The Unseen Side of Nursing Leadership: Conceptualizing Leadership Blind Spots in Healthcare Settings

BACKGROUND: Nursing leadership effectiveness depends not only on clinical expertise and formal authority but on the capacity to perceive how one's own conduct is experienced by staff. Leadership blind spots-unrecognized gaps between a nurse leader's self-perception and the actual impact of their behaviour on staff voice, trust, and psychological safety-represent a consequential and theoretically underdeveloped phenomenon in nursing management. Left unrecognized, these gaps may silently undermine staff well-being, patient safety, and organizational culture. AIM: To clarify and conceptually define leadership blind spots in nursing using Walker and Avant's concept analysis framework, identify their defining attributes, antecedents, consequences, and empirical referents, and propose a Leadership Blind Spot Pathway Model and recommendations for measurement, practice, and policy. METHODS: Walker and Avant's eight-step concept analysis framework was applied. A structured literature search was conducted across six electronic sources-PubMed, CINAHL, Scopus, PsycINFO, Web of Science, and Google Scholar-covering publications from 2020 to 2025 and supplemented by foundational theoretical works. From an initial pool of 58 records, 30 sources were retained for analysis following duplicate removal and two-stage screening. RESULTS: A nursing leadership blind spot is proposed as a recurring and insufficiently recognized discrepancy between a nurse leader's self-perceived behaviour and how that behaviour is experienced by staff. Four core defining attributes were identified: self-other perceptual discrepancy, limited recognition and integration of corrective feedback, miscalibrated confidence in leadership judgement, and relational-contextual unawareness of leadership impact. These attributes are clinically expressed through six manifestations-communication, fairness, emotional, power, performance, and change-related blind spots. Antecedents operate at individual, contextual, and organizational levels; consequences extend to nurse leaders, nursing staff, patients, and healthcare organizations. A Leadership Blind Spot Pathway Model incorporating a self-reinforcing feedback loop is proposed, in which staff silence both reflects and perpetuates leader unawareness. The concept is distinguished from destructive leadership, incompetence, burnout, and related constructs by the combination of a self-other perceptual discrepancy and limited recognition of that discrepancy. CONCLUSION: Leadership blind spots represent a potentially distinct and operationalizable construct in nursing that warrants empirical validation. Embedding multisource feedback, reflective practice, and psychological safety into leadership development represents a promising, though not yet empirically tested, pathway to their detection and reduction. Development and psychometric validation of a Nursing Leadership Blind Spot Scale is recommended as a research priority.