Background Paternalistic leaders serve as role models for their followers so that they understand the kind of behavior that is ethically unacceptable as nepotism and understand how ethical issues are handled as organizational justice. Aim This study aimed to investigate the effects of Paternalistic Leadership and Nepotism on Nurses’ Perception of Justice. Method A descriptive correlational design was employed with a Convenience sample of 267 staff nurses from one hospital, who had a minimum of two years of professional experience in the field and were willing to participate in the study. This prerequisite helps ensure that participants have a deep, practical understanding of the hospital’s culture and management. A nurse with two years of experience has moved beyond the initial training and orientation phase. They have a more comprehensive view of the workplace dynamics and have likely witnessed or been affected by various personnel decisions. Three instrument tools were used for data collection: The Paternalistic Leadership Questionnaire, which consisted of 15 items representing three dimensions; the Nepotism Questionnaire, which consisted of 12 items; and the Organizational Justice Questionnaire, which consisted of 44 items in five dimensions. Results A statistically significant positive correlation was found between total paternalistic leadership style and organizational justice (r = 0.549), and a statistically significant negative correlation was found between total nepotism practice and organizational justice (r = -0.337). More than half of the studied nurses perceive a moderate level of paternalistic leadership, less than half perceive a moderate level of nepotism practice, and less than half perceive a moderate level of organizational justice. Conclusion Based on the results of this study, we can conclude that the characteristics of paternalistic leadership, in the form of a good personality, being responsible, disciplined, and unselfish, as well as providing an example for subordinates. These moral values of paternalistic leaders regulate the ethical approach to decision-making and can create a fair environment, and be free from nepotism in an organization. Recommendations Develop a comprehensive onboarding program that includes orientation sessions, job-specific training, and mentorship programs related to paternalistic leadership style, nepotism practices, and principles of organizational justice. Implications for nursing Fairness is a critical leadership tool. Proactive nursing management must address issues of perceived injustice and nepotism head-on to build a resilient, engaged, and high-performing nursing staff. When nurses feel that leadership decisions are unfair or that nepotism is at play, it erodes morale and fuels burnout.