Impact of transformational leadership on nurses confidence in clinical practice

Background: Transformational leadership is the most recognized leadership style in nursing and wider healthcare. Central to transformational leadership is building a culture of respect and a cooperative working environment. A supportive environment empowers individuals to employ their decision-making skills and autonomy, enabling professional development. A lack of supportive leadership is identified as one of the most common reasons that nurses do not feel confident in clinical practice and leave the profession. The popularity of transformational leadership in twenty first century nursing means that it is vital to understand how a transformational approach impacts upon nurses’ confidence in clinical practice. To meet the increasingly complex biopsychosocial needs of the patient population, leaders must maximise confidence among nurses working in clinical practice. 
Aim: To understand the impact of transformational leadership on nurses’ confidence in clinical practice. 
Methodology: A qualitative systematic review was undertaken to identify relevant primary research published between 2008 and 2025. Key and alternative search terms were devised and the journal databases CINAHL, PsycInfo and ASSIA were selected to conduct the search. Primary research was reviewed against specific inclusion and exclusion criteria. Qualitative studies included in this review were appraised using the Critical Appraisal Skills Programme Tool. The quality of mixed methods research was assessed using the Mixed Methods Appraisal Tool. 
Results: Ten studies were selected for inclusion in this review. Following thematic synthesis, three themes were identified: 1) Empowerment, 2) Team Work, 3) Innovation. Transformational leadership has a positive impact on nurses’ confidence in clinical practice through the concepts of empowerment, team work and innovation. Commonalities inherent across all three themes were that nurses felt more confident to engage in professional development opportunities, collaborate with the multidisciplinary team, challenge poor practice and act as a change agent. Increasing nurses’ confidence through transformational leadership resulted in improved communication and decision-making skills, increased motivation and engagement, mutual respect, creativity and commitment to the profession. 
Conclusion: This systematic review found that transformational leadership enhanced nurses’ confidence in clinical practice, improving care quality.

Rachel is the Nurse Educator in the Neurosciences Department at Great Ormond Street Hospital for Children in London, England. In 2019, Rachel completed her Bachelor of Science (Hons) in Paediatric Nursing at the University of Nottingham. Since gaining her nursing registration, Rachel has gained seven years of clinical experience caring for children with neurological and craniofacial conditions requiring specialist care. In 2025, Rachel completed her Master of Science in Children and Young People’s Health at London South Bank University whilst pursuing her clinical role. Rachel has conducted nursing research in the areas of nursing education, leadership and adolescent experience of care.