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Background Health policies impact on nursing profession and health care. Nurses' involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable. Numerous factors influence nurse leaders' ability to be politically active in influencing health policy development. These factors can be facilitators or barriers to their participation. There is scant research evidence from Eastern African region that draws attention to this topic. This paper reports part of the larger study. The objectives reported in this paper were those aimed to: build consensus on factors that act as facilitators and barriers to nurse leaders' participation in health policy development in Kenya, Uganda and Tanzania. Methods A Delphi survey was applied which included: expert panelists, iterative rounds, statistical analysis, and consensus building. The expert panelists were purposively selected and included national nurse leaders in leadership positions in East Africa. Data collection was done, in three iterative rounds, and utilized a questionnaire with open and closed ended questions. 78 expert panelists were invited to participate in the study; the response rate was 47% of these 64.8% participated in the second round and of those 100% participated in the third round. Data analysis was done by examining the data for the most commonly occurring categories for the open ended questions and descriptive statistics for structured questions. Results The findings of the study indicate that both facilitators and barriers exist. The former include: being involved in health policy development, having knowledge and skills, enhancing the image of nursing and enabling structures and processes. The latter include: lack of involvement, negative image of nursing and structures and processes which exclude them. Conclusion There is a window of opportunity to enhance national nurse leaders' participation in health policy development. Nurse leaders have a key role in mentoring, supporting and developing future nurse policy makers.