The Influence of Perceived Physician Guidance and Trust on Early‐Career Nurse Practitioners’ Clinical Leadership: A Cross‐Sectional Mixed‐Methods Study
Guoyang Zhang, Hester W. H. Smeets, Carolin Sehlbach, Frank W. J. M. Smeenk, Renée E. StalmeijerBackground
Increasing healthcare pressures have accelerated the integration of advanced practice providers, such as nurse practitioners (NPs), into healthcare teams. NPs work at the interface of medical and nursing domains by coordinating care and facilitating interprofessional collaboration. To perform this role effectively, NPs must develop clinical leadership. However, limited research has examined clinical leadership among NPs and how physician guidance and trust are perceived to influence it.
Aims
To examine clinical leadership among early‐career NPs, assess its associations with perceived physician guidance and trust, and explore how NPs perceive these factors as shaping their clinical leadership.
Design
This was a cross‐sectional, embedded, correlational mixed‐methods study.
Methods
A total of 222 early‐career NPs in the Netherlands participated in the study. Quantitative analyses included descriptive statistics, group comparisons, multiple linear regression, and mediation analyses, while open‐ended responses were analyzed using a semantic approach to thematic analysis.
Results
NPs reported moderate to high levels of clinical leadership. First‐year student NPs reported lower clinical leadership scores, whereas NPs with four to five years of practice reported higher scores. In multivariate analyses, perceived physician guidance was positively associated with clinical leadership, whereas perceived physician trust was not directly associated with clinical leadership. Mediation analyses indicated an indirect effect between perceived physician trust and clinical leadership via perceived physician guidance. The qualitative findings complemented these results: NPs described physicians’ emotional and practical support, constructive feedback, and leadership opportunities as enhancing NPs’ confidence and professional legitimacy. They also perceived physician trust as fostering psychological safety through which perceived physician guidance could support their clinical leadership.
Conclusion
These findings underscore the importance of physician guidance and trust‐based relationships as relational conditions that may support clinical leadership among early‐career NPs.