Barriers and Enablers to Leadership in Advanced Practice Nursing: A Systematic Review

IF 3.8 3区医学 Q1 NURSING

International Nursing Review Pub Date : 2025-05-22 DOI:10.1111/inr.70034

Rosemary Fosah, Sofia Llahana

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引用次数: 0

Abstract

Aim

To explore the barriers and enablers influencing leadership enactment by advanced practice nurses and assess how these have evolved over the past decade.

Introduction

Nurses in advanced practice roles are well-positioned to drive healthcare change, addressing patient needs and service demands. However, their leadership contributions are often underestimated, with greater emphasis placed on clinical practice and education rather than leadership and research.

Methods

A systematic review of cross-sectional studies was conducted using CINAHL, MEDLINE, EMBASE, APA PsycINFO, and Cochrane databases for studies published between January 2015 and March 2024. Fourteen studies involving 5243 participants were narratively synthesised. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool, and findings are reported following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines.

Findings

The review identified 24 barriers and 18 enablers to enacting leadership in advanced practice nursing roles, grouped into eight themes across four structural levels: healthcare system, organisational, team, and individual. Key themes included leadership capacity building, role clarity, development opportunities, resource allocation, and mentorship. Major barriers were unclear roles, limited leadership training, and resource constraints, while enablers included mentorship, leadership programmes, and organisational support.

Conclusion

Despite progress, significant barriers persist in developing leadership capabilities within advanced practice nursing roles, particularly in healthcare systems and organisational levels. Standardised education and training pathways are needed to equip nurses for leadership roles, and further research is required to address these barriers.

Implications for nursing and health policy

Strengthening leadership capacity for advanced practitioners in nursing requires sustained institutional support, standardised education, and strategic engagement with policymakers. Maximising their leadership potential can drive healthcare innovation, improve patient outcomes, and ensure the long-term sustainability of these roles.

Trial and Protocol Registration

PROSPERO registration number CRD42024465777.

Reporting Method

This systematic review adhered to relevant EQUATOR guidelines and followed the PRISMA guidelines.

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高级护理实践中领导力的障碍和促进因素：系统回顾

目的探讨影响高级执业护士领导力制定的障碍和促进因素，并评估这些因素在过去十年中的演变情况。护士在先进的实践角色是很好的定位，以推动医疗变革，解决病人的需求和服务需求。然而，他们的领导贡献往往被低估，更强调临床实践和教育，而不是领导和研究。方法采用CINAHL、MEDLINE、EMBASE、APA PsycINFO和Cochrane数据库对2015年1月至2024年3月发表的横断面研究进行系统回顾。对涉及5243名参与者的14项研究进行了叙述综合。使用乔安娜布里格斯研究所关键评估工具评估研究质量，并根据系统评价和荟萃分析（PRISMA） 2020指南的首选报告项目报告研究结果。该综述确定了在高级护理实践角色中发挥领导力的24个障碍和18个促进因素，分为四个结构层次的8个主题：医疗保健系统、组织、团队和个人。关键主题包括领导能力建设、角色明晰、发展机会、资源分配和指导。主要障碍是角色不明确、领导力培训有限和资源限制，而促成因素包括指导、领导力项目和组织支持。尽管取得了进展，但在发展高级护理实践角色的领导能力方面，特别是在医疗保健系统和组织层面，仍然存在重大障碍。需要标准化的教育和培训途径，以使护士具备领导作用，并需要进一步研究以解决这些障碍。加强护理高级从业人员的领导能力需要持续的制度支持、标准化教育和与决策者的战略参与。最大限度地发挥他们的领导潜力可以推动医疗保健创新，改善患者的治疗效果，并确保这些角色的长期可持续性。试验与方案注册PROSPERO注册号CRD42024465777。本系统评价遵循相关的EQUATOR指南和PRISMA指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Nursing Review 医学-护理

CiteScore

7.90

自引率

7.30%

发文量

审稿时长

6-12 weeks

期刊介绍： International Nursing Review is a key resource for nurses world-wide. Articles are encouraged that reflect the ICN"s five key values: flexibility, inclusiveness, partnership, achievement and visionary leadership. Authors are encouraged to identify the relevance of local issues for the global community and to describe their work and to document their experience.