The leadership discourse in the United Kingdom has to date been concerned with professional issues and as a result has focused upon developing nurses and nursing. This paper reports on the findings of a research study which examined the broader socio-political factors impacting upon nursing leadership. The study forms an integral part of the Royal College of Nursing's leadership programme. The principal aim of the research was to examine critically contemporary nursing leadership within the context of health policy. An ethnographic approach was used. Informal semi-structured interviews were undertaken with a purposive sample of 24 leaders who were recognized for their effectiveness in leading nursing. Data were analysed for themes. The main themes are presented and discussed here. The findings of the study question the political success which the internally focused nature of leadership has had for the profession. Nursing and therefore nursing leadership is shaped dramatically by the impact of politics and policy. The research discovered that in recognition of this, contemporary nursing leadership has both an internal and an external focus. That is, effective nursing leadership currently is a vehicle through which both nursing practice and health policy can be influenced and shaped. The research also identified the profile of the effective nurse leader, together with the processes through which leaders interpret and translate between the macro issues of policy and the micro issues of practice. In addition, an understanding of what nursing leadership is, has been proposed. Appropriate recommendations for the future of nursing and nursing leadership are outlined.