Who Cares for the Leaders? Leadership Fatigue, Ethical Solitude and the Politics of Care in Nursing

Nursing has long recognised leadership as essential to shaping care quality, guiding teams, and sustaining safe and effective healthcare environments. Nursing leadership is often celebrated as central to organisational change, workforce wellbeing and the delivery of safe, high-quality care. Yet beneath these optimistic narratives lies a far less examined reality: leadership itself is frequently a site of vulnerability, exposure and emotional strain. In this column, we examine the hidden burden of nursing leadership, focusing on the phenomena of “bullying up,” leadership fatigue, ethical solitude and the structural conditions that leave leaders simultaneously accountable for change and unsupported in enacting it. By foregrounding the relational, political and affective dimensions of leadership, this paper challenges dominant discourses that individualise leaders’ struggles and instead situates them within the broader organisational cultures, expectations and power dynamics that shape contemporary nursing work.