Leadership is not a title. It is the trust you earn. Our conversation with Helen Loflin explores how nurse leaders build influence through presence, honesty, relationships, and a steady focus on patients—even when they have no formal authority.
When the Org Chart Doesn't Tell the Whole Story
Walk into almost any hospital in the country and you will find nurse leaders who are officially in charge of very little yet somehow the gravitational center of their unit. People come to them with problems. Their opinions shape decisions. Their presence changes the energy of a room. Their title may say charge nurse, but their influence says so much more.
You will also find the reverse: nurse managers with full formal authority, a clear reporting structure, and a team that has quietly stopped listening.
The difference between these two leaders is not their title. It is not their experience level or their clinical expertise. It is trust—and the constellation of behaviors that builds it.
On Season 2 of the Sisterly Advice™ Podcast, we sat down with Helen Loflin, a nurse with eleven years of experience who began her career in medical school in Eastern Europe, transitioned to nursing in the United States, and most recently stepped into an interim executive leadership role at a hospital where she had no formal direct reports and no established relationships.
What she shared about how she led, how she built trust, and what it means to influence without authority offers valuable lessons for nursing leadership.
Influence Without Authority: What the Research Shows
The idea that leadership is fundamentally about influence rather than authority is not new—but it remains one of the most consistently undervalued insights in healthcare leadership development.
Cohen and Bradford (1989), in their foundational work on influence without authority, established that effective leaders in organizations build influence through reciprocal relationships, by understanding what others need and offering something of genuine value in return.
This framework—developed in organizational contexts but applicable to nursing— reframes leadership as a relational practice rather than a hierarchical one.
Grossman and Valiga (2021) describe informal nurse leaders as those who demonstrate leadership behaviors regardless of their position—advocating for patients and staff, modeling professional standards, and influencing team culture through daily action.
This is what Helen described when she reflected on what had made her proudest of her eight weeks in an unfamiliar hospital as an interim executive:
"They're not my direct reports. But they reach out to me. They trust that things will be taken care of. That's what I'm proudest of right now."
— Helen Loflin
No one handed her that trust. She built it—through presence, follow-through, and a consistent orientation toward solving problems rather than claiming territory.
The Foundation Is Always Trust
Throughout the conversation, trust emerged repeatedly—not as a soft concept but as the practical prerequisite for everything else a leader wants to accomplish: feedback, accountability, culture change, and team engagement.
Kouzes and Posner (2017), in their research on leadership effectiveness, identify credibility—the combination of competence and trustworthiness—as a critical leadership attribute.
Belief in leadership is not established by a job description. It is earned through consistent, values-aligned behavior over time.
Dirks and Ferrin (2002), in a meta-analysis of trust and leadership published in the Journal of Applied Psychology, found associations between trust in leadership and important workplace outcomes, including performance and organizational citizenship.
For nurse leaders entering a new unit, facility, or role, the practical implication is clear: before attempting to change everything, invest time in becoming someone your team trusts.
How Helen Built Trust Without a Reporting Structure
Helen's approach to building trust in an unfamiliar environment offers a practical model that nurse leaders can adapt.
1. She Showed Up on the Floor, Even When It Wasn't Her Job
When a code STEMI happened early in her tenure, Helen ran to help—not because it was her responsibility, but because the team needed support.
These moments of discretionary presence, repeated consistently, communicate that a leader is genuinely invested rather than simply interested in a position.
2. She Was Transparent About What She Didn't Know
Helen described being completely unfamiliar with a timekeeping system and openly asking the team to help her figure it out together.
This kind of intellectual honesty—saying "I don't know" and asking for help—is an important trust-building practice.
Edmondson (2019) describes how leaders who model openness and vulnerability can help create psychological safety, allowing team members to raise concerns, ask questions, and contribute ideas.
3. She Connected the Work to the Patient, Every Time
Helen described redirecting conversations, including difficult ones with physicians, back to the person receiving care.
Her question was simple:
"There is a patient. They are in a bed. They need this. How do we collectively make sure they get what they need?"
This approach helps teams move beyond organizational friction by anchoring decisions to a shared purpose.
It also reflects the values-centered leadership principles described by Burns (1978).
Leadership Is Not a Reporting Structure
Perhaps the most important reframe in this episode is that leadership has nothing to do with having direct reports.
As we discussed, a bedside nurse, a nursing assistant, an LPN, or a unit secretary can all demonstrate leadership.
Leadership is reflected in how we make connections, inspire others, support collaboration, and work toward a common goal.
Research by Pearce and Conger (2003) on shared leadership explores how leadership functions can be distributed across a team rather than concentrated in one formal position.
In a clinical environment, where team members' judgments and actions directly influence patient care, leadership must exist beyond the organizational chart.
Nurse managers who cultivate informal leaders across their teams can help develop environments that are more adaptable, collaborative, and resilient.
Verbalize Where You're Going
One observation we discussed about Helen stood out as particularly actionable: Helen has always been clear about where she wants to go—and she says it out loud.
Many leaders carry a private sense of their goals and aspirations but rarely articulate them to others.
As a result, people who could become mentors, advocates, or collaborators may never know how to support them.
Research on career development in nursing identifies mentorship as an important component of professional growth (Hodgson & Scanlan, 2013).
Verbalizing your goals is not ego. It is strategy.
The Bottom Line
Helen Loflin's story is a reminder that the most powerful thing a nurse leader can offer is not expertise, authority, or a compelling résumé.
It is the consistent, patient, values-driven work of becoming someone a team trusts.
That work does not require a title to begin.
It requires showing up, staying curious, being honest about what you do not know, and always bringing the conversation back to the patient.
That is leadership. And it is available to everyone.
Continue the Conversation
Explore more leadership conversations with Helen Loflin and the Sisterly Advice™ Podcast.
Explore Sisterly Advice™References
- Burns, J. M. (1978). Leadership. Harper & Row.
- Cohen, A. R., & Bradford, D. L. (1989). Influence without authority: The use of alliances, reciprocity, and exchange to accomplish work. Organizational Dynamics, 17(3), 5–17.
- Dirks, K. T., & Ferrin, D. L. (2002). Trust in leadership: Meta-analytic findings and implications for research and practice. Journal of Applied Psychology, 87(4), 611–628.
- Edmondson, A. C. (2019). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. Wiley.
- Grossman, S. C., & Valiga, T. M. (2021). The new leadership challenge: Creating the future of nursing (6th ed.). F. A. Davis.
- Hodgson, A. K., & Scanlan, J. M. (2013). A concept analysis of mentoring in nursing leadership. Open Journal of Nursing, 3(5), 389–394.
- Kouzes, J. M., & Posner, B. Z. (2017). The leadership challenge: How to make extraordinary things happen in organizations (6th ed.). Wiley.
- Pearce, C. L., & Conger, J. A. (2003). Shared leadership: Reframing the hows and whys of leadership. Sage Publications.
