AIM Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. BACKGROUND As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. METHODS Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. RESULTS A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. CONCLUSIONS The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. IMPLICATIONS FOR NURSING MANAGEMENT Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes.