Nursing leadership is about critical thinking, action, and advocacy – and it happens in all roles and domains of nursing practice. Nursing leadership plays a pivotal role in the immediate lives of nurses and it has an impact on the entire health system. Both formal and informal and managers have to be acutely aware of the internal and external pressures that healthcare is facing and have the right skills and knowledge to be able to facilitate change in the 21st Century to improve patient outcomes. An accomplished manager will need to be equipped to deal with financial, quality and human resource management built on the foundations of a sound knowledge of the healthcare system and organizational structure and culture. Capable clinical leaders and managers are pivotal to the health care system as they are required to manage human and financial resources to provide quality patient care.