<![CDATA[Introduction: This integrative review synthesizes the existing literature on transformational leadership in nursing practice and its aggregated influence on patient outcomes, staff performance, and healthcare quality indicators. Methods: Following Whittemore and Knafl's five-stage framework and PRISMA guidelines, a systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for peer-reviewed empirical articles published in English between 2010 and 2025. Eligible studies explicitly addressed transformational leadership and reported empirical results for at least one target domain. Data were extracted using a standardized template, and the methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). As all the included studies employed quantitative designs, a structured narrative synthesis was applied, tabulating the findings by outcome domain and identifying within-domain patterns. Results: Eight studies were included, encompassing approximately 1,944 nursing participants (registered nurses, nurse managers, and charge nurses) and 1,209 patients across hospital settings in seven countries; the methodological quality was moderate to high. Transformational leadership is consistently associated with positive patient outcomes, including reduced adverse events, improved patient satisfaction, and higher-quality care. Staff-level benefits include reduced burnout, greater job satisfaction, and lower turnover intention. Healthcare quality indicators, particularly team climate and organizational commitment, improved substantially. Empowerment and social identity emerged as preliminary mediating mechanisms, warranting confirmatory research. Conclusions: Healthcare organizations should invest cautiously in leadership development, and longitudinal and interventional studies are needed to confirm the causal pathways and identify contextual moderators.]]>
