Aim: This study aimed to investigate the relationship between toxic leadership and nurse followership effectiveness. Design: A quantitative cross-sectional study. Methods: This study was carried out in all medical and surgical inpatient care units at Alexandria Main University Hospital. In total, 343 nurses completed the toxic leadership scale and followership styles questionnaires. Frequencies and percentages were used to present demographic characteristics; means and standard deviations were used to present continuous variables. An independent sample t-test, Pearson correlation, and linear regression analysis were conducted to test the nature of the relationship between study variables. Results: The results indicated a slightly moderate mean percentage score for toxic leadership and a slightly high mean percentage score for nurse followership effectiveness. In addition, there was a significant negative weak correlation between toxic leadership and nurse followership effectiveness. Conclusion: Training programs should be designed for leaders and followers to develop self-insight / awareness, maintain self-control and accountability, and advance followership skills. Controlling systems should be developed for the immediate identification of ongoing toxic leadership behavior in the organization, and a whistleblower protection system should be established.