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

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.