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Aim The aim of this paper is to examine the challenges facing the nurse executive in the 21st century by questioning the traditional attributions of leadership to the nurse executive role.

Background Historically, the leadership role in nursing has been assumed by the nurse executive. The predominantly female character of nursing, however, has ensured that demonstrations of leadership amongst nurses have been infrequent and compatible with prevailing male-defined ideologies. Examples of this include career restructuring and educational reforms in Australia.

Findings This paper found that the apparent lack of leadership in nursing was able to be traced back to early management theories which categorized leadership as a function of management.

Conclusions If nurses are to assume leadership positions in the health care system of the 21st century, nurse leaders will have to let go of traditional managerial practices and behaviours. In the emerging health care system of the new century, nurse executive practices will focus on achieving change rather than predictability in organizational outcomes.