title: The relationship between nursing leadership and patient outcomes: a systematic review update.
abstract: OBJECTIVE
  Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes.
  
  
  BACKGROUND
  As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes.
  
  
  METHODS
  Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies.
  
  
  RESULTS
  A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections.
  
  
  CONCLUSIONS
  The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted.
  
  
  CONCLUSIONS
  Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes.
authors.affiliation: Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Health Sciences Addition (HSA), The University of Western Ontario, London, Ontario, Canada. cwong2@uwo.ca
authors.forename: Carol A
authors.initials: CA
authors.lastname: Wong
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
authors.forename: Lisa
authors.initials: L
authors.lastname: Ducharme
mesh_terms: D006272:Health Facility Environment / Q000458:organization & administration; D006801:Humans; D007857:Leadership; D009718:Nurse Administrators / Q000458:organization & administration*; D009729:Nursing / Q000458:organization & administration*; D015401:Nursing Administration Research; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D017132:Workplace / Q000458:organization & administration
keywords: nursing leadership; patient outcomes; systematic review