Leadership education for nurse practitioners: a systematic review of interventions, pedagogies and gaps
Clinical Snapshot
PICO Framework
| P — Population | Nurse practitioners (NPs) at any stage of training or practice |
| I — Intervention | Formal leadership education interventions (including experiential learning, mentorship programmes, curricula, and other structured approaches) |
| C — Comparator | No comparator explicitly defined; descriptive synthesis of available interventions without a control condition |
| O — Outcomes | Leadership skill development, leadership competency attainment, evaluation of intervention effectiveness, and pedagogical approaches used in NP leadership education |
Bottom Line
This systematic review identifies a striking paucity of rigorous, theoretically grounded leadership education interventions for nurse practitioners globally. Of 3,058 articles screened, only eight met inclusion criteria — a yield that is itself the most telling finding of the review. The included studies were predominantly US-based, featured isolated rather than longitudinal interventions, and lacked robust evaluation frameworks. Experiential learning and mentorship were the most common pedagogical approaches, with leadership domains weighted toward cognitive and emotional intelligence at the expense of leader character development. No meta-analysis was possible, and the certainty of evidence is very low. For senior clinicians and NP programme directors, this review functions primarily as a gap analysis rather than a practice-changing synthesis. It confirms that NP leadership education is underdeveloped relative to the leadership demands placed on NPs in contemporary interprofessional healthcare environments. The actionable message is clear: future NP leadership curricula should be longitudinal, theoretically informed, faculty-mentored, and prospectively evaluated. In the Australian context, where NP scope of practice continues to expand, this evidence gap represents both a challenge and an opportunity for curriculum innovation.
Key Findings
Effect Size: Not applicable — narrative synthesis only; no quantitative effect sizes reported
Primary Outcome: Characterisation of existing leadership education interventions for nurse practitioners, including pedagogical approaches, theoretical frameworks, and leadership domains addressed
Nnt Or Sensitivity: Not applicable — this is a descriptive systematic review. Key descriptive findings: 8 studies met inclusion criteria from 3,058 screened; most studies were US-based; experiential learning and mentorship were the predominant pedagogical approaches; cognitive and emotional intelligence were the most commonly emphasised leadership domains; leader character development was largely absent; NP clinical faculty involvement was minimal in most interventions
Confidence Interval: Not applicable — no pooled statistical analysis performed
Clinical Application
The review does not identify a single evidence-based leadership curriculum that can be directly implemented. Rather, it provides a framework for curriculum developers to prioritise longitudinal, theory-grounded, experiential, and mentorship-based approaches. Implementation feasibility will depend on institutional resources, faculty expertise in leadership pedagogy, and integration with existing NP programme structures. The absence of robust evaluation frameworks in existing programmes suggests that any new intervention should incorporate prospective outcome measurement from inception. In Australia, nurse practitioners are registered under the Nursing and Midwifery Board of Australia (NMBA) and operate within a nationally consistent regulatory framework. The NMBA Nurse Practitioner Standards for Practice (2014, reviewed 2021) include leadership as a core competency domain. However, as this review demonstrates, the evidence base for how to effectively teach and evaluate leadership in NP education is globally sparse. Australian NP programmes, typically offered at Masters level through universities, would benefit from the review's recommendation to embed longitudinal, theoretically grounded leadership curricula. The RACGP and ACNP (Australian College of Nurse Practitioners) may find this review relevant when developing continuing professional development frameworks. There are no PBS or TGA implications. The finding that NP clinical faculty involvement in leadership education is limited is particularly pertinent in Australia, where NP workforce numbers remain relatively small and mentorship capacity may be constrained. Nurse practitioners at all stages of training and practice, particularly those in advanced practice nursing programmes seeking structured leadership development. Findings are most directly applicable to NPs practising in the United States given the composition of the included literature, though the identified gaps are likely relevant across all jurisdictions with established NP roles.
Abstract
Nurse practitioners (NPs) often lead interprofessional healthcare teams, yet many receive little or no formal leadership training. As healthcare systems grow in complexity and demand greater accountability, the need for strong and effective NP leadership has intensified. However, leadership development within NP education remains poorly defined and often lacks theoretical grounding. This systematic review explores interventions designed to build NP leadership skills. Following PRISMA and BEME Guide No. 13 guidelines, a search (July 2022, updated April 2024) identified peer-reviewed English-language articles from 1980 onward. Studies involving NPs at any training or practice stage were included if they described a leadership intervention. Of 3,058 articles, eight met inclusion criteria. Most studies originated in the U.S., featured isolated leadership interventions, and lacked NP clinical faculty involvement. Experiential learning and mentorship were common. Leadership domains emphasized cognitive and emotional intelligence, with little focus on leader character development. Evaluation of leadership interventions were limited. Overall, few theoretically informed, robust NP leadership interventions exist. Future efforts should prioritize comprehensive, longitudinal, and theory-based approaches to strengthen leadership capacity within NP education and practice.
References
- 1.Kennedy, E., Chan, R., Sultan, N., Lingard, L., Haddara, W., & Torti, J. (2026). Leadership education for nurse practitioners: a systematic review of interventions, pedagogies and gaps. International Journal of Nursing Education Scholarship. https://doi.org/10.1515/ijnes-2024-0016
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