Background: Leadership enacted by nurse managers shapes patient safety, nurse satisfaction, and retention. Transformational leadership (TL) is theorized to empower staff and improve outcomes, whereas transactional leadership (TAL) relies on contingent reward and monitoring. We aimed to synthesize empirical evidence comparing TL and TAL among nurse managers in relation to patient safety, nurse satisfaction, and turnover‐related outcomes. Methods: We followed PRISMA guidance. Eight records were supplied a priori; one was a duplicate of the same journal article (repository vs publisher), yielding seven unique empirical studies. We extracted design, setting, measures, and findings; risk of bias was appraised qualitatively. Results: Across three studies, TL related to stronger safety culture/practices and fewer adverse events, with mediation by empowerment/safety culture. Two studies linked TL to higher job satisfaction versus TAL, while passive/laisser-faire elements were unfavorable; contingent reward (a TAL component) showed limited, context-specific benefits. Two studies associated TL with lower anticipated/predicted turnover; TAL showed null or weaker associations. Conclusions: Evidence consistently favors TL over TAL for patient safety, nurse satisfaction, and turnover intentions. Contingent reward may help in specific contexts, but passive-avoidant behaviors are detrimental. Investment in manager training that builds TL behaviors and safety culture is warranted.