Abstract

Aim

Identify the characteristics of leadership competency for the nurse manager and describe the most cited
leadership styles in the literature.

Background

Leadership is a fundamental competency for nurse managers, as it plays an important role in the
healthcare environment to achieve Sustainable Development Goals and promote people-centered
organizations. Therefore, understanding the characteristics of leadership and the leadership style to be
employed is important.

Methods

A scoping review was conducted from January 2009 to January 2024 using the design of González Garcia
et al., the Arksey and O'Malley framework, and databases including Web of Science, Scopus, and
PubMed. Articles reporting on the characteristics of leadership for nurse managers were reviewed. The
authors performed the review based on a search syntax, inclusion and exclusion criteria, and the data
extraction process.

Results

Sixty-two studies were included in the final review. The review identified 38 characteristics related to
leadership competency, among which we highlighted caring for nurses as individuals, being a visionary,
knowledgeable, a change agent, and a communicator. This review highlights the prevalence of
transformational leadership, which constitutes 69.57% of the leadership styles cited, and underscores its
pivotal role in improving the work environment, effectiveness in nursing care, conflict management,
team commitment, and adaptability to change within healthcare settings.

Conclusions

The most commonly cited characteristics of leadership include caring for the team, effective
communication, and a vision for change. Transformational, people-centered, and motivational leadership
is the most appropriate style. Implications for Nursing Management. The characterization of leadership
competency will allow the development of training adapted to the current requirements for nursing
leaders. This training could be developed in simulation and virtual reality environments. It also allows for
a deeper understanding of how leadership competency affects teams and their functioning.

1. Introduction
Leaders in healthcare organizations must inspire coordinated actions and foster a social movement to
achieve the Sustainable Development Goals (SDGs), which require the development of people-centered
ethical behavior [1, 2]. This leadership style can be defined as one that focuses on achieving the highest
levels of motivation of people through the development of four components: idealized influence,
inspirational motivation, intellectual stimulation, and individual consideration [3]. They should be
responsible for positive changes in social and health systems throughout the world, taking into account
not only the interests of the organization but also the interests of the society in which it operates [4].
The SDGs refer to the global challenges facing countries and their populations [5].

Nurses are associated with the SDGs, as their work involves concern for the health impact on patients
and populations [6]. It is important to note that nurses, from a crucial position, address social
determinants of health, understanding the link between public health conditions and their impact on the
population [7]. In this sense, the nurse should exercise a participatory and collaborative leadership style
within work groups and society [8]. Furthermore, nurses' leadership focused on the SDGs would have
clear benefits related to improving global health, progress toward gender equality, and strengthening
economies [9]. Similarly, the World Health Organization (WHO) highlights the relationship between
nursing leadership and its influence on education (SDG 4), gender relations (SDG 5), and work and
economic growth (SDG 8) [10]. Benton et al. [11] also noted that the 17 SDGs have a significant impact
on people's health, underscoring the crucial role of nursing leadership in coordinating actions to achieve
these goals.

Furthermore, the nurse managers play a relevant role in the success of healthcare institutions in the
management of governance, quality, and sustainability, as well as in terms of health objectives and the
SDGs [12]. In addition, nurse managers establish strategies that guide nurses in their professional
actions, generate environments for nursing practice, and support organizational development,
influencing public health policies and positioning nurses in an ever-changing healthcare environment
[13]. Thus, developing competencies to effectively manage healthcare organizations becomes crucial,
especially when these roles serve as a vital link to clinical practice [14].

In this sense, the competency model for the nurse manager developed by González Garcia [15] provides
a core of eight competencies that nurses must develop in managerial roles in healthcare organizations
[16]. These core competencies described by González Garcia [15] include leadership.

The leadership competency of the nurse manager could be defined as the ability to influence other
professionals to achieve common objectives and a shared vision [17, 18]. This competency is especially
important in healthcare organizations because it is responsible for generating professional commitment,
reducing conflicts in workgroups, and creating relationships between team members [19]. Furthermore,
research has found that the leadership style of the nurse manager is a key determinant of the quality of
care provided by nurses [20, 21]. Research also identifies the transformational leadership style as the
most relevant style in the healthcare setting [18, 22] due to its ability to achieve commitment, reduce
stress, prevent burnout, and achieve better health outcomes and higher quality nursing care [23, 24].

The relationship between the SDGs, leadership, economic, and sustainability policies with respect to the
need to provide quality healthcare is the starting point for the present research [25–27]. However, the
review of the literature indicates that it is necessary to deepen the knowledge of leadership competence
and its characteristics in the healthcare setting [28–30].

1.1. Aim

The objectives of this scoping review were: (1) to identify and describe the characteristics of leadership
competency for the nurse manager and (2) to identify the most common leadership style in the
literature.

2. Materials and Methods

2.1. Design

A scoping review synthesizes knowledge, explanations, and interpretations from both qualitative and
quantitative research to address the research question. A scoping review is useful for exploring emerging
evidence, identifying knowledge gaps, and providing rigorous and transparent methods for identifying
and mapping available evidence [31]. This methodology enables the systematic and meaningful
extraction of data [32]. According to Tricco et al. [33], this research adhered to the checklist proposed by
PRISMA-ScR.

In addition, this scoping review followed the methodology conducted by Gonzalez-Garcia et al. [34], as
this article belongs to the line of research focused on the development of competencies for nurse
managers. The same keywords were used to refer to the nurse manager, as well as the same approach to
competencies and characteristics. Likewise, the same article selection and quality criteria were used.
Regarding data extraction and coding systems, the same tools and strategies adapted to the purpose of
the competency that is the focus of this part of the research were used.

2.2. Search Methods

The scoping review was conducted according to Arksey and O'Malley [31], which involved: Identifying
the research question, identifying relevant studies, choosing studies, identifying data, collecting,
summarizing, and reporting results.

The research questions were as follows:

What are the characteristics of leadership competency that are most often cited in the literature?

What is the most cited leadership style in the literature?

Relevant articles published between 2009 and 2024 were searched in electronic databases, including
Web of Science, Scopus, and PubMed. The search terms included references to nurse managers and
leadership competency (Table 1).

Table 1.

Search strategy.

Database 2009–2024 Search terms

WOS TI = (leader∗) AND TI = (“nurs∗ manage∗” OR “nurse supervisor” OR “nurse program manager”
OR “nurse unit manager” OR “chief nurse executive” OR “nurs∗ administrat∗” OR “director of nurs∗”
OR “head nurs∗” OR “frontline manager” OR “nurs∗ director” OR “nurs∗ executiv∗”) AND TS = (“head
nurs∗” OR “frontline manager” OR “nurs∗ director” OR “nurs∗ manag∗” OR “first line nurs∗
manage∗” OR “nurse supervisor” OR “nurse program manager” OR “nurse unit manager” OR “chief
nurse executive” OR “nurs∗ administrat∗” OR “director of nurs∗” OR “nurs∗ executiv∗”) AND TS =
(leader∗)

SCOPUSTITLE-ABS-KEY(“nurs∗ manage∗” OR “nurse supervisor” OR “nurse program manager” OR

PUBMED (leader∗) AND ((“nurse administrators”[Majr] OR “nursing, Supervisory”[Majr])

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Source: own elaboration.

The inclusion criteria for the articles in this scoping review included quantitative, qualitative, and mixed
methods studies, theses and dissertations, and reviews. Articles published between January 1, 2009, and
January 30, 2024, in English or Spanish, were included to guarantee the synthesis of updated knowledge,
considering that the role of nurse managers and leadership has evolved in recent years. The exclusion
criteria included conference abstracts, editorials, and discussion papers, as well as articles with no data
on the leadership characteristics of the nurse manager.

We limited our search to the articles that resulted from our search equations and did not include gray
literature. Additionally, we did not conduct a snowballing search.

2.3. Quality Appraisal

An evaluation of the quality of the included articles was performed. Since developed and validated tools
for assessing the different methodologies of the included publications are lacking, the development of a
specific tool to serve this purpose was necessary. To this end, parts of the method presented by Hölbl et
al. [35] were used and modified as appropriate (Table 2). The initial quality assessment of the articles
was performed by SPG and was independently reviewed by reviewers 2–6 (PMS, AP, CB, AGG, and CLP).
Although some studies had medium scores, the authors' intention was not to remove studies but to
assess the overall quality of the existing knowledge base. No articles were excluded according to the
quality assessment process.

Table 2.

Quality assessment tool adapted from Hölbl et al. [35].

DomainIndicator (0–2)

Q1-Is the nurse manager leadership characteristics described? No-moderately-yes

Q2-Are the research objectives clearly outlined? No-moderately-yes

Q3-Are the main contributions well described to the nurse management leadership? No-moderately-
yes

Q4-How appropriate is the problem-solution fit?No-moderately-yes

Q5-Are the proposed solutions feasible (scalable, economical, implementable)? No-moderately-yes

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2.4. Data Extraction

Data extraction was performed using specially designed forms. The following data were extracted from
the studies: type of study, sample size, participant characteristics, countries, leadership types, and
leadership characteristics. Data analysis was performed using Microsoft Excel.
The authors met regularly to resolve any disagreements about whether the articles met the inclusion
criteria. Each of the selected full-text articles was read thoroughly several times by the authors to
capture all relevant information and ensure that nothing important was missed. The data set for the
paper was constructed by extracting findings that were relevant to the research questions.

Studies, characteristics, and leadership styles were coded using the following process to correctly
identify them:

Articles: Coded with the letter “A” followed by three digits, beginning with A001 for the first article.

Characteristics: Coded with the letter “C” followed by three digits, beginning with C001 for the first
characteristic.

Leadership style: These were encoded with the letter “L” followed by three digits, beginning with the
code “L001.”

For example, the characteristic encoded as “A003 C007” can be identified as characteristic 7 belonging to
Article 3. Furthermore, the leadership style encoded as “A003 L003” can be identified as leadership style
3, as described in Article 3.

Using this methodology, we initially cataloged the characteristics of leadership competency described in
the articles and assigned a unique code to each. Subsequently, these characteristics were analyzed and
grouped if they were identical, and their frequency of repetition was tallied. Any disagreements were
resolved by a fourth reviewer (CB).

In this review, the “leadership characteristic” is defined as a description that distinctly recognizes a
leadership trait.

3. Results

The selection process is shown in Figure 1. A total of 622 articles were identified from electronic
databases and imported into Mendeley for screening. After screening the titles and abstracts, 141
studies remained for full-text review. Finally, 62 studies were included in this scoping review.

Figure 1.
Figure 1

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Flowchart of the study.

3.1. Bibliographic Overview

Sixty-two articles were included in the current scoping review. Table 3 presents the characteristics of the
included studies. Of the 62 studies, most were conducted in the USA (54.8%), Finland (7.54%), Iran and
China (5.66% each), Australia and Jordan (3.77% each), and 1.88% came from the UK, Saudi Arabia,
Singapore, Greece, South Africa, Italy, Japan, Brazil, Lithuania, and Sweden. As a result, 339
characteristics were identified in the 62 articles analyzed. Following the identification of the
characteristics, their meanings were analyzed, and those referring to the same leadership characteristics
were grouped together. This analysis resulted in 38 leadership characteristics (Table 4).