When I stepped into my first nursing leadership role, I thought I understood what leadership meant—to coordinate, organize, and support. Yet within months, I discovered that leadership extends far beyond management. It demands humility, courage, and the ability to hold space for others while continuing to grow yourself.
My first year as a nurse leader wasn’t defined by perfection but by progress as I learned to navigate difficult conversations, foster accountability, and lead with both evidence and empathy. It was also a year of discovering the importance of mentorship—not just for emerging nurses, but for leaders themselves.
Going where the work happens
Early in my journey, I came across the Japanese concept of Gemba, meaning “the real place” where the actual work takes place. In nursing, the Gemba is at bedside, in the hallway, at the nurses’ station. It’s wherever care is being delivered and teamwork unfolds.
In Gemba philosophy, problems are best understood and solved by the people who do the work every day. Those closest to the process hold the most insight into what’s working and what’s not. As a leader, that idea resonated deeply with me—the belief that lasting solutions come not from behind a desk, but from being present and engaging directly with those at the point of care.
Leading from the Gemba transformed my approach. Instead of observing from a distance, I began showing up where challenges were unfolding. I listened to staff frustrations, observed workflows, and experienced the team’s pressures firsthand. Presence became my most powerful leadership tool. When my team saw me in the thick of things—troubleshooting a monitor alarm or helping transport a patient—they saw that leadership isn’t about authority, but shared accountability.
Accountability with compassion
Accountability was one of the hardest yet most meaningful lessons of my first year. True accountability isn’t about blame; it’s about ownership, and it starts with the leader.
After every challenging shift or conversation, I asked myself: What could I have done differently? How did my communication affect this situation? That self-reflection set the tone for my team. Accountability became less about pointing out mistakes and more about cultivating trust.
One of the most transformative parts of becoming a leader is learning to lean into difficult conversations, even when it’s uncomfortable. That’s where real growth happens—in the moments when you choose courage over avoidance. Leaning in with empathy and intention not only strengthens relationships but also builds the kind of trust that anchors a healthy work environment.
Creating psychological safety became a priority for me. I want staff to feel safe bringing forward their concerns, frustrations, or mistakes without fear of judgment. For me, psychological safety means being the kind of leader others can approach when problems arise and knowing that listening is sometimes more powerful than solving.
One of the ways I promote this is by recognizing and celebrating vulnerability. During one of our huddles, I publicly acknowledged a nurse who had brought up a concern about a workflow issue. Instead of seeing it as criticism, I framed it as courage and as someone speaking up for patient safety and team improvement. That moment reminded the whole team that raising issues isn’t about blame; it’s about progress. When people feel heard and supported, accountability transforms from correction into collaboration.
Over time, I learned to approach these conversations with curiosity and composure. I focus on behaviors, not personalities, and I keep the goal anchored in growth rather than discipline.
Mentorship for nurses and for leaders
Mentorship became the most meaningful part of my leadership journey. Early on, I realized that many emerging nurses simply need reassurance and guidance—someone to help them connect their passion to purpose.
But I also learned something equally vital: leaders need mentors, too. I was fortunate to have senior leaders who supported me, offered perspective, and reminded me that I wasn’t alone in navigating challenges. Their experience helped me make sense of difficult moments, encouraged self-reflection, and modeled the calm confidence I aspire to pass on to others.
At my organization, Sharp Memorial Hospital, I was able to participate in the Leaders4Leaders program, which pairs developing leaders with experienced mentors across the system. Through this program, I found guidance and clarity during times of uncertainty. Having a senior leader to discuss real-world challenges with—from communication struggles to decision-making pressures—helped me grow in confidence and emotional intelligence. It reminded me that leadership doesn’t have to be lonely; it can be collaborative, connected, and shared.
Mentorship is cyclical. As I counsel nurses who find their voice, I’m mentored by those who are paving the leadership road before me. Mentorship isn’t just about developing future nurses; it’s about supporting current leaders so they can remain grounded, capable, and compassionate.
Looking ahead
As I move beyond my first year in leadership, I carry forward these lessons with purpose. Leadership isn’t about perfection; it’s about persistence, meeting people where they are, leading with evidence and empathy, and holding space for growth, both our own and others’.
The work of a nurse leader is demanding and deeply human. We lead not just policies and practices, but people with their hopes, fears, and stories. And if there’s one truth I’ve learned, it’s that leadership happens not from behind a desk, but in the Gemba—where the real work, and the real heart of nursing, lives.
Alexander Salinas CCRN-CMC is a Clinical Nurse Lead at a Stepdown ICU in a LVAD Transplant Unit at Sharp Memorial Hospital.
