare workforce, resulting in improved patient outcomes and a sustainable healthcare system. Future research should concentrate on studies from a broader range of regions, obtaining a more representative sample. This approach would provide in-depth insights into the field under investigation and may assist in identifying potential cultural variations that impact on leadership styles and nurses’ commitment. Additional research evidence is necessary, especially concerning the promotion and introduction of changes in order to ensure nurses’ retention and organizational and professional commitment.

Author Contributions

E.T., A.S., G.K. and M.R.: conceptualization, methodology, software, data curation, validation, and writing—original draft preparation. A.S., M.K.-S., D.P. and E.S.: writing—reviewing and editing and project administration. E.T., G.K., S.K. and M.M.: writing—reviewing and editing and supervision. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Informed Consent Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A

Table A1. Research studies by Author(s), Title, Year, Country, Aim, Sample size, Study design and Finding(s).
Table A1. Research studies by Author(s), Title, Year, Country, Aim, Sample size, Study design and Finding(s).
A/AAuthorTitleYearCountry aAim-VariablesSample Size (Nurses)Study Design bOutcomes
1.[49]The Impact of Transformational Leadership on Nurses’ Organizational Commitment: A Multiple Mediation Model2019PakistanThe effect of transformational leadership on professional commitment299DescriptiveTransformational leadership practices enhance higher professional commitment through increased psychological empowerment.
2.[36]Factors affecting nurses’ professional commitment during the COVID-19 pandemic: A cross-sectional study2021TurkeyFactors affecting nurses’ professional commitment389Cross-sectionalThe factors affecting nurses’ professional commitment were intention to leave the job, choice of profession, family support, supporting leadership style, job satisfaction, and educational status.
3.[37]Factors predicting organizational commitment of nurses in general hospitals: A descriptive-predictive study2022MyanmarFactors predicting nurses’ professional commitment234Descriptive–predictive, cross-sectionalWorking experience, level of education, position, perceived organizational support, and work–life balance were strong predictors of professional commitment levels.
4.[38]A multisite survey of managerial competence and organizational commitment among nurses working at public hospitals in Saudi Arabia2021Saudi ArabiaManagerial competence and professional commitment in the clinical practice226Cross-sectionalManagerial competence, interpersonal relationships, organizational support, teamwork, and training are important to enhance organizational commitment among nurses.
5.[40]Predictors of organizational commitment among Chinese nurses during the COVID-19 pandemic2022ChinaPredictors of nurses’ organizational commitment330Cross-sectionalEffective nursing leadership, stable income, social recognition, sense of responsibility, staffing, adequate resources, and teamwork influence organizational commitment.
6.[39]Job satisfaction and commitment among Registered Nurses employed in selected private hospitals in Malaysia2023MalaysiaThe relationship between nurses’ job satisfaction and their professional commitment150Cross-sectionalJob satisfaction is positively related to the nurses’ professional commitment. Career advancement opportunities, promotion, and innovation are suggested as means to increase nurses’ job satisfaction and subsequently their professional commitment levels.
7.[44]Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross-sectional study2020PhilippinesThe influence of leadership practices and toxic leadership on the nurses’ job satisfaction and commitment770Cross-sectionalTransformational leadership practices increase nurses’ job satisfaction and organizational commitment factors, whereas toxic practices cause distress and turnover.
8.[46]Improving Organizational Commitment among Healthcare Employees in Angola: The Role of Psychological Capital and Perceived Transformational Leadership2024AngolaThe relationship between psychological capital and organizational commitment through the mediating role of the perceived transformational leadership342Descriptive/cross-sectionalThe mediating role of the perceived transformational leadership is indirect but crucial in the relationship between psychological capital and affective commitment. To enhance nurses’ affective organizational commitment, leaders should provide inspirational motivation, intellectual stimulation, and share their vision.
9.[50]Transformational leadership practices of nurse managers: the effects on the organizational commitment and job satisfaction of staff nurses2022TurkeyNurse leaders’ transformational leadership practices and organizational commitment of the nurses17 nurse managers
136 staff nurses		Cross-sectional, descriptiveOrganizational commitment of nurses increases with the increase in the use of transformational leadership practices.
10.[51]The association of leadership styles and empowerment with nurses’ organizational commitment in an acute health care setting: a cross-sectional study2016Saudi ArabiaLeadership style and their impact on organizational commitment among nurses working in an acute healthcare setting332Cross-sectionalTransformational leadership has a marginal effect on nurses’ organizational commitment. Transactional leadership earns nurses’ trust and makes them feel empowered.
11.[52]Organizational commitment of health professionals and associated factors in primary healthcare facilities of Addis Ababa, Ethiopia: A multi-center cross-sectional study2022EthiopiaFactors affecting organizational commitment among health professionals working at primary health facilities in Addis Ababa, Ethiopia.459Cross-sectionalTransformational leadership behavior, age, and job satisfaction are significant predictors of organizational commitment in the primary healthcare sector.
12.[43]Affective Organizational Commitment in Swiss Nursing Homes: A Cross-Sectional Study2016SwitzerlandThe relationship between affective organizational commitment levels and organizational, situational and care personnel characteristics5323Cross-sectionalSupportive leadership and job satisfaction are positively related to organizational commitment.
13.[45]Leadership style and organizational commitment among nursing staff in Saudi Arabia2018Saudi ArabiaLeadership styles’ contribution to nurses’ organizational commitment219
Nurses and nurse managers		 Transformation leadership practices (inspirational motivation) are more likely to ensure organizational commitment than transactional and passive-avoidant leadership styles.
14.[47]Predicting nurses’ occupational commitment and turnover intention: The role of autonomous motivation and supervisor and coworker behaviors2021CanadaTransformational leadership and autonomy supportive behaviors and occupational commitment387LongitudinalEstablishment of transformational (supportive) leadership practices by leaders and co-workers provides a well-rooted workforce in the profession.
15.[48]The impact of organizational commitment and leadership style on job satisfaction of nurse practitioners in acute care practices2022TaiwanNurses’ job satisfaction, organizational commitment and leadership style1205Cross-sectionalTransformational leadership practices (idealized influence and individual consideration) increase nurses’ organizational commitment through incresed job satisfaction.
16.[42]Predictors of Organizational Commitment in Nursing: Results from Portugal2018PortugalPredictors of organizational commitment in nurses215Cross-sectionalSupportive leadership increases work engagement which increases organizational commitment.
17.[41]Quality of the leader-member relationship and the organizational commitment of nurses2017Portugalleadership relationships and the organizational commitment of nurses408Cross-sectionalThe level of organizational commitment depends on the quality of the relationship between the nurse leader and the nurse.
a Country: study country or first author country. b Study design: descriptive analysis; longitudinal analysis; cross-sectional analysis; mixed-methods.

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Hospitals 02 00010 g001
Figure 1. Flowchart illustrating the process of search and selection of studies (PRISMA).
Figure 1. Flowchart illustrating the process of search and selection of studies (PRISMA).
Hospitals 02 00010 g001
Table 1. Index using Boolean operators and specific terms.
Table 1. Index using Boolean operators and specific terms.
TermBoolean
Operator		TermBoolean
Operator		Term
Professional CommitmentANDNursing
Professional CommitmentANDNursingANDLeadership
Professional CommitmentANDTransformational LeadershipANDNursing
Nursing LeadershipANDTransformational LeadershipANDOrganizational Commitment
Nursing LeadershipANDTransformational LeadershipANDProfessional Commitment
Transformational LeadershipANDProfessional CommitmentOROrganizational Commitment
Nursing LeadershipORProfessional CommitmentNOTOrganizational Commitment
Transformational LeadershipOROrganizational CommitmentNOTProfessional Commitment
Table 2. Analysis of the attributes of the studies.
Table 2. Analysis of the attributes of the studies.
CharacteristicsStudies n (%)
Era of studies
Europe4 (23.5)
Asia11 (64.7)
USA1 (5.9)
Africa1 (5.9)
Year of publication
2016–20185 (29.4)
2019–20215 (29.4)
2022–20247 (41.2)
Type of studies
Descriptive study1 (5.9)
Longitudinal study1 (5.9)
Cross-sectional study12 (70.6)
Mixed-methods3 (17.6)
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Tsapnidou, E.; Katharakis, G.; Kelesi-Stavropoulou, M.; Rovithis, M.; Koukouli, S.; Sigala, E.; Moudatsou, M.; Papageorgiou, D.; Stavropoulou, A. Fostering Organizational and Professional Commitment Through Transformational Leadership in Nursing: A Systematic Review. Hospitals 2025, 2, 10. https://doi.org/10.3390/hospitals2020010

AMA Style

Tsapnidou E, Katharakis G, Kelesi-Stavropoulou M, Rovithis M, Koukouli S, Sigala E, Moudatsou M, Papageorgiou D, Stavropoulou A. Fostering Organizational and Professional Commitment Through Transformational Leadership in Nursing: A Systematic Review. Hospitals. 2025; 2(2):10. https://doi.org/10.3390/hospitals2020010

Chicago/Turabian Style

Tsapnidou, Eleni, Georgios Katharakis, Martha Kelesi-Stavropoulou, Michael Rovithis, Sofia Koukouli, Evangelia Sigala, Maria Moudatsou, Dimitrios Papageorgiou, and Areti Stavropoulou. 2025. "Fostering Organizational and Professional Commitment Through Transformational Leadership in Nursing: A Systematic Review" Hospitals 2, no. 2: 10. https://doi.org/10.3390/hospitals2020010

APA Style

Tsapnidou, E., Katharakis, G., Kelesi-Stavropoulou, M., Rovithis, M., Koukouli, S., Sigala, E., Moudatsou, M., Papageorgiou, D., & Stavropoulou, A. (2025). Fostering Organizational and Professional Commitment Through Transformational Leadership in Nursing: A Systematic Review. Hospitals, 2(2), 10. https://doi.org/10.3390/hospitals2020010

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