Estimated reading time: 10 minutes
Nurse leaders can include charge nurses, educators, managers, directors and chief nursing officers, but search for “nurse leadership” on the web and you’ll likely find articles full of abstract theories that feel disconnected from the chaos of a busy floor, or generic info woven into a glossy recruitment pitch for a nursing graduate program.
The reality of nurse leadership is different. Most nurses don’t wait for a formal title or a managerial designation to start leading and it isn’t a switch that you flip; it’s a day-to-day practice that’s built into the work of your bedside care.
This article will help you cut through the rhetoric and give a grounded-in-reality view of what nurse leadership actually looks like in practice, and how to get there. Whether you’re a bedside nurse deciding if leadership is worth the leap, or a manager trying to stay effective, here’s what it takes to be a good leader.
A recent small poll on Sermo captured the opinions of bedside nurses, charge nurses, nurse educators, nurse managers and more on the topic of nursing leadership. No matter what role you play on the floor, there’s a place for you at Sermo – join the discussion today.
What nurse leadership actually is
At its core, nursing leadership is the practice of influencing patient care, staff development and healthcare systems through evidence-based decision-making and team coordination. In other words, when you’re improving care in ways beyond direct hands-on bedside tasks – you’re acting as a leader.
Leadership roles can be either formal (that is, carrying an official title) or informal. Here’s what each looks like.
Formal leadership
Potential titles: Charge nurse, clinical educator, nurse manager, director of nursing, nurse executive, CNO.
What they do: This type of role is on the organizational chart and has explicit authority over staffing, scheduling, evaluation or strategy. Someone in this role may be responsible for ensuring that the facility is following evidence-based practices set by the Joint Commission and other regulatory bodies. They can also guide patient care by making adjustments to care plans when needed, with input from bedside nurses.
Informal leadership
Potential titles: Senior staff nurses, preceptors, unit-based champions for quality improvement or evidence-based practice, peer mentors.
What they do: While these roles aren’t on the org chart, it has a pivotal role to play in shaping unit culture, development of new graduates and clinical outcomes. Those in informal leader roles may mentor new and student nurses, and model high standards of patient care for coworkers. They can also help staff maintain composure during busy or stressful times by guiding team workflows for maximum efficiency.
Both formal and informal leaders are important for optimal functioning of a healthcare organization. According to AONL’s Strengthening Nurse Leadership Compendium, informal leaders can shape unit-level engagement and retention as significantly as formal managers in many settings.
Whether you are building influence on your unit or taking on flexible side projects like nurse moonlighting, developing your leadership skills can pay dividends at every stage of your career.
Is nursing leadership the right pathway for you?
Deciding whether to pursue a formal nurse leadership role can be influenced by personal preferences, professional goals and more. Informal leaders usually have better schedules and can engage in more hands-on clinical care than formal leaders.
Formal leaders, on the other hand, typically earn higher salaries and are in a better position to drive systemic change; however, they also put in longer hours and have more administrative work, like budgets and scheduling. Medical and health service managers—often including roles such as nurse managers, directors of nursing, and many “nurse executive” roles— earned a median annual salary of $117,960 in 2024, compared with $93,600 for registered nurses. Actual earning differences will depend on your role, experience, employer and location.
When deciding whether to pursue a nursing leader role, asking yourself the following questions can help you determine the right move to make:
- How many hours am I comfortable working every week?
- What annual salary do I want to make?
- Am I okay with more paperwork and less direct patient care?
- What kind of impact do I want to have on my organization?
If leadership is the path you decide to take, the steps below will help you get started.
How to become a nursing leader (the practical path)
According to a recent small poll from Sermo, many nurses are considering a leadership path, and some definitely plan to pursue it in the next one to two years. While no two journeys to nurse leadership ever look exactly alike, they tend to follow the same general steps.
Step 1: Build clinical credibility
This is the foundation of all nurse leadership. Without strong clinical credibility, nurses who attempt to step into leadership will consistently struggle to earn the respect of their teams. You can improve credibility by:
- Honing your clinical assessment skills
- Mastering patient care workflows
- Consistently demonstrating reliable judgment in stressful situations
Step 2: Take on informal leadership opportunities
You don’t have to wait for a formal title to start expanding your influence. There are plenty of ways to demonstrate leadership that don’t involve promotions. In fact, most nurses who move into formal leadership positions start with these informal opportunities. They can include:
- Taking on charge nurse rotations
- Serving as a preceptor for new hires
- Volunteering to work on quality improvement initiatives
Step 3: Pursue education aligned with your target role
Once you decide which type of leadership role you’d like to take on, you may want to invest in a relevant academic degree (this may require some financial planning). The main types of credentials are:
- Bachelor of science in nursing (BSN) – This is typically sufficient for charge nurse and clinical educator roles; make sure you pursue continuing education in leadership topics as well.
- Master of science in nursing (MSN) – Many organizations prefer that nurse managers have this degree. Some nurses pursue MSNs in nursing leadership or healthcare administration.
- Doctor of nursing practice (DNP) – If you’re interested in a director, executive or CNO role, this may be a requirement, especially within major health systems.
Step 4: Earn relevant credentials
Outside of specific degree programs, credentials and certifications can further increase your know-how and credibility. Some of these include:
- Certified Nurse Manager and Leader (CNML) through AONL: the standard credential for nurse managers.
- Certified in Executive Nursing Practice (CENP) through AONL: the standard credential for nurse executives.
- Nurse Executive-Board Certified (NE-BC) through ANCC: for nurse managers and directors.
- Nurse Executive Advanced-Board Certified (NEA-BC) through ANCC: for senior executives and CNOs.
- Clinical Nurse Leader (CNL) through CNC: for unit-based leadership at the point of care.
Step 5: Pursue leadership development training
Continuing education specifically focused on healthcare leadership will help you develop the skills you need for administrative roles that you might not get exposure to in regular clinical practice. Some options to pursue include:
- National fellowships: Programs like AONL’s Nurse Manager Fellowship are highly respected; they can help you deepen strategic leadership skills and expand your professional network.
- Internal programs: Many health systems, especially Magnet-designated hospitals, offer these as a way of developing future leaders. They may include assistant manager residencies, transition-to-practice programs for new nurse managers, and executive development cohorts that combine learning with mentorship.
Step 6: Build your leadership network
Nursing leadership is a more relational field than most, which means you’ll rely heavily on professional connections to unlock opportunities for career growth. Potential avenues for these connections include:
- Relevant personal contacts – Connect with other nurse leaders in your health system, your nursing specialty and your local area, and use their battle-tested wisdom to sharpen your own skills.
- Formal associations – State nursing associations, specialty leadership organizations and regional AONL chapters can help you network with local leaders, participate in policy discussions and gain greater professional visibility.
- The Sermo community – No matter where you are in the world, Sermo is a place to ask questions, share insights and learn more about what it takes to be a nurse manager. Connect with other nurses today to get started.
Step 7: Apply strategically and negotiate intentionally
Avoid the temptation to pursue every opening that you come across. Since your first formal leadership role can influence your long-term career trajectory, make sure that it aligns with your career goals and professional preferences. Negotiate for your desired compensation, and ensure you understand the scope of your new role before accepting it. Ideally, the position will also have protected time for you to work exclusively on leadership tasks.
Potential avenues for leadership positions include:
- Internal promotions – This is the most common path into a nursing management role. When applying, leverage your existing workplace network, and make sure to tout your on-the-job accomplishments.
- External opportunities – Pursue these when seeking a higher-tier or specialized role, or if you’re looking for a new organizational culture.
Nursing leadership styles
Nurse managers and leaders can impact nurses’ job satisfaction, as well as their burnout and retention rates, and can even improve patient outcomes. The primary nurse leadership styles include:
- Transformational leadership
- Servant leadership
- Democratic leadership
- Authentic leadership
- Situational leadership
- Autocratic leadership
- Laissez-faire leadership
For more details on each of these styles—and to figure out which style best suits you—read our comprehensive guide to leadership styles in nursing.
Challenges nursing managers face today
The professional landscape is becoming more complex as healthcare systems continue to evolve. Here are some priorities that nursing leaders are actively grappling with.
Staff retention and the post-pandemic workforce reality
According to AONL’s 2024 workforce compendium, nurse retention is the single-most-cited priority for nurse leaders in 2026. It was also mentioned as an important focus area by many nurse respondents to a recent small Sermo poll. However, it’s no small feat; workforce shortages, increased pressure to improve patient outcomes, and the ever-present risk of nurse burnout all make it challenging to retain competent nurses.
Superficial morale boosts that don’t address structural issues, like occasional pizza parties and fleeting recognition events, don’t prevent high nurse turnover. Here are some examples of what does:
- Purposeful interactions – Conduct quick, informal one-on-ones with staff to keep aware of their concerns, remove operational barriers and pinpoint whose stress levels are becoming dangerously high.
- New-hire touchpoints – Establish formal check-ins and a structured onboarding program with new staff at 30-, 60- and 90-day intervals to get a feel for how they’re doing and spot problems early on.
- Structured mentorship – Pair new hires with more-experienced colleagues to help them learn the ropes, increase their clinical confidence and reduce transition shock.
Hybrid and virtual team leadership
Nursing is no longer an exclusively in-person job. The growth of telehealth nursing and virtual nursing roles has created new team structures in many organizations, with some people on the floor and others practicing from remote locations. Nursing leaders are often expected to manage these types of teams without explicit training. For success in a hybrid or remote environment, AONL advises that leaders need to be skilled at “inclusivity, collaboration, communication, trust and psychological safety.”
Digital transformation and AI
Technological skills are a must-have for today’s nursing managers and leaders. You may be asked to lead organizational adoption of EHR enhancements, remote monitoring platforms, AI tools and more. In other words: Get comfortable with computers, because you’ll be using them a lot more than bedside nurses.
Nurse burnout
Nursing is a tough job, even on a good day. But nurse managers are in a prime position to address some of the structural drivers of nurse burnout, like poor scheduling and understaffing. Nursing leaders who want lasting impact should make these a prime focus in 2026. As a general nurse and medical director shared on Sermo: “Clinical quality and safety are always number one, but burnout and well-being [are] a close second. If our nurses are overworked and under-rested, then clinical care will suffer.”
The bottom line
At its core, nurse leadership is an evidence-backed practice that exists at every level of nursing – not just in the executive suite. The most effective nurse leaders combine clinical credibility, AONL core competencies and appropriate leadership styles. They intentionally develop their teams to improve patient care.
Nurses in any stage of their career can best develop their leadership capabilities by:
- Seeking out informal opportunities to lead
- Building clinical credibility
- Pursuing relevant degrees and credentials
- Treating leadership as a real career path instead of a title to chase
Standard nursing career advice rarely tells the whole story. In Sermo’s community of nurses, you’ll have access to the candid, unfiltered truth about nursing leadership – shared by peers who are navigating it every day.
