Leadership is an action a way of being, living, growing, succeeding. John Maxwell describes Level 5 Leaders in his book, "The Five Levels of Leadership" as pinnacle leaders who people follow because of who they are and what they represent. Level 5 nursing leaders, referred to as transitional nursing leaders move others beyond the status quo, challenge what is not working, and dynamically move the field toward progress and growth. Transformational nursing leaders are change agents working to revolutionize the health care environment of today.  These nursing leaders are artists striving to create a future that leads to positive change and growth.
Qualities of Transformational Leaders
Transformational leaders have the following qualities:
- Self-knowledge. A dynamic leader must have the ability to recognize his or her strengths and weaknesses. These leaders spend time uncovering their attitudes, strengths, weaknesses, beliefs, and thought processes. 
- Integrity. People will follow those who are authentic in the way they live and work. These leaders have consistently demonstrated an ability to act in accordance to what they believe.
- Commitment. Transformational leaders are deeply passionate and committed to the tasks at hand and the future of the organization they lead.
- Compassionate. Most successful leaders are compassionate about people. They enjoy positive relationships with coworkers and mentee.
- Active listeners. Successful leaders actively listen to what their followers, coworkers, or students say. They understand the future of their organization or group rests on the new professionals entering their respective fields.
- Life-long Learners. Transformational leaders are dedicated to the process of mentoring, self-discovery, and life-long learning. They admit they do not have all the answers but have the tenacity and drive to continue to develop. They intellectually stimulate those around them to question underlying assumptions to find more effective solutions to the problems they are facing.
- Motivators. They can easily motivate others to share their vision for change, even when their ideas seem unrealistic to their followers.
- X-Factor Quality. These leaders have the X-Factor quality because they motivate others in a way that produces results. The heights they have reached in their fields points to their credence. They create positive change that leads to solutions. They have charisma and charm that is authentically a part of who they are as an individual. This type of charisma motivates people to transform their goals and visions into reality.
- Shared leadership. They are able to lead and share this level of leadership with the leaders of tomorrow. They are not threatened by future leaders but instead mentors for novice leaders.
- Comfortable with Ambiguity. They do not get anxious, fretful, angry, or frozen over ambiguity, uncertainty, or complexity. Rather they understand and even expect that uncertain situations will arise.
- Self-assured. These people have a deep sense of self-assurance. They are not narcissistic or defeated but rather confident in their ability to create change that has a positive effect on their industry or organization.
Transformational Nursing Leaders
I interviewed 7 nursing leaders via phone and/or email. These individuals were recognized as transformational leaders based on their scholarly work, research, books, and active involvement in charity and other nursing organizations. They had all contributed positively to the field of nursing.
The leaders described themselves as "energetic, patient, innovative, self-confident, committed, persistent visionary leaders who negotiate and initiate the future."  These nursing leaders were able to accomplish the goals they set without needing consistent recognition for their successes.
One leader said Tom Sawyer symbolized her leadership style because her excitement for life, like Tom Sawyer, inspired others to live out their dreams. Another leader said 1% inspiration and 99% perspiration symbolized her style because being a leader still required a lot of work and commitment. One individual said her leadership style symbolized a lighthouse providing others with a sense of direction and purpose while at the same time warning others about potential dangers. Another leader described the elephant as a symbol of her style because she said she like the elephant was consistently steady, serviceable, hardworking, and smart but still from time to time tore down the circus tent!
Idea of Successful Leader
When the nursing leaders were asked to describe their idea of a successful leader they listed the following characteristics.
- Ability to listen
- Ability to share
- Risk taker
- Clinical expertise
Environment for Success
These individuals said the environment for their success included supportive faculty, colleagues, mentors, supportive organizations, family, friends, and consistent financial resources. They also said they worked in organizations that aligned with their beliefs. When the environment became unsupportive they used humor, reorganized the atmosphere, implemented change, discovered the power sources, created something new and different. In the end if all these interventions failed they changed organizations.
The leaders said they enjoyed connecting with other individuals who were honest, trusting, energetic, funny, and optimistic. They stressed the importance of optimism in leading the profession into the future. They said they enjoy interacting with individuals who are intelligent, responsive, compassionate, and critical thinkers.
Factors for Success
These leaders described the most important factors for success included a good work ethic, support, encouragement, longevity, high achievement, high standards, and some element of being in the right place at the right time. They also identified having a sense of responsibility, colleagues to share their ideas and work, and never compromising their values and beliefs.
Road To Success
They all said the road to their success began with a strong desire to improve a certain aspect of nursing care. This seemed to come from recognizing a problem or a need that impelled the leaders to find a solution to the problem or need. One leader said that seeing babies in pain, unmedicated and untreated broke her heart and then made her angry. Her anger forced her to change the way the nursing profession managed pain in children.
The Future of Nursing
These leaders had high hopes for the future of nursing. They said although the field will probably remain in a level of crisis many leaders envisioned positive change over the next 20 years. Many said they saw a baccalaureate level of entry into the field and a broadening of the clinical nurse provider role. They also talked about the virtual learning centers linked with technology being a futuristic way of educating and training nursing students and professionals. Some envisioned nurse run and managed organizations who contracted nurses to work throughout the community and across the country. Most leaders described the nursing profession to have a future filled with more complex technology that will add a level of efficiency but also a level of complexity to the practice.
These leaders shared many commonalities. They were confident, intelligent, inquisitive, authentic, honest, and uncompromising on their values and beliefs. They shaped the environment for success by finding solutions to problems. They were and continue to be optimistic, perseverant, life-long learners who possess a genuine compassion for people. These transformational nursing leaders demonstrated John Maxwells 5th level of leadership as pinnacle leaders that others follow because of who they are and what they represent.