Background <p>Based on the social exchange theory, this study examines how servant leadership influences the nursing staff’s job-related outcomes by fostering perceived member status and interpersonal coordination. Precisely, the study investigates the mediating mechanism of perceived member status and interpersonal coordination in the relationship between servant leadership and job-related outcomes, i.e., job execution, psychological safety, and institutional identification. The study further explores the moderating role of a symbiotic diversity setting (SDS) between servant leadership, perceived member status, and interpersonal coordination. The SDS refers to the workplace environment in which employees from diverse backgrounds collaborate via mutual support. Furthermore, to synthesize the existing literature and validate the link between variables, the study conducted a meta-analysis.</p> Methods <p>We used a multi-source survey design for data collection. Validated measurement scales, i.e., questionnaires, were distributed among the nursing staff and healthcare managers working in the leading hospitals of Pakistan. For estimating the hierarchical nature of data, multilevel modeling was used to evaluate within-group, between-group, and cross-level relationships. In addition, meta-analytic procedures were used to synthesize and validate the relationship between the study variables. For data analysis, we used Python (v3.12) and JASP version 0.16.4.0.</p> Results <p>The findings indicate two key process mechanisms, i.e., perceived member status and interpersonal coordination, that partially mediate the link between servant leadership and job-related outcomes. Moreover, a symbiotic diversity setting is found to be a significant boundary condition that strengthens the relationships linking servant leadership with perceived member status and interpersonal coordination.</p> Conclusion <p>This study demonstrates that the effectiveness of servant leadership in healthcare is not solely direct but operates via vital relational mechanisms and contextual conditions. The findings indicate that servant leadership improves employee outcomes by fostering social exchange processes, emphasizing the critical role of leadership-driven relational dynamics in shaping workplace functioning.</p> Clinical trial registration <p>Not applicable.</p>