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Effect of Transformational leadership style on work engagement among nurses working at public hospital globally: a systematic review and meta-analysis

This systematic review and meta-analysis of 18 studies published between 2016 and 2026 reveals a significant, moderate positive correlation (r ≈ 0.50) between transformational leadership and work engagement among nurses in public hospitals globally, with variations attributed to measurement tools and geographical regions rather than publication year.

Original authors: Degu Tegegne, Fentahun Meseret, Tesfaye Assebe, Nega Assefa

Published 2026-06-28

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CC BY 4.0

Original authors: Degu Tegegne, Fentahun Meseret, Tesfaye Assebe, Nega Assefa

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a hospital not as a building of steel and glass, but as a massive, complex orchestra. The nurses are the musicians, playing their instruments (providing care) day in and day out. But even the most talented musician can sound flat if the conductor is just standing there waving a stick without any passion or vision.

This research paper is essentially a "super-review" that looked at 18 different studies from around the world to answer one big question: Does having a passionate, inspiring conductor (a Transformational Leader) make the musicians (nurses) play with more energy and heart (Work Engagement)?

Here is the breakdown of what they found, using simple analogies:

The Main Discovery: The "Spark" Connection

The researchers combined data from thousands of nurses globally and found a clear, positive link. Think of Transformational Leadership as a special kind of "spark" or "fuel" that leaders give to their teams. These leaders don't just give orders; they paint a vivid picture of the future, give personal encouragement, and make everyone feel like their work matters.

The study found that when nurses have this kind of leader, their Work Engagement (which is like their energy, dedication, and ability to get "lost" in the joy of their work) goes up significantly.

The Result: The connection is like a strong magnet. The data showed a "moderate to strong" pull between the two. If you have a leader who inspires, the nurses are much more likely to be energized and dedicated to their jobs.

Why the Numbers Varied: Different "Rulers" and "Terrains"

If you ask 18 different people to measure the same object, they might get slightly different numbers. The researchers noticed that the strength of this "spark" wasn't exactly the same in every single study. They found two main reasons for this:

The Measuring Tape (Measurement Versions): Some studies used a very long, detailed survey (the full "Utrecht Work Engagement Scale") to measure how engaged nurses felt, while others used a shorter, 9-question version.
- The Analogy: It's like trying to measure the depth of a swimming pool. The studies using the full, detailed survey found a stronger connection (a deeper pool) than those using the shorter, 9-question survey. The longer survey just captured the full picture better.
The Location (Geography): The studies came from different countries like China, Saudi Arabia, the USA, Nigeria, and the Philippines.
- The Analogy: Just as a plant might grow taller in one type of soil than another, the "spark" of leadership seemed to land differently depending on the country's culture, healthcare system, and economic conditions. For example, the connection was particularly strong in some ICU settings in China and Saudi Arabia.

What Didn't Matter: The "Time Machine"

The researchers wondered: "Is this connection getting stronger or weaker as time goes on? Did leadership styles change between 2016 and 2026?"

The Finding: No. The "spark" has been consistent. Whether the study was published in 2016 or 2025, the relationship between an inspiring leader and an engaged nurse stayed the same. Time didn't change the recipe.

The "No-Go" Zone: What We Can't Say Yet

It is important to stick to what the paper actually says.

Cause and Effect: The paper looked at snapshots in time (cross-sectional studies). It's like taking a photo of the orchestra and the conductor at one moment. We know they look good together, but we can't prove from this paper alone that the conductor caused the music to get better, or if the musicians were already happy and just picked a good conductor.
Future Fixes: The paper does not prescribe a specific training program or a new policy to fix hospitals. It simply says, "Look, the data shows these two things go hand-in-hand."

The Bottom Line

In simple terms, this paper confirms that leadership matters. When hospital leaders act like "Transformational Leaders"—inspiring, supporting, and caring for their nurses—the nurses feel more energized, dedicated, and absorbed in their work.

The study suggests that if you want nurses to be more engaged, you need to focus on the leaders who can provide that "spark." However, the exact strength of that spark depends on how you measure it and where in the world you are looking. The paper concludes that institutions should focus on building these specific leadership skills to help nurses feel more connected to their work.

Technical Summary: Effect of Transformational Leadership on Nurse Work Engagement

Problem Statement
Healthcare systems rely heavily on the motivation and engagement of nurses, who constitute the largest segment of the healthcare workforce. While leadership practices are known to shape work environments and influence staff outcomes, existing research on leadership and management in healthcare systems remains limited and scattered. Specifically, there is a need to synthesize global evidence regarding the relationship between transformational leadership and work engagement among nurses in public hospital settings to inform policy and management strategies.

Methodology
This study employed a systematic review and meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was registered with PROSPERO (CRD420261349834).

Search Strategy: A comprehensive search was conducted across multiple electronic databases (PubMed, Scopus, AJOL, PsycInfo, Hinari, and Google Scholar) for articles published between January 1, 2016, and March 20, 2026.
Eligibility Criteria: The review included quantitative observational studies involving registered nurses in public hospitals that measured transformational leadership as the exposure and work engagement as the outcome. Studies were required to report statistical correlation coefficients ( $r$ ) and utilize validated tools such as the Utrecht Work Engagement Scale (UWES). Qualitative studies, non-public hospital settings, and studies lacking statistical relationships were excluded.
Data Analysis: Data were extracted using Microsoft Excel and analyzed using Comprehensive Meta-Analysis (CMA) version 3. The primary outcome was the pooled correlation coefficient ( $r$ ) between transformational leadership and work engagement. Heterogeneity was assessed using $I^2$ statistics, and a random-effects model was applied due to significant heterogeneity. Subgroup analyses were conducted based on geographical region and measurement versions (UWES vs. UWES-9), and meta-regression was performed to test the influence of the publication year. Publication bias was evaluated using funnel plots and Egger's test.
Quality Appraisal: Included studies were critically appraised using the Joanna Briggs Institute (JBI) checklist for observational cross-sectional studies.

Key Results

Study Selection: From an initial pool of 1,641 articles, 18 studies met the inclusion criteria, comprising a total sample size of 6,768 nurses.
Pooled Effect Size: The meta-analysis revealed a statistically significant, moderate positive correlation between transformational leadership and work engagement. The overall pooled correlation was $r \approx 0.50$ (95% CI: 0.415–0.579; $p < 0.001$ ).
Heterogeneity: Significant heterogeneity was observed among the studies ( $I^2 = 95.112\%$ , $p < 0.01$ ).
Subgroup Analysis:
- Geographical Variation: Effect sizes varied by region. Saudi Arabia showed the highest pooled effect ( $r = 0.660$ ), followed by China ( $r = 0.596$ ), and the USA ( $r = 0.424$ ).
- Measurement Variation: Studies utilizing the full Utrecht Work Engagement Scale (UWES) demonstrated a stronger pooled correlation ( $r = 0.48$ ) compared to those using the shorter UWES-9 version ( $r = 0.33$ ).
- ICU Nurses: Studies focusing specifically on Intensive Care Unit (ICU) nurses reported higher correlation coefficients, ranging from 0.79 to 0.89.
Meta-Regression: The analysis indicated that the year of publication did not significantly explain the variability in effect sizes ( $p = 0.6165$ ), suggesting the relationship has remained stable over time.
Publication Bias: Funnel plot analysis and Egger's test indicated slight asymmetry, but the authors concluded that publication bias was unlikely to substantially impact the findings.

Significance and Claims
The paper claims that transformational leadership is a consistent and significant predictor of nurses' work engagement globally. The findings support the theoretical framework that leaders influence followers' motivation and performance through inspiration, vision, and individualized support. The study aligns with the Job Demands–Resources (JD-R) model, positing that transformational leadership acts as a critical job resource that fosters engagement.

The authors assert that while the strength of the association varies based on contextual factors (such as geography and cultural norms) and methodological factors (such as measurement instruments), the direction of the relationship is universally positive. Consequently, the paper recommends that healthcare institutions focus on developing leadership practices that enhance nurse leaders' capacity, specifically in transformational leadership, to improve staff engagement and, by extension, healthcare outcomes. The study acknowledges limitations, primarily the cross-sectional nature of the included data which limits causal inference, and the potential influence of cultural and organizational differences on generalizability.