Nursing Leadership in Practice: A Qualitative Scoping Review of Framework Implementation Experiences in Public Healthcare Systems

Aim: To explore how nurse leaders in public healthcare systems experience the implementation of professional practice and leadership frameworks and to identify contextual factors that infuence their practical application.

Background: Leadership frameworks are widely promoted to enhance nursing leadership capability, yet their translation into practice remains inconsistent. Understanding how nurse leaders experience these frameworks is essential to inform leadership development and organisational strategy

Methods: A qualitative scoping review was conducted using Braun and Clarke’s refexive thematic analysis. Fourteen qualitative studies published between 2015 and 2024 were identifed through systematic searches of CINAHL, Scopus and MEDLINE. The review followed the Arksey and O’Malley framework and PRISMA-ScR guidelines.

Results: Five themes were identifed: leadership skills, leadership development, leadership challenges, evidence-based practice and workplace culture. Leadership was described as a responsive practice shaped by clinical credibility, strategic management and interprofessional infuence. A conceptual model, the Clinical–Administrative–Research Nexus, emerged refecting the concurrent demands placed on nurse leaders. Systemic barriers such as hierarchical constraints, limited resources and inconsistent organisational support contributed to a persistent ‘knowing-doing’ gap. Workplace culture was the most infuential factor, shaping leadership development, evidence translation and team cohesion.

Conclusion:Leadership frameworks were experienced as contextual tools rather than standalone solutions. Their implementation depends on structural support, mentorship and alignment with clinical realities. Leadership success was shaped more by the conditions in which it is enacted than by individual capability alone.

Implications for Nursing Management: The fndings highlight the need for integrated system-level support to enable nurse leaders to navigate the complexities of their clinical, administrative and research responsibilities. Organisational strategies must move beyond individual skill building to address structural barriers and foster cultures that support leadership development and evidence-based practice.