IntroductionEven though leadership can be an essential place of development, the desire to create your conditions, which serve and stimulate new models of leadership, is certainly more important, even if it is certainly not more important. Another dimension to take into account in the implementation of clinical governance and leadership would be the disempowerment of the nursing profession. Hitchcock (2013) supported this view, arguing that yesterday's methods do not work in the permanent whitewater world, where managers traditionally manage within the system and focus on doing things according to the rules . Like Klinger, Hitchcock agreed that in a management role is essential and serves a vital function, leadership must take precedence to make management more effective. If management is efficiency in climbing the ladder, then it is leadership that determines whether the ladder leans against the right wall. To help individuals, teams, and organizations safely navigate the constant whitewater environment, Hitchcock (2013) suggested that there are three constants that provide stability in times of great uncertainty, such as change, a choice and principles. This work considers each of these three constants, focusing primarily on the principles that underpin transformational and effective leadership in health care settings. (Hitchcock, Klinger, 2012) Workplace leadership position, commanding progress, integration and innovation In the NHS, where leaders work with managers to improve outcomes, a recent study found that 'Over the last five decades of working together there was an increase in conflict over goals, how the team should function and how decisions should be made instead of improving relationships...... in the middle of paper ......grams. J Health Adm Educ. 2012;25(4):307-328. Stoller JK. Building physician leaders: a call to action. J Gen Intern Med. 2012;24(7):876-878.Anderson J. “Assessing Clinical Leadership: A Case Study.” » Health Leadersh Serv 22, no. 3 (2012): 210-224. Ferguson L, Calvert J, Davie M et al. Clinical Leadership: Use observations of care to focus risk management and quality improvement activities in the clinical setting. Contempt Nurse. 2012;24(2):212-224.Burns D. “Clinical Leadership for General Practice Nurses, Part I.” Practical Nursing 20, no. 9 (2012): 466-469. Davidson PM, Elliott D, Daly J. Clinical leadership in contemporary clinical practice: implications for nursing in Australia. J Nurses Manag. 2012;14(3):180-187.Murphy J, Quillinan B, Carolan M. “The role of clinical nurse leadership in improving patient care.” » Nurses Manage 16, no. 8 (2012): 26-28.