Effect of transformational leadership on job satisfaction and patient safety outcomes

Nurs Outlook. Mar-Apr 2018;66(2):180-189. doi: 10.1016/j.outlook.2017.10.004. Epub 2017 Nov 23.


Background: Improving patient safety within health care organizations requires effective leadership at all levels.

Purpose: The objective of this study was to investigate the effects of nurse managers' transformational leadership behaviors on job satisfaction and patient safety outcomes.

Methods: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling.

Finding: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses' job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events.

Conclusion: The findings provide support for managers' use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

Keywords: Empowerment; Job satisfaction; Patient safety; Transformational leadership; Work environment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Sectional Studies
  • Female
  • Humans
  • Job Satisfaction*
  • Leadership*
  • Male
  • Middle Aged
  • Models, Theoretical
  • Nurse Administrators*
  • Nursing Staff, Hospital*
  • Ontario
  • Patient Safety*
  • Power, Psychological
  • Surveys and Questionnaires
  • Workplace