Digital-Era Nurse Leadership and Psychological Empowerment DuringeHealth Implementation: A Systematic Review

Abstract

Background:
Hospitals continue to scale telehealth and electronic health records (EHRs), placing nurse leadership and psychological empowerment at the center of successful implementation. Leadership that protects learning time, ensures responsive support, and involves nurses in redesign is theorized to improve adoption and retention.
Methods:
A systematic search (PubMed) from inception to May 2025 identified studies of hospital-based nurses examining leadership constructs and psychological empowerment during telehealth/EHR implementation. Eligibility required quantitative or mixed-methods designs reporting adoption or retention (intent-to-stay/leave) and empowerment measures. Two reviewers screened, extracted, and synthesized data narratively in line with PRISMA.
Results:
Nine observational studies (cross-sectional or cohort) were included. Adoption-related findings showed that leadership and empowerment-adjacent factors (competence, autonomy, self-efficacy) were associated with higher readiness and use. Examples included EHR readiness 52.8% (95% CI 47.9-56.6) with higher odds among staff with positive attitudes and technology self-efficacy; comprehensive EHRs were associated with fewer fair/poor quality ratings (OR 0.83; 95% CI 0.71-0.96). Implementation leadership independently predicted nurses’ actual use of mobile health at the point of care (β 0.22; p=0.001).
Conclusions:
Across diverse hospital settings, digitally competent, supportive leadership that fosters psychological empowerment aligned with higher eHealth adoption and more favorable retention signals. Implementation programs should integrate leadership development, co-design, usability remediation, and protected learning time.