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Objectives: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally., Design: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022., Setting: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya., Participants: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218)., Measurements: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics., Findings: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy., Key Conclusions and Implications for Practice: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Global healthcare expenditure is increasing, along with the numbers of older patients with multiple comorbidities, while the numbers of health workers are hugely decreasing, and many nursing and midwifery vacancies remain unfilled. With the World Health Organization declaring 2020 the Year of the Nurse and Midwife, and commencing the Nursing Now campaign with partners including the International Council of Nurses and the International Confederation of Midwives, has allowed these professions to unite, encourage advocacy and the call for global investment in nursing and midwifery. These actions will permit these professions to address universal health coverage, global inconsistencies of professional practice, and recruitment and retention. The Nightingale Challenge seeks to place early career nurses and midwives at the forefront of transformation, calling on employers worldwide to invest and provide nursing leadership development, and to become a key part of the solution to address the issues of providing universal health coverage, promoting gender equality and supporting economic growth. This will help place them at the heart of tackling 21st century health challenges., (© 2020 International Council of Nurses.)

The Francis report highlighted the importance of strong leadership from health professionals but it is unclear how prepared those who are newly qualified feel to take on a leadership role. We aimed to assess the confidence of newly qualified health professionals working in the West Midlands in the different competencies of the NHS Leadership Framework. Most respondents felt confident in their abilities to demonstrate personal qualities and work with others, but less so at managing or improving services or setting direction.