Cultural Differences in the Relationship Between Negative Leadership Behaviours and Nurses' Emotional Exhaustion: A Systematic Review.

AIMS: Nurses face the risk of emotional exhaustion due to high-intensity work, resource shortages and multiple stressors. Negative leadership behaviours exacerbate emotional exhaustion through the abuse of power and psychological oppression. Therefore, this study aims to summarise the current evidence on the relationship between negative leadership behaviours and nurse emotional exhaustion in different cultures.

METHODS

Databases such as PubMed, Web of Science, Embase, the Cochrane Library, Scopus, CINAHL, APA PsycInfo, CNKI, Wanfang and VIP were searched for related studies, from inception until 20 November 2025, without any language restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review these studies. The PEO (population, Exposure and outcome) framework was followed with nurses as the population, negative leadership behaviour as the exposure and emotional exhaustion as the outcome. The final studies were reviewed and selected using EndNote 21, with information extracted according to specific criteria. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the included studies.

RESULTS

The initial search yielded 1990 records, and after duplicate removal and screening, 11 studies published between 2007 and 2025 were included. Of these, four were longitudinal studies and seven were cross-sectional studies. Eight of the 11 articles included in this systematic review were conducted in Asia. The correlation coefficients between negative leadership behaviour and emotional exhaustion ranged from 0.18 to 0.76, indicating moderate to strong positive associations, and other variables were found to play a role in the relationship between them.

CONCLUSION

This systematic review summarises that negative leadership behaviours are significantly positively correlated with nurses' emotional exhaustion, and this correlation shows significant cultural differences. Future research should conduct cross-cultural longitudinal studies and develop targeted intervention strategies.