Barriers to Women's Leadership in Nursing: A Rapid Evidence Assessment and Proposal for an Integrated Theoretical Framework.

Abstract

AIM(S) This review analyses and synthesises the available evidence on the barriers limiting women's career advancement in nursing. It aims to identify effective interventions to promote gender equity in healthcare leadership through an integrated framework informed by Social Role Theory, Ambivalent Sexism Theory and Theory of Planned Behaviour. DESIGN Rapid Evidence Assessment. DATA SOURCES The search was conducted on the databases: PubMed, CINAHL Complete, MEDLINE, ApaPsycArticles, ApaPsycInfo between March and May 2025. METHODS The Population-Exposure-Outcome framework guided the formulation of the research question. Two reviewers independently conducted screening, quality appraisal and data extraction. RESULTS Eight studies with heterogeneous research designs were included: four literature reviews, three quantitative studies and one qualitative study. The analysis identified four themes: (1) gender pay gap; (2) gender stereotypes and cultural expectations; (3) systemic barriers: organisational structures and institutional culture; (4) organisational strategies for gender equity and female leadership. CONCLUSION Career advancement for female nurses is limited by systemic and internalised constraints that reinforce vertical segregation. Multilevel interventions are needed to dismantle structural inequalities and reshape gender norms within nursing leadership. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Targeted reforms, including transparent promotion criteria, structured mentoring, bias awareness training and inclusive organisational policies, are essential to promote leadership equity, improve workplace justice and foster a sustainable health system. IMPACT This study addresses the persistent gender gap in nursing leadership, identifying systemic, cultural and individual barriers to women's career progression. Through a Rapid Evidence Assessment, it proposes a new multilevel theoretical framework. The results support policies and interventions to promote gender equity in nursing leadership. REPORTING METHODS This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting. PATIENT OR PUBLIC CONTRIBUTION None.