Fosah Rosemary, Llahana Sofia
University College London Hospital NHS Foundation Trust, London, UK.
School of Health and Medical Sciences, City St George's, University of London, London, UK.
Int Nurs Rev. 2025 Jun;72(2):e70034. doi: 10.1111/inr.70034.
To explore the barriers and enablers influencing leadership enactment by advanced practice nurses and assess how these have evolved over the past decade.
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.
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.
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.
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.
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.
PROSPERO registration number CRD42024465777.
This systematic review adhered to relevant EQUATOR guidelines and followed the PRISMA guidelines.
探讨影响高级实践护士发挥领导作用的障碍因素和促进因素，并评估这些因素在过去十年中的演变情况。
担任高级实践角色的护士处于推动医疗保健变革、满足患者需求和服务需求的有利位置。然而，他们的领导贡献往往被低估，更多的重点放在临床实践和教育上，而非领导能力和研究方面。
使用CINAHL、MEDLINE、EMBASE、美国心理学会心理学文摘数据库（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综述。对涉及5243名参与者的14项研究进行了叙述性综合分析。使用乔安娜·布里格斯研究所批判性评价工具评估研究质量，并按照系统综述和Meta分析的首选报告项目（PRISMA）2020指南报告研究结果。
该综述确定了24个高级实践护理角色中发挥领导作用的障碍因素和18个促进因素，分为四个结构层面的八个主题：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、角色清晰度、发展机会、资源分配和指导。主要障碍包括角色不明确、领导培训有限和资源限制，而促进因素包括指导、领导项目和组织支持。
尽管取得了进展，但在高级实践护理角色中培养领导能力方面仍存在重大障碍，尤其是在医疗保健系统和组织层面。需要标准化的教育和培训途径，以使护士具备担任领导角色的能力，并且需要进一步研究以克服这些障碍。
加强护理高级从业者的领导能力需要持续的机构支持、标准化教育以及与政策制定者的战略互动。最大限度地发挥他们的领导潜力可以推动医疗保健创新、改善患者结局，并确保这些角色的长期可持续性。
PROSPERO注册号CRD42024465777。
本系统综述遵循相关的赤道指南并遵循PRISMA指南。
