To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice.Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice.Data were collected on a sample of nurses and midwives in the Republic of Ireland, using a cross-sectional study design (n=324). The Clinical Leadership Needs Analysis Instrument (CLeeNA) was used to measure perceived importance and performance of clinical leadership in practice. Grades of nurses/midwives included; staff, manager, advanced practitioner and senior manager.Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p<0.01) and Financial & Service Management (p=0.02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309)=6.06 p<0.01].There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff.Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.