Background: Healthcare systems face persistent shortages in nursing leadership, high turnover among nurse managers, and variability in quality outcomes. Leadership instability contributes to workforce disengagement, increased burnout, and diminished patient care quality, underscoring the need for structured, competency-based approaches to leadership development.

Objective: This study synthesizes empirical and theoretical evidence on nursing leadership competency frameworks and advances an integrated competency-to-outcome model linking leadership development to workforce retention, quality outcomes, and strategic human capital optimization.

Methods: An integrative review methodology was employed following Whittemore and Knafl [1], incorporating PRISMA-aligned processes for transparency. A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science (2010–2025) yielded 1,320 records, of which 65 studies met the inclusion criteria. Data were analyzed using thematic synthesis to identify core competency domains and their relationships to workforce, clinical, and organizational outcomes. Findings were mapped onto a multilevel conceptual framework that incorporates mediating mechanisms and feedback loops.

Results: Four interrelated competency domains emerged: foundational, operational, strategic, and transformational leadership. These competencies influence outcomes through key mediators, including leadership behaviors, organizational culture, psychological safety, and work environment quality. Evidence consistently demonstrates that competency-based leadership development is associated with reduced turnover, lower burnout, increased job satisfaction, improved patient outcomes, and strengthened leadership pipelines. The proposed model highlights dynamic feedback loops in which improvements in retention and performance enable reinvestment in leadership development, thereby reinforcing organizational capability.

Conclusion: Competency-based leadership development serves as a strategic infrastructure within healthcare organizations, shaping workforce stability, care quality, and long-term organizational performance. Integrating leadership competencies into human capital strategies, including succession planning, workforce analytics, and competency-based advancement, offers a scalable and sustainable approach to leadership pipeline development and organizational resilience. These findings support a paradigm shift from episodic training to continuous, system-integrated leadership development.