The role of organizational culture in nurse wellbeing and work-related psychosocial outcomes: a systematic review

Abstract Background Nurses are a cornerstone of global healthcare systems, yet nursing organizations face persistent challenges including workforce shortages and burnout. With the World Health Organization projecting a global deficit of 4.5 million nurses by 2030, fostering a positive organizational culture and enhancing professional wellbeing are critical strategies for nurse retention. This systematic review aims to synthesize evidence on the impact of organizational culture on nurse wellbeing and related psychosocial outcomes (including happiness, job satisfaction, burnout, and psychological health), identify key moderating factors, and propose evidence-based interventions. Methods Following a protocol registered in PROSPERO (CRD420261377119), we conducted a systematic review in accordance with the Cochrane Handbook and PRISMA guidelines. A comprehensive search was performed in January 2026 across PubMed, Scopus, and Web of Science using the PEO framework. After screening, 29 studies were included. Results A thematic synthesis of 29 studies indicated that a positive organizational culture characterized by trust, social support, and justice was generally associated with higher nurse happiness and lower burnout. However, it is important to note that the included studies were predominantly cross-sectional with low to moderate methodological quality. There was significant heterogeneity in the measurement tools used for organizational culture and wellbeing outcomes, which limits the ability to pool results quantitatively. Contextual stressors such as heavy workloads were consistently identified as attenuating factors. Conclusion While the current evidence base is of low quality and characterized by high heterogeneity, the synthesized findings suggest that fostering a positive, ethical, and supportive organizational culture is likely a key factor in enhancing nurse happiness and retention. Due to the limitations of the existing literature (primarily cross sectional designs), these associations should not be interpreted as causal. Healthcare leaders should consider cultural interventions as part of a broader strategy to improve workforce wellbeing, while prioritizing future longitudinal research to establish robust evidence for policy making.