Specialist nurses describe how clinical leadership shapes everyday hospital practice

Clinical leadership among specialist nurses in China is real but fuzzy at the edges, according to a qualitative study published in BMC Nursing. Researchers interviewed 16 specialist nurses at a tertiary hospital and found that while these nurses routinely lead in practice—guiding colleagues, solving clinical problems, and coordinating care—they did not always clearly distinguish leadership from their specialist clinical work or from managerial responsibilities.

The study used a qualitative descriptive design, recruiting participants through maximum variation purposive sampling to capture a range of specialties and experience levels. Data came from semi-structured interviews and were analysed using Braun and Clarke’s reflexive thematic analysis, with reporting guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Four themes emerged from the analysis. The first concerned how nurses understood and enacted clinical leadership in everyday professional practice. Participants framed leadership not as a formal title but as something woven into routine work: guiding colleagues through complex cases, addressing clinical problems as they arose, coordinating practice across teams, and facilitating communication and collaboration.

The second theme described how clinical leadership developed within professional and organisational contexts. Nurses linked their capacity to lead to their specialist expertise, their professional relationships, and the recognition they received from colleagues and managers. Professional growth, role expectations, and opportunities for specialist practice were described as factors shaping their ability to develop and exercise leadership.

The third theme captured tensions. Participants reported that heavy workloads, role expectations, and variable organisational support shaped their experiences of practising leadership. Their accounts revealed considerable overlap between clinical leadership, specialist clinical practice, and managerial responsibilities, which made the boundaries of the leadership role difficult to define.

The fourth theme pointed to a demand for clearer pathways. Nurses wanted more explicit explanations of what clinical leadership means and more accessible, practical, and interactive learning opportunities to develop it.

The authors conclude that clinical leadership is embedded in everyday professional practice and shaped by both professional and organisational contexts, but that conceptual clarity is lacking. They note that broader organisational and educational approaches warrant further evaluation across different healthcare settings.

The findings are limited by their scope: the study involved 16 nurses at a single tertiary hospital in China and reflects their subjective accounts, so the themes describe experiences rather than measuring the effect of leadership on patient outcomes. As an exploratory qualitative study, it offers a grounded picture of how leadership is understood in one setting and a starting point for developing training and role clarity, rather than evidence of which interventions work.

Subject of Research: How specialist nurses in China understand and enact clinical leadership in everyday practice

Article Title: Enacting clinical leadership in everyday practice: a qualitative descriptive study of specialist nurses

Article References: Ye, Y., Qiao, Y., Zhang, Q., Zhuang, X., Zhang, C. S., & Han, X. (2026). Enacting clinical leadership in everyday practice: a qualitative descriptive study of specialist nurses. BMC Nursing. https://doi.org/10.1186/s12912-026-05560-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05560-5

Keywords: clinical leadership, specialist nurses, qualitative research, thematic analysis, tertiary hospital, nursing practice, China, professional development, role clarity, BMC Nursing, Enacting, clinical