Relationship between leadership and psychological empowerment in nursing: a meta-analysis exploring the role of country development level.

BACKGROUND

In recent years, empowering nurses has gained importance in decision-making processes, particularly in fast-paced clinical environments. Ethical, transparent and supportive leadership styles have been found to positively influence the psychological empowerment dimensions of nurses, such as meaning, competence, autonomy and influence. However, existing evidence remains fragmented, and the magnitude of this relationship across different health system contexts has not been quantitatively synthesised.

OBJECTIVE

This meta-analysis aimed to investigate the association between leadership styles and nurses' levels of psychological empowerment and to assess whether this relationship varies according to countries' level of development.

METHODS

The study was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and registered in the International Prospective Register of Systematic Reviews. Literature searches were performed on 20-21 June 2025, using 15 relevant keywords across PubMed, Cochrane Library, Web of Science, Scopus, SpringerLink and ScienceDirect. Following the predefined inclusion and exclusion criteria, 20 studies encompassing 24 datasets were included in the analysis. A random-effects model was applied, and heterogeneity as well as moderator analyses were undertaken. All statistical analyses were conducted using Jamovi software.

RESULTS

The findings indicated a statistically significant and positive association between leadership styles and psychological empowerment among nurses, although considerable variability was evident across the included studies. Moderator analyses indicated that country development level significantly influenced the strength of this association.

CONCLUSION

Leadership constitutes a key determinant of nurses' psychological empowerment. The strength of this relationship varies according to national development context, suggesting that organisational and systemic conditions shape how leadership practices translate into empowerment outcomes. Strengthening leadership capacity may be particularly important in developing health systems to support nurse empowerment, workforce sustainability and effective clinical decision-making. These findings highlight the need for context-sensitive leadership development strategies in nursing practice and policy. Therefore, leadership training should be supported, and work environments should be structured to encourage psychological empowerment.