Future Leadership: Advanced Practice Nursing

Liderazgo del futuro: Enfermería de práctica avanzada

Liderança do Futuro: Enfermagem de Prática Avançada

Denise Bryant-Lukosius

Future Leadership: Advanced Practice Nursing

Investigación en Enfermería: Imagen y Desarrollo, vol. 24, 2022

Pontificia Universidad Javeriana

To coin a phrase from the lyrics of an old song, “what the world needs now” to improve global health is nursing leadership. Several policy reports from the World Health Organization1,2 and the Pan America Health Organization (PAHO)3 emphasize the strategic importance of nursing leadership and the strengthening of nursing leadership at all levels of health systems for improving access and quality of care and population health outcomes. Similarly, these reports recognize the enhanced clinical expertise provided by advanced practice nurses and advocate for their expanded use and optimized scope of practice to deliver needed health care services in all countries, but especially in lower- and middle-income countries where advanced practice nurses may be few or non-existent, and where there is high health inequity.

Advanced practice nurses, including clinical nurse specialists, nurse practitioners, nurse anesthetists, nurse midwives, and nurse consultants, have expert knowledge, complex decision-making skills, and clinical competencies that are acquired through graduate education and practice experience.4 A primary focus on clinical practice makes advanced practice nurses distinct from nurses in other types of roles (e.g., manager, educator) requiring graduate education. Strong research evidence exists demonstrating the clinical impact of advanced practice nursing roles for achieving better care for individuals, improving population health, and lowering health care costs.5

Perhaps a less recognized aspect, is that in addition to clinical practice, leadership is a core competency of advanced practice nursing roles.4 As such, advanced practice nurses could be viewed as clinical leaders. They provide clinical leadership by demonstrating and role modeling best practices and the pursuit of clinical nursing excellence through continuing education and professional development. They also provide clinical consultation to address complex patient health problems, lead and coordinate patient care, and advocate for resources necessary to meet patient health needs. Further, advanced practice nurses provide clinical leadership to build human resource capacity and improve care delivery by educating and mentoring nurses and other health professionals and promoting effective interprofessional teamwork.

However, advanced practice nurses are much more than clinical leaders.5,6 They provide organization and systems level leadership by identifying gaps and advocating for new models of care and health care policies and practices to better meet population health needs. Advanced practice nurses are also instrumental for leading the development of new policies and implementing practice change initiatives to promote evidence-informed care. Advanced practice nurses lead by contributing to an organizational culture of excellence and creating supportive practice environments that foster the recruitment and retention of nurses. Within the nursing profession, advanced practice nurses provide leadership by participating in research and knowledge dissemination, contributing to professional nursing organizations, and by advocating for and influencing change to health care policies that optimize the use of nursing and advanced nursing roles. The leadership provided by advanced practice nurses is powerful and cannot be attributed to one activity. Rather, leadership is the synergistic effect of the combined personal attributes, knowledge, skills, and expertise that advanced practice nurses bring to innovate and improve patient health, quality of care, and health system outcomes. Thus, advance practice nurses should be positioned as more than clinical leaders, but as a strategic and essential vehicle for strengthening nursing and health systems leadership to improve global health.

Recently, I had the priviledge of co-leading a project involving over 120 participants from 36 countries to examine the international response and impact of advanced practice nurses for addressing health and health system needs resulting from the COVID-19 pandemic.7 Participants noted that decision and policy makers in health care organizations and governments often lacked awareness and understanding of advanced practice roles. This persistent and pervasive issue resulted in failure to introduce advanced practice nurses or to fully leverage their enhanced expertise and scope of practice prior to and during the pandemic. In contrast, when health care decision-makers had a good understanding of the leadership capabilities of advanced practice nursing roles, organizations and countries were able to pivot quickly in response to surging health care demands resulting from COVID-19 by maximizing and extending the use of these roles. Advanced practice nurses were placed in leadership roles to design, implement, and evaluate new policies, practices, and services to reduce the spread of COVID-19 and to ensure the delivery of safe, evidence-informed, coordinated, and accessible care. They were redeployed to provide advanced practice nurse-led services or to educate, supervise, and support nurses and other health professionals in team-based models of care. Advanced practice nurses provided leadership by acting as a liaison between senior managers and clinical staff to communicate and support practice change, and by responding to address the mental health needs of health care providers. Advanced practice nurses reported that when organizational and regulatory barriers to implementing their roles were relaxed due to the demands of COVID-19, they were more empowered to lead and to innovate.

Participants provided several recommendations to build on the momentum created by the COVID-19 pandemic and to break the cycle of barriers to the optimal use and health system integration of advanced practice nursing roles.7 Chief among these recommendations were to strengthen country-level leadership within the nursing profession to lead and influence policy development to support advanced practice nursing education, regulation, and credentialing. Advanced practice nurses should also be positioned in leadership roles in health care policy and decision-making. The need for novel knowledge translation approaches to promote evidence-informed policy and decision-making for the effective use of advanced practice nursing roles was also identified.

In summary, “what the world needs now and into the future” to improve global health, is more advanced practice nursing leadership. Advanced practice nurses are an untapped but ready-made solution for providing and strengthening nursing leadership at practice setting, organization, and health systems levels and within the nursing profession itself. At a time when we have an unprecedented global shortfall of nurses, advanced practice nursing provides a motivating career development opportunity to retain high quality nurses within the profession. Advanced practice nurses also provide organizations with critical leadership to recruit, nurture, and retain nurses in clinical practice. Strengthening the advanced practice nursing workforce across countries, especially where the roles are absent or just emerging, will provide the leadership capacity necessary to improve population health, and to innovate to enhance access to, and the quality and efficiency of health care services.


(1) World Health Organization. State of the World’s Nursing Report – 2020: Investing in Education, Jobs and Leadership. 2020 Geneva: WHO. https://www.who.int/publications/i/item/9789240003279

(2) World Health Organization. The WHO Global Strategic Directions for Nursing and Midwifery (2021-2025). 2021 Geneva: WHO. https://www.who.int/publications/i/item/9789240033863

(3) Pan American Health Organization and the World Health Organization. The Strategic Importance of National Investment in Nursing Professionals in the Region of the Americas. Policy Brief. 2022 Washington, DC: PAHO. https://iris.paho.org/handle/10665.2/55957

(4) International Council of Nurses. Guidelines on Advanced Practice Nursing 2020. 2020 Geneva: ICN. https://www.icn.ch/system/files/documents/2020-04/ICN_APN%20Report_EN_WEB.pdf

(5) Bryant-Lukosius, D., & Martin-Misener, R. Advanced Practice Nursing: An Essential Component of Country Level Human Resources for Health. Policy Brief for the International Council of Nurses. 2015 Geneva: ICN. https://fhs.mcmaster.ca/ccapnr/documents/ICNPolicyBrief6AdvancedPracticeNursing_000.pdf

(6) Bryant-Lukosius, D., Ziegler, E., Kilpatrick, K., & Martin-Misener, R. Advanced practice nursing in Canada. In S.B. Hassmiller & J. Pulcini (Eds.), Advanced Practice Nursing Leadership: A Global Perspective. 2020 (pp. 77-92). Springer.

(7) Ziegler, E., Bryant-Lukosius, D., Baumann, A., Bourgeault, I., Kovacevic, N., Martin-Misener, R., Et.al. The Response and Impact of Advanced Practice Nurses for Addressing Health and Health System Needs Resulting from the COVID-19 Pandemic. Stakeholder Report. 2021. School of Nursing, McMaster University.

Author notes

a Corresponding author. E-mail: bryantl@mcmaster.ca

Additional information

How to cite this article: Bryant-Lukosius, D. (2022). Future Leadership: Advanced Practice Nursing. Investigación En Enfermería: Imagen Y Desarrollo, 24. DOI: https://doi.org/10.11144/Javeriana.ie24.flap