The Nurse Executive: Who is allowed to be a nurse leader?
Too many nurse leaders are turned away—not for lack of skill, but because they don’t ‘fit’ a narrow mold.
People sometimes assume that leadership roles go to the person who “fits” best — the one who communicates the way others expect, plays by unwritten social rules, and never makes anyone uncomfortable. But there’s another side to leadership. Sometimes the most capable, committed person in the room doesn’t fit those norms, and the differences that make them valuable are also the ones that get misunderstood, especially when bias —conscious or not— creeps in.
It happened to me.
I’ve spent decades in nursing—leading, mentoring, teaching, and building programs designed to improve outcomes and elevate practice. I’ve always believed that strong leadership is rooted in ethics, clarity, and a commitment to systems-level change. But over time, I’ve come to wrestle with a difficult, personal question:
Who is allowed to be a nurse leader?
That question stopped being theoretical when, despite years of high performance, successful collaborations, and national recognition, I began to sense a shift. Invitations to meetings quietly stopped. Communication from key colleagues faded. I was no longer included in the work I’d been hired to lead.
Through indirect comments and backchannel conversations, I came to understand that I was being perceived as… uncomfortable. Not my work, not my results—but me. My communication style. My presence. My difference.
I wasn’t given direct feedback or a chance to respond—just the clear signal that I was no longer welcome in certain rooms.
The doors didn’t slam; they simply stopped opening.
I am neurodivergent. I think fast, speak directly, and hold systems accountable. I notice patterns, ask questions others might avoid, and stay focused on outcomes that matter. These traits have helped me lead complex initiatives, coach rising leaders, and improve care delivery. But in this environment, they seemed to create friction.
Not because of any failure. But because I didn’t feel familiar.
That experience forced me to confront something many of us already know: leadership in nursing isn’t always about capability. Sometimes, it’s about comfort. It’s about whether your presence matches the unwritten expectations of those in power—how you talk, how you relate, how easily you fit in.
So I ask again:
Who is allowed to be a nurse leader?
I’d like to invite you into this question with me:
If you’re neurodivergent: Have you ever found yourself excluded without clear explanation? Have you picked up on perceptions about your tone, intensity, or “fit” that seemed to matter more than your actual work?
If you’re neurotypical: Can you think of a time when a colleague made you uncomfortable—not through harmful behavior, but simply because they communicated differently? Is it possible that discomfort was about neurodiversity rather than conflict?
Most importantly:
Can neurodivergent nurses be leaders—even if we sometimes make others uncomfortable?
And if not, what does that mean for the future of our profession?
I believe we need more ways of thinking at the table—not fewer. But that means reexamining how we define leadership, and who gets pushed aside when they don’t match the mold.
Let’s talk about it. I’d love to hear your experiences, your reflections, your questions.
Because this isn’t just about me. It’s about building a nursing profession that’s brave enough to lead with equity—and smart enough to make room for every kind of mind.
Keep leading,
Pam
