District nurses have a pivotal role in the NHS but lack visibility at executive board level. This narrative review of the literature aimed to describe what is known about leadership in district nursing and to better understand why district nurses need to be more visible in leadership roles at strategic level. A database search for qualitative studies generated only eight studies for inclusion in the review, which shows that the evidence on leadership in district nursing is limited. The findings show that district nurses have attributes which make them compassionate and transformational leaders, but that they need to increase the visibility of their profession and articulate its patient-focused vision. Investment in training is crucial to develop leadership within district nursing and in the NHS more widely.