ArticleBMC nursing2025
Bridging the gap: a qualitative study of role ambiguity, educational misalignment, and systemic barriers in China's advanced practice nurse training.
Article in BMC nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Breastfeeding consulting core competency among Chinese obstetric nurses and its influencing factors: a cross-sectional study.BMC nursing · 2026Article
- Actual Scope of Nursing Practice and the Influencing Factors: A Single-Center Cross-Sectional Study in China.Journal of nursing management · 2026Article
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5 authors.
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Abstract
backgroundAdvanced Practice Nurses are pivotal globally for addressing complex healthcare demands, yet their development in China through the Master of Nursing Specialist (MNS) program faces uncharted systemic challenges. While the MNS program launched aims to cultivate clinical experts, evidence suggests graduates often diverge from intended APN roles.
aimTo explore Chinese MNS trainees’ perceptions of the APN role, their experiences and demands regarding advanced practice training, and the systemic barriers they perceive hindering APN role enactment.
methodsA qualitative descriptive design (Sandelowski) was employed. Purposeful sampling with maximum variation ensured diverse perspectives based on training stage and specialty. Semi-structured interviews were conducted with 15 MNS trainees (8 students, 7 nurses within 36 months of graduation) from three major teaching hospitals in Northern China. Data were analyzed using Braun & Clarke’s reflexive thematic analysis.
resultsThree themes emerged: (1) Ambiguous APN Role Cognition and Expectations: fragmented understanding with students emphasizing technical skills and nurses prioritizing autonomy; (2) Clinical-Training Misalignment: curriculum homogenization, research overload, and missed skill-building opportunities; (3) Systemic Barriers to APN Implementation: resource constraints, cultural resistance from physicians, patients, and institutional ambiguity. These factors form a self-reinforcing “Cycle of Constrained APN Development.”
conclusionTo break the constraining cycle, China’s MNS education requires synergistic reforms: establishing nationally standardized APN role frameworks with structured transition programs; redesigning curricula around competency progression and interdisciplinary simulation; and piloting policy-enabled APN roles (e.g., chronic wound clinics) to legitimize autonomy. Addressing institutional hierarchies and curricular gaps is essential for realizing APNs’ potential in transforming healthcare. CLINICAL TRIAL NUMBER: Not applicable.
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