What constitutes successful leadership in today’s healthcare environment and what are the principal components of an organization that supports the role of the nurse leader? To answer these questions, 16 nurse leaders from four acute care hospitals were interviewed for their perception of leadership traits that are effective in the inpatient hospital setting and types of organizational infrastructures that create conditions for job effectiveness. Kanter’s theory of organizational behavior provided the conceptual framework for this study. Leadership effectiveness is linked to having access to opportunity, resources, information, and formal and informal power in the work setting. Nurse leaders with access to these structures are empowered and successful, which leads to enhanced worth and overall organizational achievement. Also, strong central beliefs and business astuteness are considered vital attributes in today’s economically oriented environment.