Exploring the Role of Nurse Leadership Through a Systems Thinking Lens: A Systematic Review of Conceptual and Empirical Evidence

Aims: To explore the impact of systems thinking in nursing leadership on healthcare quality, decision-making and resource management. Design: A systematic review. Data Sources: A comprehensive literature search was conducted in PubMed, CINAHL, Scopus and Web of Science for studies published in English and Italian up to 2024. Review Methods: Studies were selected based on predefined eligibility criteria, focusing on nursing leadership integrating systems thinking. The Joanna Briggs Institute (JBI) checklist was used to assess methodological quality. A narrative synthesis was conducted to identify key themes and patterns. Results: Fifteen studies met the inclusion criteria. Findings suggest that systems thinking enhances resource management, decision-making and patient safety, while also reducing errors and improving staff collaboration. Adopting a systems approach allows nursing leaders to navigate complex healthcare environments effectively. However, variability in study designs and implementation strategies limits the generalizability of findings. Conclusion: Integrating systems thinking into nursing leadership promotes a proactive, holistic approach to problem-solving, optimising healthcare outcomes. While evidence supports its benefits, further empirical studies are needed to confirm its effectiveness across diverse healthcare settings. Impact: What problem did the study address? The need for structured systems thinking in nursing leadership. What were the main findings? Improved decision-making, resource optimisation and patient safety through systems-oriented leadership. Where and on whom will the research have an impact? Nurse leaders, healthcare administrators and policymakers in diverse healthcare settings. Patient or Public Contribution: Although patients and the public were not directly involved, this study has implications for enhancing patient safety and healthcare efficiency.