Barriers to Implementing Specialist and Advanced Specialist Nursing Roles in Jordan: Perspectives of Regulators, Nursing Leaders, and Educators

Abstract

Introduction

Specialization in nursing is essential to enhance effectiveness, quality, and accessibility of healthcare. Barriers to implementing advanced practice nurses and specialist nurses have been widely reported to limit advanced practice roles in many countries. Identifying these barriers and promoting integration of the role requires an understanding of stakeholders' perspectives. The current study aimed to explore barriers to implementing specialist and advanced specialist nursing roles in Jordan from the perspective of nursing regulators, nursing leaders, and nursing educators.

Methods

A qualitative descriptive design was used to collect data from a purposive sample of 23 nursing stakeholders from the private and public sectors. Data were collected through in-depth semi-structured interviews using an interview guide developed specifically for this study. Sample adequacy was guided by data saturation. Inductive thematic analysis following Braun and Clarke's 6-step approach was used.

Results

Based on the participants' narratives, findings were classified into four main themes and six sub-themes: (1) Policy and Regulatory Constraints, with two sub-themes: Scope of Practice limitations and Role Ambiguity, (2) Knowledge and Skill Gaps with two sub-themes: Incompetent Graduates and the Nature of Educational Programs, (3) Organizational and Administrative Obstacles with two sub-themes: Inefficient Management Structures and Burdens, and (4) the Reluctance to Implement. In addition, participants proposed recommendations and approaches such as clarifying scope of practice, defining roles, curricular reforms, and creating a supportive organization to facilitate effective role implementation.

Conclusion

This study demonstrates that implementation of specialist and advanced specialist roles in Jordan is constrained by educational, regulatory organizational structure gaps, and absence of coordinated policy alignment across all levels. Establishing a collaborative implementation model supported by effective policies is crucial to assist healthcare institutions in overcoming obstacles and barriers and to support the specialized roles in Jordan.