Background: The leadership role in nursing reflects the complexity and rapid transformations which take place in healthcare. The influences of this catalyst of change are important for nurses’ identity and professional development, as well as for evolving and innovating nursing practices. Objective: This study is part of a larger research project on doctoral Leadership in Nursing, aims to identify nurses’ perceptions regarding their similarities and differences compared to nurses in manager roles, in order to understand and recognise the influences and barriers to leadership in the nursing hierarchy. Methods: A descriptive cross-sectional study of a qualitative nature, involved the participation of 19 registered nurses (RNs), based on the Zavalloni Ego-Ecological Theory. Results: From the dimension of identification emerged two major themes - the vision of the profession and the competency skills required. The major theme of competency skills includes subthemes of relational, technical/scientific, leadership and management competencies. From the dimension of differentiation emerged two major themes - the vision of the profession and the competency skills. The major theme competency skills included two subthemes - the deficit of relational and management competency skills. Conclusions: Nurse-managers may choose to distance or influence nurses; influence can be achieved through not only a combination of leadership and management competencies but also on the nurse-managers’ evidence-based expertise and relational skills alongside a vision to support team unity in order to create a positive environment which encourages the nurses to be involved in high quality and innovative practices. Implications for nursing management: This study may help to understand the approaches undertaken by leaders in nursing and subsequently enhance their performance. It may also inform future leadership training for nurses.