Aim The purpose of this article was to highlight the increasing corporate style pressures being exerted upon the NHS in England and Wales and how the nursing profession needs to fundamentally change in response to this emerging environment. Through examining a range of nursing leadership responses this paper offers a way forward to meet these challenges. Background Given the accelerating pace of fundamental change within health service delivery the nursing profession is particularly challenged to enact not just new structures but a new, eclectic model of nursing leadership that engages nurses at the clinical interface. Without this, both individual nurses and the wider professions risks being inert within an era of profound change. Conclusion The palpable incongruence between health organizations and leadership models create ineffectiveness and a paucity of self-determinism within nursing. Apparent is the wide range of leadership styles required to respond to these challenges that overtly exceed a single leadership model alone.