Transitioning into a leadership role is difficult. If, like many nurses, you were promoted into a leadership role because you stood out as an excellent caregiver, you’ve likely found that leadership requires a different set of skills than the ones that made you effective at the frontline. You’re now the point person for solving virtually any and all problems that arise in your areas of oversight. Suddenly you’ve become responsible for managing operations, financial performance, human resources, and mediating a variety of conflicts. As a new nurse leader you may have little or no formal training in these disciplines, so there is a significant amount of technical knowledge and skill to absorb.
With all this learning, there are some lessons that are uniquely difficult. Not because they are cognitively difficult to grasp, but rather they are hard to swallow. Hard to understand, internalize, and integrate into your identity, philosophy, and behavior as a leader. While this is certainly not an exhaustive list of such lessons, I’ve chosen five that I found transformative in my development as a nurse leader to reflect on here.
Lesson 1: No, you really can’t make everyone happy
It might be a cliche, but it is an important truth that is best learnt early. Healthcare organizations are dizzyingly complex, and nursing care is often at the center of multiple webs of this complexity. As a nurse leader, you will be asked to meet demands from a seemingly endless array of stakeholders. This includes your staff, the leaders in your chain of command, other patient care areas, support departments, vendors, and… I almost forgot, patients.
It’s normal to want to meet all these demands, especially as a new leader because it seems like an obvious measure of your own competence. Spoiler: it’s not. In fact, when you try to please everyone and meet all the demands made of you, you only sabotage your own effectiveness. The harsh reality of leadership is that you must make difficult choices that will inevitably upset some people. If you try too hard to make everyone happy, you risk becoming a chameleon – undermining peoples trust through overcommitting, overpromising, poor follow-through, and inconsistency.
The antidote: develop a clear set of values and priorities that balance personal authenticity and alignment with your superiors. Then do your best to act consistently with those values. Also prioritize your level of obligation toward your various relationships. For example, your relationship and responsibility to the staff who report to you and the patients on your own unit is fundamentally different than that with the lab. Know which matter most to you and to your oversight, and stick to those priorities
Lesson 2: Employees leave good nurse leaders, too
You’ve probably heard the popular aphorism “employees don’t leave bad jobs, they leave bad managers.” There is some truth to this, but the full picture is more complicated, especially in healthcare.
Nursing shortages and increasing demand have created an environment with myriad employment options and shorter on-ramps to specialized roles across settings. In 2025, Nurses can truly cherry-pick their career opportunities. Job-seekers are in the drivers seat as organizations expend tremendous resources to recruit and retain an adequate nursing workforce.
Further, millennial and Gen z nurses are less likely to remain in jobs for a long time, preferring more frequent transitions and shorter tenures compared to their more senior colleagues.
Importantly, people’s lives are also complicated. Circumstances change, influencing what your employees need and want from work, and what they can realistically give to their employer.
When an employee resigns or transfers, it’s easy to take this personally as a sign of your failure as a leader. While that might be the case, it is wise to evaluate the situation on its own merits. Sometimes people leave for perfectly good reasons that have nothing to do with you. Other times, you may find a resignation reveals ways you could be more effective. In both cases, learn quickly and move on.
Lesson 3: Politics matter
In this case, I mean organizational politics. Many people have an “ick factor” attached to the concept of organizational politics, associating it with poor integrity, favoritism, and quid-pro-quo dealmaking. If you feel similarly, you may find yourself frustrated by the enormous role that politics plays in organizational decision making and resource allocation. You can either struggle against this reality or learn the skills to be effective in internal politics.
This doesn’t mean eschewing your ethical principles and becoming a swindler, it simply means paying more attention to the role of relationships in getting things done. Every good nurse leader needs to be an effective politician, but simply being an effective politician does not make you a good leader.
Take time to get to know your colleagues as people, help them solve problems, praise and celebrate their successes, and make them look good in front of their peers and bosses. Do it sincerely and honestly. Spend more time and energy listening and assess where key people stand on organizational issues. Use informal conversations to plant seeds and shift perspectives. Often this means playing the long game instead of trying to get your way in the short term. This is closely related to Lesson # 5.
Lesson 4: You will be judged unfairly
All leaders are under a microscope. as outlined in Lesson # 1, many people will have expectations and demands of you. They will also be closely watching how you behave and communicate. Unfortunately, though, you will very rarely get “credit” for handling situations well. A single negative interaction, however, can leave a large blemish on your reputation and take a long time to recover from. This risk is inversely related to how frequently you interact with the person. The resulting challenge is that for every thousand situations you handle diplomatically, one misstep will have more weight in the sum of your reputation. What’s worse is, some of the people occupying this risky zone of infrequent interactions are likely powerful in the organization, impacting your prospects for promotion or strategic assignments in the future.
Is it fair? No. But it is reality. The antidote is to become mindful of your audience. You cannot engage a room full of senior leaders the same way you engage with your peers or your staff. Recognize that colleagues who don’t work with you often wont be tuned into your nonverbal quirks and use of humor, sarcasm, or hyperbole; proceed cautiously and adapt your approach.
Lesson 5: Nobody cares if you’re right
This is the hardest one. You’re a smart person; you couldn’t be a nurse if you weren’t. You would not be in a leadership role if you didn’t at least occasionally have a good idea. You’re probably pretty good at solving certain kinds of problems, and you likely have a degree of expertise in your clinical specialty. I bet you could fix the quality scores if people would just. listen!
Unfortunately, even if you’re right, no one cares. Nobody cares that you have experience. Nobody cares that you have data. Nobody cares that the literature agrees with you. And absolutely no one gives two you-know-what’s about your advanced education and credentials.
Okay, maybe its not that harsh, but what’s my point? My point is that decisions aren’t made based on who is objectively right, they’re made based on how people feel about the options. This is closely related to Lesson # 3 in that relationships, persuasion, and influence matter more than evidence. What’s more, people don’t like a know-it-all, even when they have their facts straight. Flaunting your expertise comes across as arrogant and sometimes simply reveals how little you actually know.
On the other hand, people love it when they are right. It feels like “winning” and makes them feel smart and valued. The ultimate act of influence is to get someone else to propose your idea and think it was their own; let them take credit too. How? Ask more questions and make fewer suggestions. Invite exploration of new perspectives with “what if we…?” questions. Reflect back to ensure you actually understand the problems. Most importantly, be humble and open to being wrong, or to having your ideas improved upon.
Leadership is a lifelong journey, and the hardest skills to learn are neither technical nor clinical, they are relational. These are a handful of those lessons that, while difficult, are transformative in developing your leadership potential. The earlier you learn and internalize them, the more effective you will be.
