By Temitope Ogunkoya
As a Nigerian woman who has experienced healthcare firsthand in Nigeria, from routine check-ups to maternal care and later became certified and practised in the United States, I have witnessed two distinct approaches to nursing leadership. And these contrasting experiences offer valuable lessons for health practitioners in developing countries and developed ones.
In Nigeria, the most populous Black nation on earth, healthcare leadership often follows a traditional, top-down model and rigid hierarchies where authority is centralised, and communication flows downward. In contrast, the CNL model I encountered in the U.S. established that effective leadership is not about control but collaboration.
Today, both Nigeria and the U.S. are confronting a common crisis of overwhelmed healthcare systems grappling with workforce shortages, rising patient complexity, and strained infrastructure, which I have analysed extensively before now.
To address these challenges, we must move beyond outdated command-and-control structures and adopt collaborative leadership as the new standard—beginning with how we train, empower, and position nurses.
The traditional model of nursing leadership
In Nigeria, the archetype of a nurse leader is often that of an authority figure, one who is distant from the clinical floor but focused on enforcing policies, managing shifts, and responding to crises from an office. While this model may preserve structure, it often silences the voices of frontline nurses and discourages interprofessional collaboration.
Younger nurses are frequently expected to follow instructions without question, even when their insights could improve patient safety or care outcomes. I share this observation with respect for the many nurse leaders who work under incredibly difficult conditions. But in an era of increasingly complex, patient-centred care, this leadership model is no longer sufficient.
Even in the U.S. which boasts of more advanced resources and systems, the traditional leadership approach is under scrutiny. Burnout is widespread, particularly in the post-COVID landscape, and many nurses are leaving the profession due to feeling unheard or being excluded from key decisions. The way forward then becomes rather clear that leadership must evolve from command to empowerment, from individual authority to shared influence.
CNL as a blueprint for collaborative leadership
Having experienced traditional leadership style, my CNL training introduced me to a model of leadership rooted in teamwork, communication, and clinical excellence. Unlike traditional managers, Clinical Nurse Leaders are embedded within care teams. They coordinate across disciplines, lead quality improvement efforts, and ensure care is patient-centred and data-driven.
What struck me most was how CNLs facilitate real collaboration and bring nurses, doctors, pharmacists, social workers, and even patients into the decision-making process. They lead from within, not above. This collaborative style transforms healthcare delivery, empowering every team member to contribute ideas, voice concerns, and participate in coming up with solutions.
Nigeria, other developing countries must rethink nursing leadership
Nigeria’s healthcare system is powered by dedicated nurses working under intense pressure. But many are disheartened by the lack of recognition, autonomy, and leadership support at the clinical level. This situation also applies to many other (African) countries, not just Nigeria.
Therefore, to retain talent, improve care outcomes, and reduce preventable harm, we must reimagine what leadership looks like. That starts by shifting from hierarchical systems to collaborative structures that value and empower nurses at every level.
This evolution requires: leadership training in communication, systems thinking, and conflict resolution; redefining leadership not as rank, but as impact, accountability, and influence; implementing shared governance, where nurses have a voice in policy and protocol decisions; and fostering interprofessional collaboration, breaking down silos that limit innovation.
Lessons for the US and other developed systems
Though Nigeria has much to gain from adopting more collaborative leadership models, the United States also has work to do as it is far from being the ultimate system. Despite widespread adoption of roles like the CNL, many American nurses still face burnout, understaffing, and limited influence in shaping care environments.
The broader lesson is that no healthcare system is too advanced to evolve, and none is immune to the consequences of outdated leadership. Whether in Lagos or Los Angeles, collaborative clinical leadership boosts patient safety, staff morale, and system resilience.
Paving the path for change in nursing leadership
While titles are the most obvious indicators of leadership in nursing, leadership should be about influence, advocacy, and the ability to drive meaningful change. That change must begin in the classroom and continue at the bedside.
In Nigeria, the path forward could include piloting CNL-style roles in tertiary hospitals; launching short-term leadership development programmes; and creating mentorship networks that guide early-career nurses into leadership with confidence.
In the U.S., we must continue supporting the CNL model while amplifying underrepresented voices, especially immigrant and internationally trained nurses who bring global insights and resilience to the profession.
We are navigating an era of unprecedented complexity in healthcare. No single administrator or practitioner can manage it alone. What we need are empowered, interdisciplinary teams led from within—by nurses who are trained, trusted, and supported to lead.
And as someone who has lived and worked in both Nigeria and the United States, I know firsthand that the future of nursing leadership lies not in authority, but in collaboration. For the sake of nurses, other health practitioners, patients, and the future of global health, we need to evolve and keep evolving.
- Temitope Ogunkoya, a licensed Registered Nurse (RN), a certified Clinical Nurse Leader (CNL) and a Master of Science in Nursing (MSN), writes from the United States.
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