Staff turnover and leadership style: a narrative review of their relationship in health sciences

Authors

DOI:

https://doi.org/10.56294/hl2023207

Keywords:

Staff turnover, leadership styles, health sciences, workplace well-being, organizational trust

Abstract

Staff turnover represents a critical challenge in the health and management sciences, impacting team stability, quality of care, and organizational costs. This article explores the relationship between leadership styles and staff retention through a narrative review of the literature published between 2018 and 2022 in the Scopus database. The analysis focused on 21 documents selected under criteria of pertinence, relevance, and academic quality. Through a semi-systematic methodology, thematic patterns and key theoretical perspectives were identified that underline how leadership can mitigate factors associated with staff turnover. The results showed that leadership styles play a crucial role in creating a positive work environment, where well-being, trust, and inclusion are priority categories. These approaches promote job satisfaction, reduce stress, and strengthen employee engagement, which contributes to minimizing the intention to leave. The importance of adapting strategies to generational expectations was also highlighted, particularly in relation to work flexibility, professional development and individual recognition. It is concluded that the implementation of adaptive and people-centred leadership styles, together with comprehensive organisational policies, is essential to meet the challenges of staff turnover in the health sector

References

1. Gandhi A, Yu H, Grabowski DC. High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information: Study examines high turnover of nursing staff at US nursing homes. Health Affairs. 2021;40(3): 384–91. https://doi.org/10.1377/hlthaff.2020.00957

2. Temkin-Greener H, Cen X, Li Y. Nursing Home Staff Turnover and Perceived Patient Safety Culture: Results from a National Survey. Meeks S, editor. The Gerontologist. 2020;60(7):1303–11. https://doi.org/10.1093/geront/gnaa015

3. Poon YSR, Lin YP, Griffiths P, Yong KK, Seah B, Liaw SY. A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions. Human Resources for Health. 2022;20(1):70. https://doi.org/10.1186/s12960-022-00764-7

4. Mengstie MM. Perceived organizational justice and turnover intention among hospital healthcare workers. BMC Psychology. 2020;8(1):19. https://doi.org/10.1186/s40359-020-0387-8

5. Johnson J, Hall LH, Berzins K, Baker J, Melling K, Thompson C. Mental healthcare staff well‐being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions. International Journal of Mental Health Nursing. 2018;27(1):20–32. https://doi.org/10.1111/inm.12416

6. Van De Klundert J, Van Dongen- Van Den Broek J, Yesuf EM, Vreugdenhil J, Yimer SM. ‘We are planning to leave, all of us’—a realist study of mechanisms explaining healthcare employee turnover in rural Ethiopia. Human Resources for Health. 2018;16(1):37. https://doi.org/10.1186/s12960-018-0301-0

7. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. Journal of Internal Medicine. 2018;283(6):516–29. https://doi.org/10.1111/joim.12752

8. Ferede A, Kibret GD, Million Y, Simeneh MM, Belay YA, Hailemariam D. Magnitude of Turnover Intention and Associated Factors among Health Professionals Working in Public Health Institutions of North Shoa Zone, Amhara Region, Ethiopia. BioMed Research International. 2018:1–9. https://doi.org/10.1155/2018/3165379

9. Princes E, Said A. The impacts of project complexity, trust in leader, performance readiness and situational leadership on financial sustainability. International Journal of Managing Projects in Business. 2022;15(4):619–44. https://doi.org/10.1108/IJMPB-03-2021-0082

10. Chigudu S, Jasseh M, d’Alessandro U, Corrah T, Demba A, Balen J. The role of leadership in people-centred health systems: a sub-national study in The Gambia. Health Policy and Planning. 2018;33(1): e14–25. https://doi.org/10.1093/heapol/czu078

11. Van Diggele C, Burgess A, Roberts C, Mellis C. Leadership in healthcare education. BMC Medical Education. 2020;20(S2):456. https://doi.org/10.1186/s12909-020-02288-x

12. Moyo T, Crafford G, Emuze F. People-centred management for improving construction workers’ productivity in Zimbabwe. Built Environment Project and Asset Management. 2021;11(2):350–68. https://doi.org/10.1108/BEPAM-02-2020-0029

13. Weintraub P, McKee M. Leadership for Innovation in Healthcare: An Exploration. International journal of health policy and management. 2018;8(3):138–44. https://doi.org/10.15171/ijhpm.2018.122

14. Solman A, Manley K, Christie J, Setchfield I. Systems Leadership Enablement of Collaborative Healthcare Practices. En: International Practice Development in Health and Social Care. 1a ed. Wiley; 2021. 187–204. https://onlinelibrary.wiley.com/doi/10.1002/9781119698463.ch14

15. Alilyyani B, Wong CA, Cummings G. Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review. International Journal of Nursing Studies. 2018;83:34–64. https://doi.org/10.1016/j.ijnurstu.2018.04.001

16. Giddens J. Transformational leadership: What every nursing dean should know. Journal of Professional Nursing. 2018;34(2):117–21. https://doi.org/10.1016/j.profnurs.2017.10.004

17. Saad Alessa G. The Dimensions of Transformational Leadership and Its Organizational Effects in Public Universities in Saudi Arabia: A Systematic Review. Frontiers in psychology. 2021;12:682092. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.682092/full

18. Asif M, Qing M, Hwang J, Shi H. Ethical Leadership, Affective Commitment, Work Engagement, and Creativity: Testing a Multiple Mediation Approach. Sustainability. 2019;11(16):4489. https://doi.org/10.3390/su11164489

19. Ko C, Ma J, Bartnik R, Haney MH, Kang M. Ethical Leadership: An Integrative Review and Future Research Agenda. Ethics & Behavior. 2018;28(2):104–32. https://doi.org/10.1080/10508422.2017.1318069

20. Daniëls E, Hondeghem A, Dochy F. A review on leadership and leadership development in educational settings. Educational Research Review. 2019;27:110–25. https://doi.org/10.1016/j.edurev.2019.02.003

21. Specchia ML, Cozzolino MR, Carini E, Di Pilla A, Galletti C, Ricciardi W, et al. Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(4):1552. https://doi.org/10.3390/ijerph18041552

22. Cummings GG, Lee S, Tate K, Penconek T, Micaroni SPM, Paananen T, et al. The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies. 2021;115:103842. https://doi.org/10.1016/j.ijnurstu.2020.103842

23. Bokhour BG, Fix GM, Mueller NM, Barker AM, Lavela SL, Hill JN, et al. How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC Health Services Research. 2018;18(1):168. https://doi.org/10.1186/s12913-018-2949-5

24. McDermid F, Judy Mannix, Peters K. Factors contributing to high turnover rates of emergency nurses: A review of the literature. Australian Critical Care. 2020;33(4):390–6. https://doi.org/10.1016/j.aucc.2019.09.002

25. Hoff T, Carabetta S, Collinson GE. Satisfaction, Burnout, and Turnover Among Nurse Practitioners and Physician Assistants: A Review of the Empirical Literature. Medical Care Research and Review. 2019;76(1):3–31. https://doi.org/10.1177/10775587177301

26. Neumann JL, Mau LW, Virani S, Denzen EM, Boyle DA, Boyle NJ, et al. Burnout, Moral Distress, Work–Life Balance, and Career Satisfaction among Hematopoietic Cell Transplantation Professionals. Biology of Blood and Marrow Transplantation. 2018;24(4):849–60. https://doi.org/10.1016/j.bbmt.2017.11.015

27. Gribben L, Semple CJ. Factors contributing to burnout and work-life balance in adult oncology nursing: An integrative review. European Journal of Oncology Nursing. 2021;50:101887. https://doi.org/10.1016/j.ejon.2020.101887

28. Barasa E, Mbau R, Gilson L. What Is Resilience and How Can It Be Nurtured? A Systematic Review of Empirical Literature on Organizational Resilience. International Journal of Health Policy and Management. 2018;7(6):491–503. https://doi.org/10.15171/ijhpm.2018.06

29. Uhl-Bien M, Arena M. Leadership for organizational adaptability: A theoretical synthesis and integrative framework. The Leadership Quarterly. 2018;29(1):89–104. https://doi.org/10.1016/j.leaqua.2017.12.009

30. Noriega Morales S, Martínez LR, Hernández Gómez JA, Romero López R, Torres-Argüelles V. Predictors of organizational resilience by factorial analysis. International Journal of Engineering Business Management. 2019;11:1847979019837046. https://doi.org/10.1177/1847979019837046

31. Snyder H. Literature review as a research methodology: An overview and guidelines. Journal of Business Research. 2019;104:333–9. https://doi.org/10.1016/j.jbusres.2019.07.039

32. Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology. 2021;18(3):328–52. https://doi.org/10.1080/14780887.2020.1769238

33. Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Qualitative Psychology. 2022;9(1):3–26. https://doi.org/10.1037/qup0000196

34. Zhao F, Ahmed F, Faraz NA. Caring for the caregiver during COVID-19 outbreak: Does inclusive leadership improve psychological safety and curb psychological distress? A cross-sectional study. International Journal of Nursing Studies. 2020;110:103725. https://doi.org/10.1016/j.ijnurstu.2020.103725

35. Veli Korkmaz A, Van Engen ML, Knappert L, Schalk R. About and beyond leading uniqueness and belongingness: A systematic review of inclusive leadership research. Human Resource Management Review. 2022;32(4):100894. https://doi.org/10.1016/j.hrmr.2022.100894

36. Shore LM, Chung BG. Inclusive Leadership: How Leaders Sustain or Discourage Work Group Inclusion. Group & Organization Management. 2022;47(4):723–54. https://doi.org/10.1177/1059601121999580

37. Ashikali T, Groeneveld S, Kuipers B. The Role of Inclusive Leadership in Supporting an Inclusive Climate in Diverse Public Sector Teams. Review of Public Personnel Administration. 2021;41(3):497–519. https://doi.org/10.1177/0734371X19899722

38. Shore LM, Cleveland JN, Sanchez D. Inclusive workplaces: A review and model. Human Resource Management Review. 2018;28(2):176–89. https://doi.org/10.1016/j.hrmr.2017.07.003

39. Weiss M, Kolbe M, Grote G, Spahn DR, Grande B. We can do it! Inclusive leader language promotes voice behavior in multi-professional teams. The Leadership Quarterly. 2018;29(3):389–402. https://doi.org/10.1016/j.leaqua.2017.09.002

40. Javed B, Naqvi SMMR, Khan AK, Arjoon S, Tayyeb HH. Impact of inclusive leadership on innovative work behavior: The role of psychological safety. Journal of Management & Organization. 2019;25(1):117–36. https://doi.org/10.1017/jmo.2017.3

41. Mousa M, Boyle J, Skouteris H, Mullins AK, Currie G, Riach K, et al. Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions. EClinicalMedicine. 2021;39:101084. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00364-3/fulltext

42. Pagán-Castaño E, Maseda-Moreno A, Santos-Rojo C. Wellbeing in work environments. Journal of Business Research. 2020;115:469–74. https://doi.org/10.1016/j.jbusres.2019.12.007

43. Rasool SF, Wang M, Tang M, Saeed A, Iqbal J. How Toxic Workplace Environment Effects the Employee Engagement: The Mediating Role of Organizational Support and Employee Wellbeing. International Journal of Environmental Research and Public Health. e 2021;18(5):2294. https://doi.org/10.3390/ijerph18052294

44. Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Relationship Between Organizational Leadership and Health Care Employee Burnout and Satisfaction. Mayo Clinic Proceedings. 2020;95(4):698–708. https://doi.org/10.1016/j.mayocp.2019.10.041

45. Sexton JB, Adair KC, Profit J, Bae J, Rehder KJ, Gosselin T, et al. Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds. The Joint Commission Journal on Quality and Patient Safety. 2021;47(7):403–11. https://doi.org/10.1016/j.jcjq.2021.04.001

46. Matthews M, Carsten MK, Ayers DJ, Menachemi N. Determinants of turnover among low wage earners in long term care: the role of manager-employee relationships. Geriatric Nursing. 2018;39(4):407–13. https://doi.org/10.1016/j.gerinurse.2017.12.004

47. Cummings GG, Tate K, Lee S, Wong CA, Paananen T, Micaroni SPM, et al. Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies. 2018;85:19–60. https://doi.org/10.1016/j.ijnurstu.2009.08.006

48. Pedrosa J, Sousa L, Valentim O, Antunes V. Organizational culture and nurse’s turnover: A systematic literature review. International Journal of Healthcare Management. 2021;14(4):1542–50. https://doi.org/10.1080/20479700.2020.1801160

49. Wharton C, Kotera Y, Brennan S. A well‐being champion and the role of SELF‐REFLECTIVE practice for ICU nurses during COVID ‐19 and beyond. Nursing in Critical Care. 2021;26(2):70–2. https://doi.org/10.1111/nicc.12563

50. Liew MF, Siow WT, MacLaren G, See KC. Preparing for COVID-19: early experience from an intensive care unit in Singapore. Critical Care. 2020;24(1):83. https://doi.org/10.1186/s13054-020-2814-x

51. Dwyer PA, Hunter Revell SM, Sethares KA, Ayotte BJ. The influence of psychological capital, authentic leadership in preceptors, and structural empowerment on new graduate nurse burnout and turnover intent. Applied Nursing Research. 2019;48:37–44. https://doi.org/10.1016/j.apnr.2019.04.005

52. Olson K, Marchalik D, Farley H, Dean SM, Lawrence EC, Hamidi MS, et al. Organizational strategies to reduce physician burnout and improve professional fulfillment. Current Problems in Pediatric and Adolescent Health Care. 2019;49(12):100664. https://doi.org/10.1016/j.cppeds.2019.100664

53. Penconek T, Tate K, Bernardes A, Lee S, Micaroni SPM, Balsanelli AP, et al. Determinants of nurse manager job satisfaction: A systematic review. International Journal of Nursing Studies. 2021;118:103906. https://doi.org/10.1016/j.ijnurstu.2021.103906

54. Gorman VLA. Future Emergency Nursing Workforce: What the Evidence Is Telling Us. Journal of Emergency Nursing. 2019;45(2):132–6. https://doi.org/10.1016/j.jen.2018.09.009

55. Juvet TM, Corbaz-Kurth S, Roos P, Benzakour L, Cereghetti S, Moullec G, et al. Adapting to the unexpected: Problematic work situations and resilience strategies in healthcare institutions during the COVID-19 pandemic’s first wave. Safety Science. 2021;139:105277. https://doi.org/10.1016/j.ssci.2021.105277

56. Hamm B, Pozuelo L, Brendel R. General Hospital Agitation Management: Leadership Theory and Health Care Team Best Practices Using TeamSTEPPS. Journal of the Academy of Consultation-Liaison Psychiatry. 2022;63(3):213–24. https://doi.org/10.1016/j.jaclp.2021.10.007

57. Beilstein CM, Lehmann LE, Braun M, Urman RD, Luedi MM, Stüber F. Leadership in a time of crisis: Lessons learned from a pandemic. Best Practice & Research Clinical Anaesthesiology. 2021;35(3):405–14. https://doi.org/10.1016/j.bpa.2020.11.011

58. Aveling EL, Stone J, Sundt T, Wright C, Gino F, Singer S. Factors Influencing Team Behaviors in Surgery: A Qualitative Study to Inform Teamwork Interventions. The Annals of Thoracic Surgery. 2018;106(1):115–20. https://doi.org/10.1016/j.athoracsur.2017.12.045

59. Gros E, Shi R, Hasty B, Anderson T, Schmiederer I, Roman-Micek T, et al. In situ interprofessional operating room simulations: Empowering learners in crisis resource management principles. Surgery. 2021;170(2):432–9. https://doi.org/10.1016/j.surg.2021.02.011

60. Huang N, Qiu S, Yang S, Deng R. Ethical Leadership and Organizational Citizenship Behavior: Mediation of Trust and Psychological Well-Being. Psychology Research and Behavior Management. 2021; (14):655–64. https://doi.org/10.2147/PRBM.S311856

61. Ooms A, Heaton-Shrestha C, Connor S, McCawley S, McShannon J, Music G, et al. Enhancing the well-being of front-line healthcare professionals in high pressure clinical environments: A mixed-methods evaluative research project. International Journal of Nursing Studies. 2022;132:104257. https://doi.org/10.1016/j.ijnurstu.2022.104257

62. Viola C, Toma P, Manta F, Benvenuto M. The more you know, the better you act? Institutional communication in Covid-19 crisis management. Technological Forecasting and Social Change. 2021;170:120929. https://doi.org/10.1016/j.techfore.2021.120929

63. Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, et al. Ethical elements in priority setting in nursing care: A scoping review. International Journal of Nursing Studies. 2018;88:25–42. https://doi.org/10.1016/j.ijnurstu.2018.08.006

64. Dey M, Bhattacharjee S, Mahmood M, Uddin MA, Biswas SR. Ethical leadership for better sustainable performance: Role of employee values, behavior and ethical climate. Journal of Cleaner Production. 2022;337:130527. https://doi.org/10.1016/j.jclepro.2022.130527

65. Ilyas S, Abid G, Ashfaq F. Ethical leadership in sustainable organizations: The moderating role of general self-efficacy and the mediating role of organizational trust. Sustainable Production and Consumption. 2020;22:195–204. https://doi.org/10.1016/j.spc.2020.03.003

66. Eluwole KK, Karatepe OM, Avci T. Ethical leadership, trust in organization and their impacts on critical hotel employee outcomes. International Journal of Hospitality Management. 2022;102:103153. https://doi.org/10.1016/j.ijhm.2022.103153

67. Bahadori M, Ghasemi M, Hasanpoor E, Hosseini SM, Alimohammadzadeh K. The influence of ethical leadership on the organizational commitment in fire organizations. International Journal of Ethics and Systems. 2021;37(1):145–56. https://doi.org/10.1108/IJOES-04-2020-0043

68. Wood BP, Eid R, Agag G. A Multilevel investigation of the link between ethical leadership behaviour and employees green behaviour in the hospitality industry. International Journal of Hospitality Management. 2021;97:102993. https://doi.org/10.1016/j.ijhm.2021.102993

69. Gillet N, Fouquereau E, Coillot H, Bonnetain F, Dupont S, Moret L, et al. Ethical leadership, professional caregivers’ well-being, and patients’ perceptions of quality of care in oncology. European Journal of Oncology Nursing. 2018;33:1–7. https://doi.org/10.1016/j.ejon.2018.01.002

70. Ferine KF, Aditia R, Rahmadana MF, Indri. An empirical study of leadership, organizational culture, conflict, and work ethic in determining work performance in Indonesia’s education authority. Heliyon. 2021;7(7):e07698. https://doi.org/10.1016/j.heliyon.2021.e07698.

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Published

2023-12-30

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1.
Ultreras-Rodríguez A, Nieves-Lizárraga DO, Olguín-Martínez CM, Bueno-Fernández MM. Staff turnover and leadership style: a narrative review of their relationship in health sciences. Health Leadership and Quality of Life [Internet]. 2023 Dec. 30 [cited 2025 Aug. 30];2:207. Available from: https://hl.ageditor.ar/index.php/hl/article/view/207