Rethinking Leadership Beyond Roles and Titles
By Alicia Sacks, NNP-BC DNP
In the field of neonatal nursing, leadership is often equated with positions such as charge nurse, nurse manager, or director of nursing. These formal titles come with defined responsibilities and recognition, but leadership is not confined to hierarchy. Leadership is a mindset, a set of behaviors, and a commitment to advocacy and influence, regardless of rank or title.
Neonatal nurses, in particular, demonstrate leadership daily through clinical expertise, patient advocacy, communication, and mentorship. Recognizing and cultivating informal leadership is essential to advancing nursing practice, improving patient outcomes, and sustaining a positive workplace culture.
Defining ‘Informal Leadership’
Informal leadership refers to the ability to influence others and contribute to a shared goal without holding a formal leadership position. This type of leadership is rooted in credibility, trust, initiative, and communication (Vana & Tazbir, 2021). In the context of neonatal care, informal leadership might involve a bedside nurse mentoring a new team member, initiating a quality improvement project, or guiding a family through a difficult care decision. These actions are not defined by a job description but are critical to the function and integrity of a healthcare team.
According to Lawson and Fleshman (2020), coworkers respect informal leaders due to seniority, skill, maturity, and influence. They model best practices, maintain calm in crisis, and advocate for both patients and colleagues. Though they may not carry an official leadership title, their influence can shape team dynamics, drive change, and create a culture of excellence.
Examples of Leadership Without a Title
In the neonatal intensive care unit (NICU), the nature of patient care often demands leadership from every team member. For instance, when a neonatal nurse recognizes early signs of sepsis and swiftly coordinates with the care team, that proactive response demonstrates clinical leadership. Similarly, when a nurse supports a family in understanding complex medical information or facilitates culturally sensitive care, they lead by fostering trust and empowerment.
Another example of informal leadership includes advocating for policy changes based on observed patient needs. A nurse might notice that families struggle with discharge planning and take the initiative to create a more effective education tool. These types of contributions not only improve patient outcomes but also strengthen the system in which nurses work.
Barriers to Recognizing Informal Leadership
Despite the value of informal leadership, many nurses do not view themselves as leaders unless they hold a managerial title. This mindset can be influenced by organizational culture, lack of recognition, or limited leadership training during nursing education (Cummings et al., 2021). Nurses may undervalue their contributions or assume that leadership requires seniority or credentials. Fostering a culture that recognizes and develops informal leadership can empower more nurses to lead confidently from where they stand.
To overcome barriers, nurse leaders and educators must redefine what leadership looks like in practice. Creating mentorship programs, offering leadership workshops, and recognizing everyday acts of leadership can help nurses at all levels see their potential and value.
Resources to Cultivate Leadership Skills
Developing leadership skills doesn’t require a promotion—just initiative and the right tools. Fortunately, several professional resources exist to support nurses who want to grow their influence:
- The National Association of Neonatal Nurses offers resources such as the Emerging Leader Fellowship, NANN Mentor Program, and educational webinars tailored for neonatal nurses. These programs provide guidance on communication, advocacy, and strategic thinking.
- The American Nurses Association (ANA, 2025) provides a variety of leadership development resources, including toolkits, self-assessment instruments, and continuing education on leadership in clinical practice. ANA emphasizes that leadership is a core nursing competency, not specialized to specific roles.
- Nursing Leadership Webinars, available through organizations such as the American Organization for Nursing Leadership (AONL, 2025), equip bedside nurses with the skills and confidence to take on leadership responsibilities, regardless of whether they intend to pursue a formal leadership title.
You can also develop your informal leadership by attending local conferences, joining professional committees, reading leadership literature, or collaborating on unit-based projects.
Each opportunity you participate in contributes to a broader leadership identity.
Leading From Where You Stand
Leadership in nursing is not about power or prestige; it’s about influence, integrity, and the desire to create positive change. Every nurse has the capacity to lead, and many already do in ways that may go unrecognized. As the demands of health care evolve, cultivating leadership at every level is essential, not just beneficial.
Nurses who lead without a title create ripple effects in patient care, team morale, and organizational performance. They model professionalism, elevate standards, and inspire others. By acknowledging and supporting this kind of leadership, we expand what is possible in nursing practice.
As neonatal nurses continue to advocate for the smallest and most vulnerable patients, their leadership is already evident—in the ways they teach, listen, act, and care. It is time to celebrate and cultivate that leadership, title or not.
References
American Association of Critical-Care Nurses. (2025). Fundamental Skills for Nurse Managers. https://www.aacn.org/education/online-courses/fundamental-skills-for-nurse-managers
American Association of Colleges of Nursing. (2025). Developing Nursing Well-Being and Leadership Tool Kit. https://www.aacnnursing.org/developing-nurse-well-being-and-leadership-tool-kit
American Nurses Association (2025). Leadership and Excellence. https://www.nursingworld.org/continuing-education/ce-subcategories/leadership/
Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P. M., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115, 103842. https://doi.org/10.1016/j.ijnurstu.2020.103842
Vana, P. K. & Tazbir, J. (Eds.). (2021). Kelly Vana’s nursing leadership & management (4th ed.). Wiley-Blackwell.
Lawson, D. & Fleshman, J. W. (2020). Informal leadership in health care. Clinics in Colon and Rectal Surgery, 33(4), 225-227. https://doi.org/10.1055/s-0040-1709439