An executive director oversees the formal leadership of a psychiatric institution. Reporting to this role is the medical director, a psychiatrist who also has informal power by virtue of their physical presence in the environment, and due to their expertise. Nursing roles imbued with formal power are the Director of Nursing, and Psychiatric Mental Health (PMH) Clinical Nurse Specialists (CNS). The Director of Nursing is a registered nurse who oversees the care of all patients in the facility. The PMH Clinical Nurse Specialist assesses the mental health needs of the patients. These nurses are viewed as senior staff members who demonstrate a high degree of competency in problem identification and solution, analysing and interpreting clinical data, and decision-making.

The informal leaders in this same setting are the Psychiatric Mental Health Nurse Practitioners. These nurses also determine mental health issues and accordingly treat patients, and recognize if a patient is high-risk for developing mental illness. This role differs from that of Clinical Nurse Specialist in that the Clinical Nurse Specialist has a doctoral degree, and is highly specialized. However, these nurses have a high degree of responsibility because they can prescribe medications and provide emergency psychiatric services.

The value of a nurse leader is varied. A high degree of training and experience is desirable, as can be found within a formal leadership role, and this leadership is invaluable. Likewise, a great deal of value can found in an informal leadership role. As well as having extensive training, informal leadership nursing roles are valuable due to their day-to-day care of patients, as well the decision-making process that is a part of their job.