Clinical Nursing Leadership and Nurses' Performance: A Systematic Review of Mechanisms, Mediating Processes, and Organizational Pathways

Abstract

Introduction: Clinical nursing leadership is increasingly recognized as a key factor influencing nurses' performance, quality of care, and patient safety. However, existing evidence remains fragmented and lacks a comprehensive explanation of the mechanisms underlying this relationship. This study aims to synthesize evidence on how clinical nursing leadership influences nurses' performance through mechanisms, mediating processes, and organizational pathways. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Literature was retrieved from Scopus, PubMed, CINAHL, and Web of Science. Studies published between 2018–2026 were included based on predefined criteria. Quality appraisal was conducted using the JBI Critical Appraisal Checklist. Data were synthesized using a narrative approach. Results: Ten studies were included in the final synthesis. Clinical nursing leadership improves nurses' performance through core mechanisms such as communication, teamwork, and decision-making. Mediating processes include structural empowerment, work engagement, and psychological safety. At the organizational level, supportive culture, leadership environment, and managerial support strengthen leadership effectiveness. Conclusions: Clinical nursing leadership influences nurses' performance through multidimensional and non-linear pathways involving clinical, psychological, and organizational processes. These findings highlight the importance of an integrative, mechanism-based approach to leadership development in nursing practice.