This article outlines how chief nurse executives (CNEs) in an urban regional hospital network are navigating the balancing act of organizational (internal) and system-level (regional and/or provincial) accountabilities amid the coronavirus disease 2019 (COVID-19) pandemic. Key to their leadership efforts is finding the right balance in making critical decisions and building trust to ensure staff resiliency and safety amid managing their own resilience while enacting both internal and external accountabilities. These accountabilities include having presence and influence at the regional planning, executive planning and incident command decision-making tables. Insights from their experiences and lessons learned will be shared alongside recent calls to action for nursing leadership that can serve as a playbook for CNEs dealing with future waves of COVID-19 and unplanned events.