This scenario would obviously be detrimental to patient care. It would also challenge the legitimacy of the leadership roles of the politicians, academics and managers. The research findings clearly indicate that effective nurse leaders attempt to combine their sphere of influence with clinical practice. With a future scenario for nursing that has leaders with limited interface or linkage with practice and the knowledge contained therein, then it may be time for a radical re-think of career structures for nursing, together with the leadership development needs of clinical leaders.