Some barriers faced by nursing leaders as a result of institutional culture include a vertical hierarchical leadership which is defined cable of authority from the lowest to the highest levels within an organization. Vertical hierarchical authority prioritizes conformity and obedience by the lowest authority towards the highest authority. In a healthcare setup, this would require subordinate healthcare workers to obey what healthcare administrators and owners require them to do, thus making it difficult for junior staff to implement change or assert their authority as they may feel like they do not have authority to enact change by working under limited guidelines instituted (Duncombe, 2018). As a result, they may not communicate and collaborate effectively with front-line staff.Another challenge is a culture that is resistant to change. A health care facility that does not comply with changes that technology has introduced, such as healthcare trackers, gene sequencing projects, an institutional leadership culture that causes barriers to change by misallocation of funds, and inappropriate health plans by health officials could fail to achieve its goals. Similarly, personalities could be a barrier to change due to anger, denial caused by unwillingness to learn new ideas, and lack of skill and understanding of the advantage of change. Therefore, a negative impact could be witnessed in a healthcare culture where individual barriers among healthcare workers and leaders crop up. For example, a clinical official who addresses patients rudely out of his frustrations could discourage clients from accessing services from the clinic (Mills et al., 2019).A negative organizational culture that limits personnel duties and powers can lead to a lack of communication and collaboration among healthcare leaders and other members of the institution because if the managerial officials in a higher hierarchy are not able to have a voice in holding conversations and decision-making processes, they find it hard to get their messages across to subordinates, and can also make it difficult for junior staff to understand what their leaders expect of them. This discourages cooperation among staff, creating a major problem.