Leaders are in best position to facilitate the changes because they are considered as change agents. Transformational leadership is defined as a leadership approach that causes changes in individuals and social systems. The purpose of this study was to determine leadership styles of nurse managers and their outcomes in government hospitals in Hail City (Saudi Arabia). The study respondents were head nurses and nurses working in 4 government hospitals. The Multifactor Leadership Questionnaire was used to measure nurse manager leadership styles as perceived by nurses and the nurse managers themselves. There were no significant differences between the perceived leadership styles of the nurse managers themselves and the perception of the nurses on the nurse managers' leadership styles (P = 0.719). When determining whether there was a significant association between the perceived leadership styles of the nurse managers and the outcomes of that leadership, the results yielded a significant (moderate) relationship between a transformational leadership style and the outcomes of leadership in terms of extra effort (P = 0.000), effectiveness (P = 0.000), and satisfaction (P = 0.000).