In response to improving upon a leadership development program at a US regional medical center, coupled with the understanding that transformational leadership is linked with better outcomes, as a first step, we examined the perceived leadership styles, outcomes of leadership, and level of self-efficacy among nurse leaders, namely nurse managers, clinical supervisors, and nurse directors. Twenty-three hospital-based nurse leaders completed the surveys with a response rate of 57.5%. The majority of the leadership styles aligned with that of transformational. However, the items with the 3 lowest average frequency ratings within the transformational leadership style were in the areas of communication and showing confidence. Additionally, the perceived median self-efficacy score was low. Organizational support by way of providing continuous, sustainable professional leadership development, especially in the area of communication, and building self-efficacy is needed to ensure leader effectiveness, and improvement in staff and patient outcomes.