title: Factors influencing advanced practitioners' ability to enact leadership: a case study within Irish healthcare.
abstract: OBJECTIVE
  To report the factors that influence clinical specialists' and advanced nurse practitioners' ability to enact their clinical and professional leadership roles; findings from the SCAPE study.
  
  
  BACKGROUND
  The importance of leadership for specialist and advanced practitioners is highlighted in the international literature and is considered an important factor in the provision of improved patient outcomes. Despite many studies identifying the barriers in developing and integrating new specialist/advanced practice roles into health services, little is known about the factors that influence the leadership dimension of their role.
  
  
  METHODS
  A case study design involving 23 clinical specialist/advanced practitioners working in Ireland and multidisciplinary team members working with them, was used. Data were collected using interview, observation and documentary analysis.
  
  
  RESULTS
  Four mediating factors influence the specialist/advanced practitioner's ability to perform a leadership role, namely the presence of a framework for the professional development of the role; opportunities to act as leaders; mechanisms for sustaining leadership; and personal attributes of practitioners.
  
  
  CONCLUSIONS
  Nursing/midwifery leaders and managers at all levels have a key role in supporting leadership potential, through countering the negative impact of professional isolation, expanding opportunities for specialist/advanced practitioners to influence policy and network with wider professional groups.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Agnes
authors.initials: A
authors.lastname: Higgins
authors.forename: Cecily
authors.initials: C
authors.lastname: Begley
authors.forename: Joan
authors.initials: J
authors.lastname: Lalor
authors.forename: Imelda
authors.initials: I
authors.lastname: Coyne
authors.forename: Kathy
authors.initials: K
authors.lastname: Murphy
authors.forename: Naomi
authors.initials: N
authors.lastname: Elliott
mesh_terms: D006801:Humans; D007494:Ireland; D007857:Leadership; D008880:Midwifery; D009722:Nurse Practitioners; D024802:Nurse's Role; D011209:Power, Psychological
keywords: advanced practitioner; barriers; case study; clinical leadership; enablers; professional leadership