Leadership in Nursing and Advanced Practice

Leadership is part of advanced nursing practice whether or not your career includes a formal management role. The 2026 AACN Essentials include leadership development, systems-based practice, evidence translation, policy engagement, quality improvement, and organizational change within advanced nursing education (American Association of Colleges of Nursing [AACN], 2026).

For DNP-FNP students, leadership may occur in direct patient care, practice improvement, interdisciplinary teams, committees, professional organizations, policy work, education, or formal administrative roles. The setting changes, but many of the underlying skills are transferable.

This page focuses on those skills and how they apply to advanced nursing practice.

Skip ahead:

Leadership in Nursing and Advanced Practice

Leadership Extends Beyond Formal Authority

A job title can provide formal authority, but leadership also occurs through professional influence.

The American Organization for Nursing Leadership (AONL) describes contemporary nurse leadership through competencies that include leadership, communication and relational leadership, professionalism, knowledge of the healthcare environment, business skills, and development of the leader as an individual (American Organization for Nursing Leadership [AONL], 2026).

That broader view makes room for leadership in many forms.

A nurse may demonstrate leadership by identifying a recurring safety concern, helping a team examine a workflow problem, bringing current evidence to a practice discussion, contributing meaningfully to shared governance, mentoring a colleague, or advocating for a change in policy.

Formal leadership roles add responsibilities such as workforce leadership, strategic planning, financial management, regulatory leadership, and organizational accountability (AONL, 2026).

Leadership Principle

Professional influence grows when people can rely on your judgment, preparation, communication, and follow-through.

Understand the System Before Trying to Change It

Systems thinking expands the focus beyond individual actions to the structures, processes, relationships, resources, and policies influencing an outcome.

AACN identifies systems-based practice as an advanced nursing competency. Its current framework expects advanced-level nurses to analyze system processes, use performance data, develop improvement strategies, incorporate evidence, and evaluate the effects of system-level changes (AACN, 2026).

Before proposing a change, understand the current state.

Consider:

How the process currently works
Who participates in it
Where decisions are made
Which policies or regulations affect it
What resources are available
Where delays or failures occur
What data describe the problem
Who will be affected by a change
Which competing priorities may influence implementation

A problem that appears to be caused by individual behavior may also involve workflow design, staffing, technology, communication, unclear policy, access barriers, competing expectations, or resource limitations.

Systems thinking helps identify where an intervention is most likely to have an effect.

Leadership Principle

Map the current process before designing the change.

→ Explore the DNP Project Toolkit

Lead With Evidence and Data

Leadership decisions should be informed by more than tradition, personal preference, or the experience of a single clinician.

AACN’s scholarship competencies include appraising and synthesizing evidence, identifying inconsistencies between evidence and practice, translating evidence into practice, implementing change, and evaluating outcomes (AACN, 2026).

When you identify a practice problem, ask:

What does current evidence support?
What does local data show?
How large is the gap?
Who is affected?
What outcomes are already being measured?
What evidence supports the proposed change?
How will we know whether the change worked?

Published evidence and local data serve different purposes. Published evidence can inform what approaches are supported and how an intervention might be designed. Local data can establish whether a problem exists in your setting, describe its scope, and help evaluate whether performance changes after implementation.

Leadership requires connecting the two.

Leadership Principle

Bring both the evidence and the local data. They answer different questions.

→ Evidence-Based Practice & Research for DNP Students

Lead Change Deliberately

Healthcare organizations regularly implement new workflows, technologies, clinical recommendations, regulatory requirements, and quality initiatives. Introducing a change is only part of the work.

AACN’s systems-based competencies include assessing factors that influence improvement initiatives, engaging stakeholders, applying evidence-based strategies, evaluating outcomes, and developing approaches to sustain successful changes (AACN, 2026).

Before implementation, clarify:

What needs to change
Why the change is needed
Who will be affected
Who needs to participate in planning
What barriers are likely
What education or resources are required
How implementation will be monitored
Which outcomes will be evaluated
What will support sustainability

Stakeholder engagement deserves particular attention. People closest to the workflow may identify practical barriers, unintended consequences, and implementation needs that are difficult to see from outside the process.

Resistance can also provide useful information. Concerns about workload, safety, feasibility, resources, or unintended effects should be examined on their merits.

Leadership requires maintaining focus on the purpose of the change while remaining willing to modify the implementation strategy when evidence, data, or experience indicate that an adjustment is needed.

Communication and Relationships Shape Leadership

Communication is a clinical skill, a professional skill, and a leadership skill.

AONL places communication and relational leadership among its core leadership domains, alongside leadership, professionalism, healthcare-environment knowledge, business skills, and development of the leader within (AONL, 2026).

Leadership communication includes more than presenting an idea clearly. It also requires listening for information that changes your understanding of the problem.

In practice, that can mean:

Asking questions before proposing a solution
Explaining the reasoning behind a recommendation
Communicating uncertainty when it exists
Inviting perspectives from people affected by a decision
Giving specific and usable feedback
Receiving corrective feedback professionally
Addressing disagreement directly and respectfully
Closing the loop after decisions are made

Communication becomes particularly important when authority is distributed across professions, departments, or organizational levels. You may need cooperation from people you do not supervise and whose priorities differ from your own.

Credibility, relationships, and clear reasoning become especially important in those situations.

Leadership Principle

Before finalizing a decision, ask whose perspective is missing and whether that perspective could change the plan.

Accountability and Ethical Leadership

Leadership increases responsibility for how decisions affect other people.

The 2025 Code of Ethics for Nurses establishes accountability, advocacy, ethical practice, professional responsibility, and obligations to patients, colleagues, the profession, and society across nursing roles and settings (American Nurses Association [ANA], 2025).

Ethical leadership includes:

Being transparent about what you know and what remains uncertain
Recognizing the limits of your authority or expertise
Seeking appropriate input before consequential decisions
Addressing conflicts of interest
Protecting confidentiality
Taking responsibility for mistakes
Correcting misinformation
Applying standards consistently
Considering who may be helped or burdened by a decision

Accountability also includes evaluating what happens after a decision or practice change. A well-intended intervention can still produce unintended effects.

Nursing accountability can also be shared with organizations when systems or institutional conditions contribute to an outcome. ANA’s current Code explicitly recognizes both individual accountability and circumstances in which responsibility may also rest with an institution or organization (ANA, 2025).

Advocacy and Policy Are Leadership Work

Clinical care occurs within organizational policies, professional standards, regulation, payment structures, and broader healthcare systems.

Nursing advocacy can occur at multiple levels. ANA’s 2025 Code addresses advocacy for individual patients as well as nursing’s collective role in shaping healthcare practices, policies, legislation, and systems (ANA, 2025).

At the patient level, advocacy may involve raising a safety concern, addressing an access barrier, or helping ensure that a patient’s values and priorities are represented in decision-making.

Within an organization, advocacy may involve recommending a policy revision, presenting data to a committee, participating in shared governance, or supporting a change intended to improve care.

At the professional or policy level, nurses may participate through professional organizations, regulatory processes, community initiatives, public comment, legislative advocacy, or policy development.

Effective advocacy requires understanding an issue well enough to explain the problem, supporting evidence, affected stakeholders, and potential consequences of proposed solutions.

→ Explore Boards & Licensure

Leadership Influences the Work Environment

Workplace culture develops through organizational systems and the behavior of people working within them.

The American Association of Critical-Care Nurses identifies six standards for establishing and sustaining healthy work environments: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership (American Association of Critical-Care Nurses, 2016).

These standards reinforce that a healthy work environment depends on more than individual professionalism. Staffing structures, decision-making processes, organizational resources, communication norms, recognition, collaboration, and formal leadership practices all contribute to the environment in which care is delivered.

ANA’s current Code similarly states that nurses have individual and collective responsibilities for improving the ethical work environment, while nurses in formal leadership roles carry particular responsibilities related to fairness, safety, working conditions, and responsiveness to staff concerns (ANA, 2025).

Nurses without formal titles still influence team culture through communication, collaboration, accountability, and participation in decisions. Formal leaders have additional influence because they may control resources, staffing, policy implementation, evaluation, and organizational processes.

A healthy culture cannot depend on individual clinicians indefinitely compensating for dysfunctional systems.

Leadership Principle

Culture is reinforced by what a team repeatedly permits, rewards, corrects, and prioritizes.

Develop Leadership Deliberately

Leadership development is an ongoing professional process. AACN’s leadership-development domain includes self-reflection, professional growth, lifelong learning, adaptation, advocacy, and development of leadership capacity (AACN, 2026).

Graduate school provides opportunities to practice these skills before holding a formal leadership position.

Choose experiences that develop something specific:

Join a committee to understand how decisions are made.
Participate in quality improvement to see how change is implemented and measured.
Present evidence to strengthen professional communication.
Seek mentorship from someone whose judgment you respect.
Ask for feedback after difficult conversations.
Examine an organizational policy and the evidence supporting it.
Participate in a professional organization or advocacy activity.
Reflect on decisions that did not produce the outcome you expected.

Leadership development becomes more useful when reflection is specific.

Consider:

Did I understand the problem before proposing a solution?
Did I involve the people affected by the decision?
Was the recommendation supported by evidence?
Did I communicate clearly?
What resistance or concerns did I hear?
What happened after the decision?
What would I approach differently next time?

Those questions create something concrete to improve.

Leadership in Advanced Practice

Advanced practice creates opportunities to influence care at more than one level.

An FNP may make decisions with an individual patient while also noticing recurring access barriers, inconsistent practice patterns, outdated workflows, safety concerns, or system problems affecting an entire population.

DNP education prepares nurses to work across those levels. AACN’s current framework combines advanced clinical practice with scholarship, systems-based practice, interprofessional collaboration, professionalism, and leadership development (AACN, 2026).

Clinical expertise helps identify what is happening at the point of care. Evidence, data, systems thinking, communication, implementation skills, policy knowledge, and leadership help determine what can be improved beyond a single encounter.

Leadership becomes visible in what happens next: whether the concern is examined carefully, whether the right people participate, whether evidence informs the response, and whether the outcome is evaluated after a change is made.

Content last reviewed:

July 9, 2026

References

American Association of Colleges of Nursing. (2026). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2026.pdf

American Association of Critical-Care Nurses. (2016). AACN standards for establishing and sustaining healthy work environments: A journey to excellence (2nd ed.). https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

American Organization for Nursing Leadership. (2026). AONL nurse leader core competencies. https://www.aonl.org/resources/nurse-leader-competencies

↑