The profession of nursing has undergone significant change in the last century but more so in the last two decades since the Report of the Commission on Nursing (1998). This Report is highlighted because of its significant contribution to the advancement of the profession. It heralded radical change both in education requirements and the structure of the profession. This study took place at a time when the Department of Health was in the process of developing systems to restructure the acute hospital system in Ireland into seven hospital groups with the objective of eventually converting the groups into Hospital Trusts similar to the English system. The aim of the study was to explore the leadership experience of the Assistant Directors of Nursing (ADON) in five of the six Dublin Academic Teaching Hospitals referred to as DATHs. Both the historical context and the current role of the nursing profession were explored including the role of the Assistant Director of Nursing. Twenty participants were interviewed using phenomenological methodology with Giorgi’s Framework being used for analysis. The role of the ADON was found to be multifaceted and is discussed in the context of the characteristics of transformational and transactional leadership. Themes identified included aspects of both these styles of leadership with a strong emphasis on Governance and patient safety. The essential meaning structure of the phenomenon that was highlighted in the study relates to the balance the Assistant Directors must maintain between their clinical role and their management role. At the time of the study, Ireland (and the world), was in an economic crisis and this was reflected in the health service budget. This was mirrored in the experiences of the ADONs. In their managerial role, they were given directives for budget savings while in their clinical professional role they were managing the clinical environment with staff shortages and a moratorium on recruitment with resultant governance and patient safety concerns. Patient safety concerns were paramount with this group and remained so when cutbacks and workloads became more demanding.