This cross-sectional study investigates the relationship between nursing leadership styles and patient satisfaction in 4 public hospitals in Saudi Arabia. The nonrandom convenience sampling method was used with 150 nurses who were involved in caring for 180 patients from 4 different hospitals in the central region of Saudi Arabia. Nursing leadership styles were assessed from nurses using the Multifactor Leadership Questionnaire, while patient satisfaction was measured using the Patient Satisfaction with Nursing Care Quality Questionnaire. Passive-avoidant (PA) leadership style was most prevalent among nurse managers (62.6%, n = 94) and was associated with the lowest patient satisfaction (m = 1.7, SD = 0.1), with ratings ranging from 0 (low satisfaction) to 4 (high satisfaction). Analysis of variance (ANOVA) revealed a statistically significant difference in patient satisfaction scores among leadership styles (F (3, 176) = 25.421, P <
.001). The transactional leadership demonstrated higher mean scores (m = 2.7) compared to both the PA leadership style (m = 2.1) (MD = 0.60, SE = 0.071, P <
.001, 95% CI [0.42, 0.79]) and the transformational leadership leadership style (m = 2.2) (MD = 0.54, SE = 0.10, P = .004, 95% CI [0.21, 0.88]). Conversely, the PA leadership style had lower mean scores (m = 2.1) than both the transactional leadership group (MD = 0.60, SE = 0.07, P <
.001, 95% CI [0.42, 0.79]) and the outcome leadership style (m = 2.5) (MD = 0.37, SE = 0.09, P = .008, 95% CI [0.09, 0.65]). In Saudi Arabian public hospitals, PA leadership style was found to be the most prevalent among nurse managers, associated with the lowest levels of patient satisfaction. These findings underscore the importance of nursing leadership styles in affecting patient satisfaction. Further research is needed to explore the specific strategies that can be employed to foster effective leadership styles for improved patient outcomes.