Articles / Leadership in Nursing: Understanding NMC Standards and Professional Excellence
Development, Training & CoachingExplore NMC leadership standards, Platform 5 proficiencies, and clinical leadership requirements for nurses at every career stage. Learn how the NMC Code shapes nursing leadership in the NHS.
Written by Laura Bouttell • Sun 4th January 2026
Leadership in nursing extends far beyond corner offices and management titles. The Nursing and Midwifery Council (NMC) recognises that every registered nurse, regardless of their role or seniority, exercises leadership in their daily practice. This fundamental principle reshapes how we understand professional nursing in the United Kingdom.
The NMC Code establishes that nurses must "be a model of integrity and leadership for others to aspire to." This expectation applies whether you are a newly qualified staff nurse on a busy medical ward or a director of nursing shaping organisational strategy. Understanding these leadership requirements is essential for career progression, professional development, and—most importantly—delivering excellent patient care.
This comprehensive guide examines the NMC's leadership standards, explores how leadership expectations evolve across nursing career stages, and provides practical guidance for developing clinical leadership capabilities within the NHS framework.
The NMC Code serves as the cornerstone of professional nursing practice in the United Kingdom. Published in its current form in 2018, with visual updates in 2024, this document establishes the professional standards that all nurses, midwives, and nursing associates must uphold throughout their careers.
The Code organises professional expectations around four interconnected themes:
| Theme | Core Focus | Leadership Implications |
|---|---|---|
| Prioritise People | Treating individuals with dignity, respecting preferences, and ensuring safety | Leading person-centred care, advocating for patients, modelling compassionate practice |
| Practise Effectively | Maintaining knowledge, skills, and evidence-based practice | Staying current with research, mentoring colleagues, driving quality improvement |
| Preserve Safety | Recognising and responding to risks, raising concerns | Creating safety cultures, implementing governance systems, speaking up for patients |
| Promote Professionalism and Trust | Upholding reputation, maintaining integrity | Acting as role models, demonstrating ethical behaviour, maintaining professional boundaries |
The Code explicitly states that nurses must "provide leadership to make sure people's wellbeing is protected and to improve their experiences of the health and care system." This is not a suggestion—it is a professional requirement applicable to every registrant.
What distinguishes the NMC's approach to leadership is its universality. The Code applies "whether you are providing direct care to individuals, groups or communities or bringing your professional knowledge to bear on nursing and midwifery practice in other roles, such as leadership, education, or research."
This means that leadership is not reserved for those with "manager" or "matron" in their job title. A band 5 staff nurse coordinating a patient's discharge demonstrates leadership. A practice nurse implementing a new vaccination protocol demonstrates leadership. A healthcare assistant supervising a student demonstrates leadership under appropriate delegation.
The NMC's position reflects contemporary leadership theory, which recognises that effective organisations require leadership contributions from multiple levels simultaneously—not merely top-down direction from senior figures.
The Standards of Proficiency for Registered Nurses, often called the "Future Nurse" standards, establish seven platforms representing broad categories of nursing capability. Platform 5—"Leading and Managing Nursing Care and Working in Teams"—specifically addresses leadership competencies.
At the point of registration, nurses must demonstrate capability across several leadership domains:
Understanding and Applying Leadership Principles Newly registered nurses must comprehend effective leadership theories, management approaches, group dynamics, and organisational culture. They should apply this knowledge to team working and decision-making in clinical contexts. This is not theoretical knowledge for future use—it is expected capability from day one.
Managing Teams and Coordinating Care Registered nurses must organise and manage nursing and multidisciplinary care delivery, delegating appropriately, supervising others, and maintaining accountability for overall care quality. Even without formal management responsibility, nurses coordinate care across shifts, handovers, and interdisciplinary boundaries.
Applying Human Factors and Systems Thinking Platform 5.2 specifically requires registrants to "understand and apply the principles of human factors, environmental factors and strength-based approaches when working in teams." This includes recognising how fatigue, stress, communication breakdowns, and environmental factors affect safety, using this knowledge to strengthen team performance and reduce risks.
| Proficiency Area | Key Requirements | Practical Application |
|---|---|---|
| Leadership Theories | Understand and apply leadership and management theories | Adapting leadership style to team needs and clinical situations |
| Team Coordination | Manage nursing care delivery and coordinate multidisciplinary teams | Organising shift patterns, leading handovers, coordinating complex discharges |
| Delegation and Supervision | Delegate appropriately and maintain accountability | Assigning tasks to healthcare assistants while retaining overall responsibility |
| Human Factors | Apply human factors principles to enhance safety | Recognising cognitive load, implementing checklists, supporting fatigued colleagues |
| Service Improvement | Contribute to processes of organisational change | Participating in audits, implementing quality improvement projects, challenging inefficient practices |
| Role Modelling | Act as role model demonstrating exemplary professional behaviour | Maintaining standards under pressure, demonstrating compassionate care, supporting colleagues |
These proficiencies establish baseline expectations. As nurses progress through their careers, leadership expectations expand significantly in scope, complexity, and strategic influence.
The NHS Agenda for Change banding system provides a useful framework for understanding how leadership expectations evolve across nursing careers. Each band represents not merely increased clinical expertise but expanded leadership responsibility.
Newly qualified nurses at band 5 begin exercising leadership from their first shift. Whilst they may not supervise staff directly, they lead patient care episodes, coordinate with multidisciplinary colleagues, and serve as professional role models.
Key leadership activities:
The NMC expects band 5 nurses to be "responsible for managing nursing care and accountable for the appropriate delegation and supervision of care provided by others in the team including lay carers." This accountability begins immediately upon registration.
Band 6 roles—senior staff nurse, junior sister, specialist nurse practitioner—mark a significant expansion of leadership responsibility. These nurses often manage shifts, lead specific clinical areas, and take responsibility for service development.
Expanded leadership responsibilities:
Band 6 nurses bridge clinical practice and organisational management. They translate strategic priorities into operational reality whilst maintaining direct patient contact. This dual focus develops the capabilities required for more senior leadership roles.
Ward sisters, charge nurses, and ward managers at band 7 hold substantial operational leadership responsibility. They balance clinical expertise with management functions, creating environments where high-quality care can flourish.
Band 7 leadership functions:
| Domain | Responsibilities |
|---|---|
| Operational Management | Safe staffing, budget management, admissions coordination, documentation standards |
| Team Leadership | Staff development, performance management, psychological safety, team cohesion |
| Quality Assurance | Clinical audit, incident investigation, policy implementation, governance compliance |
| Professional Development | Mentorship, revalidation support, career guidance, education coordination |
Band 7 roles often require master's level qualification or equivalent. Trusts frequently support nursing staff in attaining these qualifications, recognising that effective ward leadership requires sophisticated knowledge of leadership theory, change management, and organisational dynamics.
Modern matrons (band 8a), directors of nursing, and executive nurse leaders operate at strategic and system levels. Their leadership extends beyond individual clinical areas to shape organisational direction and influence healthcare policy.
Strategic leadership responsibilities:
The Matron's Handbook, published by NHS England, emphasises that "matrons provide key assurance to the board, providing evidence that the organisation is delivering safe care and supporting and developing staff to fulfil their roles." This board-level accountability distinguishes senior nursing leadership from operational management.
Whilst the NMC establishes professional standards, the NHS provides complementary frameworks to support leadership development across clinical professions.
The Clinical Leadership Competency Framework (CLCF), hosted by the NHS Leadership Academy, applies to all practising clinicians throughout their careers. It emphasises that leadership is shared—that every clinician contributes to the leadership task where their expertise and qualities are relevant.
The CLCF comprises five domains centred on "delivering the service":
These domains provide a developmental pathway that complements NMC proficiency requirements. Nurses can use both frameworks to identify development needs and plan career progression.
The NHS Healthcare Leadership Model, delivered by the NHS Leadership Academy, comprises nine dimensions of leadership behaviour:
| Dimension | Description |
|---|---|
| Inspiring Shared Purpose | Valuing a service ethos, curious about how to improve services |
| Leading with Care | Having the essential qualities of compassion and empathy |
| Evaluating Information | Seeking out, interpreting and using information effectively |
| Connecting Our Service | Understanding how services connect and how to improve them |
| Sharing the Vision | Communicating a compelling vision and strategic direction |
| Engaging the Team | Involving individuals and teams to achieve high performance |
| Holding to Account | Agreeing and setting objectives and holding people accountable |
| Developing Capability | Building capability in individuals and the organisation |
| Influencing for Results | Deciding how to make a positive difference and achieve results |
The model applies across leadership levels, with expectations scaling according to role complexity. A band 5 nurse might demonstrate "Engaging the Team" by actively contributing to ward discussions, whilst a director of nursing demonstrates the same dimension by leading culture change across an organisation.
The UK offers extensive leadership development opportunities for nurses, from foundation programmes to executive development. Understanding available options enables strategic career planning.
The NHS Leadership Academy provides a suite of programmes designed for different career stages:
Foundation Level:
Development Level:
Senior Level:
The Florence Nightingale Foundation offers leadership scholarships and programmes specifically for nurses and midwives:
Mary Seacole Leadership Development Programme Delivered in partnership with The Mary Seacole Trust and NHS England, this programme targets nurses and midwives from Black, Asian or Ethnic Minority backgrounds at band 7 or 8a. Now in its fourth cohort, the programme addresses long-standing inequalities in access to leadership development and representation in senior roles.
The programme includes a Quality Improvement project focusing on health inequalities, ensuring leadership development translates into tangible improvements for underserved communities.
Additional FNF Programmes:
The RCN offers the Developing Leadership Programme, a two-day intensive suited for NHS, independent sector, and third sector organisations. This programme is designed for aspiring leaders seeking practical leadership skills development.
Regional NHS programmes, such as the Future Leaders Programme in Yorkshire and Humber, offer year-long leadership fellowships combining practical experience with academic development. University programmes, including the MSc Advanced Leadership for Professional Practice (Nursing) at the University of Manchester, provide master's level qualification alongside leadership development.
The relationship between nursing leadership and patient outcomes is well-established. Research consistently demonstrates that positive clinical nurse leadership associates with lower medical errors, higher quality of care, and improved patient satisfaction and safety.
Studies examining clinical nurse leadership identify several mechanisms through which leadership influences patient outcomes:
Communication and Safety Culture Effective nurse leaders create environments where staff feel empowered to speak up about safety concerns. This psychological safety is essential for identifying near-misses, reporting incidents, and implementing improvements before harm occurs.
Quality Improvement Capacity Nurse leaders drive quality improvement by cultivating cultures where all staff members feel empowered to identify opportunities for enhancement. This involves encouraging health care workers to speak up, providing necessary resources to explore improvements, and recognising contributions to quality initiatives.
Team Performance and Engagement Clinical leadership in the context of registered nurses is of vast importance, particularly in relation to patient safety and risk management. Nurses with clinical leadership capabilities identify areas for improvement, motivate team members, and lead change initiatives addressing problems in daily clinical practice.
Research examining leadership styles and patient outcomes reveals important patterns:
| Leadership Style | Associated Outcomes |
|---|---|
| Transformational | Lower patient mortality, increased staff engagement |
| Relational | Higher patient satisfaction, improved team cohesion |
| Task-Oriented | Higher patient satisfaction, clear accountability |
| Resonant | Lower patient mortality, enhanced staff wellbeing |
These findings suggest that effective clinical leadership requires flexibility—adapting leadership approach to team needs, clinical contexts, and organisational requirements. No single leadership style optimally serves all situations.
Nurse leaders contribute to patient safety through several concrete actions:
These actions require leadership at every nursing level. A band 5 nurse reporting an incident exercises leadership. A band 7 ward manager investigating patterns exercises leadership. A director of nursing implementing system-wide improvements exercises leadership.
Nursing leadership in the United Kingdom faces significant challenges and opportunities. Understanding emerging trends enables nurses to position themselves for future leadership requirements.
The NHS Long Term Workforce Plan, accepted by government with over £2.4 billion committed for additional education and training, sets ambitious targets for nursing workforce development:
This workforce expansion creates significant leadership opportunities. New nurses will require mentorship, supervision, and leadership development. Healthcare organisations will need expanded leadership capacity to manage larger, more diverse nursing teams.
Dame Ruth May, Chief Nursing Officer for England, has articulated a three-point strategy for nursing leadership:
The forthcoming Professional Strategy for Nursing and Midwifery in England represents what NHS England describes as "a defining moment for our professions—a collective opportunity to shape the next era of nursing and midwifery practice, education, research and leadership."
Future nursing leaders will navigate several emerging challenges:
Digital Transformation The integration of digital health technologies requires nurses who can lead implementation, manage change resistance, and ensure technology enhances rather than impedes person-centred care.
Integrated Care Systems The shift to integrated care systems demands leaders who can work across organisational boundaries, build relationships with partners, and maintain nursing voice in system-level decisions.
Workforce Diversity With increasing numbers of internationally educated nurses and nursing associates, leadership must embrace diverse perspectives and support successful integration.
Health Inequalities The focus on health inequalities requires leaders committed to equity, capable of identifying and addressing disparities in care quality and access.
The NMC Code explicitly states that nurses must "be a model of integrity and leadership for others to aspire to." This leadership expectation applies to all registrants regardless of their role or seniority. The Code establishes that nurses must provide leadership to protect people's wellbeing and improve their experiences of healthcare. This means exercising leadership through professional behaviour, clinical decision-making, and advocacy for patients—not merely through formal management positions.
Platform 5 of the NMC Standards of Proficiency for Registered Nurses addresses "Leading and Managing Nursing Care and Working in Teams." It establishes competencies that all registered nurses must demonstrate at the point of registration, including understanding leadership theories, managing teams, delegating appropriately, applying human factors principles, and acting as professional role models. Platform 5 matters because it establishes leadership as a core nursing competency rather than an optional career direction.
Leadership expectations expand significantly across NHS bands. Band 5 nurses lead patient care episodes and coordinate with multidisciplinary teams. Band 6 nurses manage shifts, supervise junior staff, and lead specialist services. Band 7 nurses hold operational leadership responsibility including staffing, budgets, and quality governance. Band 8 and above nurses operate at strategic levels, shaping workforce strategy, influencing policy, and providing board-level assurance about care quality and safety.
UK nurses can access extensive leadership development opportunities including NHS Leadership Academy programmes (Edward Jenner, Mary Seacole, Elizabeth Garrett Anderson, Nye Bevan, and Aspiring Chief Executives), Florence Nightingale Foundation scholarships and programmes, Royal College of Nursing leadership courses, regional NHS programmes such as the Future Leaders Programme, and university master's programmes in nursing leadership. Many programmes are funded or subsidised for NHS staff.
Research consistently demonstrates that positive clinical nurse leadership associates with lower medical errors, reduced patient mortality, higher quality of care, and improved patient satisfaction. Effective nurse leaders create psychological safety enabling staff to report concerns, drive quality improvement initiatives, implement evidence-based practices, and maintain safety cultures. Transformational and resonant leadership styles show particularly strong associations with positive patient outcomes.
NMC revalidation requires 35 hours of continuing professional development every three years, including 20 hours of participatory learning. Leadership activities can count toward these requirements when relevant to scope of practice. The NMC specifically mentions leadership as an area for CPD, and reflective accounts may address leadership development, feedback on leadership style, or leadership-related learning. Revalidation encourages nurses to identify leadership development needs and plan appropriate learning activities.
The NHS Long Term Workforce Plan commits to substantially expanding the nursing workforce, creating significant leadership opportunities. The Chief Nursing Officer's strategy prioritises building future-fit workforce, enhancing professional reputation, and empowering nurses to lead change. Future nursing leaders will need capabilities in digital transformation, integrated care systems, workforce diversity, and health inequalities. Leadership development at all career stages will be essential to meet these challenges.
Leadership in nursing is not a destination but a continuous journey of professional development. The NMC's standards establish clear expectations, but meeting those expectations requires ongoing commitment to learning, reflection, and growth. Whether you are beginning your nursing career or approaching its pinnacle, leadership development remains both a professional obligation and a personal opportunity to improve care for the patients and communities you serve.