The Role of Transformational Leadership in Improving Nurse Retention and Well-Being in Non-Western Countries: A Systematic Review

Background: High nursing turnover threatens global healthcare stability. Transformational leadership, defined by inspiring a shared vision and intellectual stimulation, is a potential remedy, yet evidence remains Western-centric. A knowledge gap exists regarding its impact amidst the distinct cultural norms and resource constraints of non-Western systems. This review synthesizes evidence on transformational leadership's association with nurse retention and well-being in these settings. Methods: Following PRISMA 2020 guidelines and a PROSPERO protocol (CRD420251108875), we searched PubMed, CINAHL, and Scopus (January 2015-June 2025). We included quantitative studies examining transformational leadership's impact on nurse well-being or retention in hospitals. Quality was assessed using Joanna Briggs Institute (JBI) tools. Data were analyzed using narrative synthesis due to methodological heterogeneity. Results: Thirteen quantitative studies were synthesized. Results revealed robust positive correlations between transformational leadership and well-being, specifically job satisfaction (r = 0.48-0.76) and work engagement (r = 0.65). This leadership style significantly predicted retention, explaining up to 71% of turnover intention variance. However, findings must be viewed with caution as most studies raised "some concerns" regarding risk of bias. Conclusion: This review provides associative evidence linking transformational leadership to enhanced nurse well-being and workforce sustainability in non-Western systems. Its value lies in direct influence and fostering healthier work environments. Healthcare organizations should invest in developing these leadership capabilities to strengthen the nursing workforce and ensure quality patient care.