© 2019 John Wiley & Sons Ltd Aim: To explore the differences in perceived importance and actual performance of clinical leadership for all grades of nurses and midwives engaged in clinical practice. Background: Clinical leadership is central to the provision of person-centred care. However, little is known about how nurses and midwives perceive this in practice. Methods: 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 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. Results: Senior managers were more likely to report significantly higher scores than staff grades for perceived importance of Technology & Care Initiatives (p <.01) and Financial & Service Management (p =.02). Performance of Staff & Care Delivery was significantly higher for senior managers than staff grades [F(5,309) = 6.06 p <.01]. Conclusion: There was a mismatch between the perceived importance and actual performance of clinical leadership in practice between different grades of staff. Implications for Nursing Management: Leadership training for all grades and mentoring of staff grades can promote the building of confidence and empower staff in leading clinical practice.