According to Click et al. (2014), the Institute of Medicine (IOM) report, tasks the professional nurse to boost the leadership roles given to nurses within the healthcare field. The primary goal of performing a study like this was to evaluate the various self-perceived leadership activities of registered nurses (RNs) involved in a clinical ladder initiative. As defined by the Affordable Care Act (ACA), RNs are obligated to lead clients towards positive healthcare outcomes. However, it is imperative for the healthcare organizations to have a true critical understanding of how the nursing process develops decisions related to nursing patient care. The authors employed many different avenues for the purpose of collecting necessary data, such as: correlational, descriptive and cross-sectional studies to assess the self-perceived behaviors of RNs enrolled within a ladder career pathway. Moreover, a self-report survey had been performed using demographic questionnaires and the leadership practice inventory. The results of the study revealed the existence of an intimate relationship between categorical and continuous demographic factors. In addition, Click et al. (2014) found that RNs who have attained higher levels of experience inversely have developed low perception of various leadership behaviors. Transformational leadership is defined as a critical element towards enhancing the effectiveness of communication and collaboration in the healthcare field. Therefore, RNs must be required to proficiently collaborate with other healthcare providers, families, and patients given that they are identified as the change agents who can transform the experience of patients (Click et al., 2014), In conclusion, the development of leadership and is fundamental for nurses in the various fields of practice. Therefore, the finding from this study offers evidence of the benefits and drawbacks related to leadership behaviors of employees in clinical RNs because they are the ones who are on the tip of the spear in regards to making decisions regarding patients.