Aim <p>This systematic review examines the relationship between transformational leadership and extra-role behaviors among nurses, focusing on how this leadership style influences nurses’ engagement in activities beyond their formal job responsibilities.</p> Subject and methods <p>A systematic review was conducted across databases, including PubMed, CINAHL, Scopus, and Web of Science, covering studies from 2014 to 2024. The PRISMA guidelines were followed, with study selection, data extraction, and quality assessment using standardized tools and the Cochrane Risk of Bias and Joanna Briggs Institute checklists.</p> Results <p>Eighteen studies, primarily cross-sectional, from various countries were included. The findings consistently show that transformational leadership positively influences extra-role behaviors by enhancing nurses’ job satisfaction, motivation, and organizational commitment.</p> Conclusion <p>Transformational leadership significantly impacts extra-role behaviors among nurses, improving patient care and organizational outcomes. Leadership development tailored to specific cultural and organizational contexts is crucial for maximizing these benefits. Nursing managers should prioritize the development and implementation of transformational leadership training programs tailored to their specific cultural and organizational contexts to foster extra-role behaviors among nurses, thereby enhancing both patient care and organizational effectiveness.</p>