This paper outlines the processes and results of a participatory action research study undertaken to identify issues that may impact on strategies to foster nurse leadership in rural hospitals. Five Directors of Nursing from rural regions of Victoria, Australia participated. The group activities involved discussion and analysis of previous research, a review of current literature and critical reflection of the leadership performance of their organization. The analysis identified five key themes; dispel the myths, adopt big-picture thinking, connect with colleagues, reflect on your own conduct, and create organizational buy-in. It is essential to have an awareness of contextual challenges, an understanding of the importance of your own conduct as a visible leader, and the need for effective communication to inform the development of strategies that may be used to foster nurse leadership in rural hospitals. The platform to discuss and critically analyze leadership saw a group consensus that affirmed the need for any approach to nursing leadership to be tailored to the individual healthcare organization.