The impact of clinical nurse leadership models on the quality of care at the unit level: a systematic review

Effective leadership is one of the most critical factors in achieving successful outcomes for an organization. Therefore, modern healthcare needs effective clinical nurse leadership to improve the quality of care. This study aimed to analyse the effectiveness of clinical nurse leadership models and the impact that these models have on the quality of care at the unit level. Initial searches were performed from January 2012 to January 2025 on the platforms PubMed, The Cochrane Library, Web of Science, EBSCO, Scopus and Science Direct. A total of 2822 articles were obtained, their abstracts and titles were read. The full texts of 84 articles were read and critically evaluated using the Mixed Methods Appraisal Tool. The screening of titles and abstracts, and subsequently full-text publications, was performed blinded by two author teams using the inclusion/exclusion criteria. A total of five studies satisfied the eligibility criteria and were included. Current evidence suggests associations between positive clinical nurse leadership, increased openness in communication, lower medical errors, higher quality of care and patient satisfaction and safety. There is a positive association between clinical nurse leadership style and quality of care. However, future investigation of various clinical leadership models is required to test the best mechanisms to implement clinical leadership in nursing practice. Findings provide encouraging support for the conceptualization of clinical nurse leadership models at the unit level for nurse leaders. The organizational policies regarding the competencies of clinical nursing leaders needs to be improved to increase the quality of care at the unit level. Features of clinical nurse leadership models that have a positive impact on quality of care, should be taught in practice and academic environments. The most effective CNL model is needed to improve the quality of care at the unit level in the health care system. There is no clear information on which CNL model is more effective on quality of care. There are a limited number of studies in the literature conducted on the impact of CNL models on the quality of care at the unit level. When CNL models are implemented effectively, they have a positive impact on the quality of care at the unit level. There are effective CNL models that improve the quality of care at the unit level. Prospective studies with a high level of evidence are required to examine the CNL model that are the most effective in improving the quality of care at the unit level.