Leadership and capability development in advanced practice nursing

Introduction: This paper focuses on the intersection of capability and leadership as discussed in the literature and manifested in the results of a phenomenographic study on nurse practitioner (NP) capability development. Capability has been suggested as an approach to advanced practice nursing (APN) and education, including for NPs. Findings are synthesized from a phenomenographic study looking at NP capability development in one care context (opioid use disorder treatment) and results from a scoping review on capability in APN. Literature on crisis leadership in nursing and the impact of the COVID-19 pandemic on the results are discussed.
Goals and Methods: A scoping review on capability as a concept in APN was conducted using the JBI methodology, with 35 included sources. For the phenomenographic study, qualitative interviews were conducted with 21 NPs treating opioid use disorder, recruited through purposive and network sampling. Demographics were collected through an online survey. Data was analyzed by hand using a phenomenographic approach; iterative readings identified a set of hierarchical and inclusive categories of description.
Results: The phenomenographic study yielded five categories of description incorporating conceptions of capability development: developing practice knowledge; integration of knowledge; evolving practice perspectives; adapting practice; and becoming expert. Referential and structural aspects of the categories were defined through a focus on dimensions of variation – including role of the self as NP, relationality with people who use drugs, confidence, and collaboration. Later stages of capability development were characterized by leadership role adoption, interprofessional collaboration, and analytical approaches to practice. Although leadership appears in the capability literature, and NPs adopted leadership roles, NP study participants did not explicitly reference leadership.
Conclusions: Capability attributes may manifest in the assumption of expert roles and leadership responsibilities by NPs. NPs demonstrated that they are well positioned to lead in the treatment of opioid use disorder.