Abstract
Background and aims: Advanced Practice Nurses (APNs) are not only clinical experts but also emerging leaders who shape care delivery, culture, and professional values. While international frameworks define leadership as a core APN competency, little is known about how leadership identity forms during postgraduate education. Estonia provides a unique case, where APN implementation coincides with national policy, service pilots and ongoing organisational adaptation. This study examined how APN master’s students construct their leadership identity during training and how their perceptions evolve over time.
Methods: Longitudinal qualitative research was conducted in a Health Sciences master’s programme between 2019 and 2026. Students submitted reflective narrative essays describing a personal experience illustrating their role in development, influence or change. A total of 350 essays were analysed using inductive content analysis and frequency counts, expanding upon the earlier foundational dataset of 183 essays collected during the first phase of implementation(Rannus & Weir-Hughes, 2023). Leadership indicators were traced across cohorts, including agency, team direction, value-based influence and system-level engagement.
Results: Eight leadership-related APN roles were identified consistently: continuously evolving direct care provider, developer and promoter, improving practitioner, leader, team player, experience counsellor, fighter and advocate, and advancer on the move. Early cohorts framed leadership implicitly through personal excellence or service improvement. Later cohorts articulated leadership explicitly: organising teams, challenging norms, safeguarding patient and professional rights, and influencing service pathways. The decline of “advancer on the move” suggests reduced career uncertainty and stabilised organisational identity. Leadership formation was strongly associated with confidence, purpose, and alignment with broader system reform.
Conclusions: APN leadership identity in Estonia develops progressively from competence-driven self-improvement toward collective, value-based and organisational leadership. Students increasingly see themselves as catalysts for cultural change and protectors of equitable care. These findings highlight the need for educational strategies, mentorship and regulatory environments that foster leadership formation rather than expecting leadership to emerge solely through clinical experience.
Notes
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Key Reference:
Rannus, K., & Weir-Hughes, D. (2023). The evolving roles of the Advanced Practice Nurse in postgraduate studies. Proceedings of the Estonian Academy of Sciences, 72(3): 220–229. https://doi.org/10.3176/proc.2023.3.04
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Longitudinal Study
Research Approach
Qualitative Research
Keywords:
Sustainable Development Goals, Workforce, Academic-Clinical Partnership, Advanced Practice Registered Nurses, Leadership, Clinical Nurse Leaders, Nursing Leadership, Estonia
Recommended Citation
Rannus, Kristi, "Emerging Leadership Identity in Advanced Practice Nursing: Estonia 2019-2026" (2026). International Nursing Research Congress (INRC). 337.
https://www.sigmarepository.org/inrc/2026/presentations_2026/337
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-27
Emerging Leadership Identity in Advanced Practice Nursing: Estonia 2019-2026
Toronto, Ontario, Canada
Background and aims: Advanced Practice Nurses (APNs) are not only clinical experts but also emerging leaders who shape care delivery, culture, and professional values. While international frameworks define leadership as a core APN competency, little is known about how leadership identity forms during postgraduate education. Estonia provides a unique case, where APN implementation coincides with national policy, service pilots and ongoing organisational adaptation. This study examined how APN master’s students construct their leadership identity during training and how their perceptions evolve over time.
Methods: Longitudinal qualitative research was conducted in a Health Sciences master’s programme between 2019 and 2026. Students submitted reflective narrative essays describing a personal experience illustrating their role in development, influence or change. A total of 350 essays were analysed using inductive content analysis and frequency counts, expanding upon the earlier foundational dataset of 183 essays collected during the first phase of implementation(Rannus & Weir-Hughes, 2023). Leadership indicators were traced across cohorts, including agency, team direction, value-based influence and system-level engagement.
Results: Eight leadership-related APN roles were identified consistently: continuously evolving direct care provider, developer and promoter, improving practitioner, leader, team player, experience counsellor, fighter and advocate, and advancer on the move. Early cohorts framed leadership implicitly through personal excellence or service improvement. Later cohorts articulated leadership explicitly: organising teams, challenging norms, safeguarding patient and professional rights, and influencing service pathways. The decline of “advancer on the move” suggests reduced career uncertainty and stabilised organisational identity. Leadership formation was strongly associated with confidence, purpose, and alignment with broader system reform.
Conclusions: APN leadership identity in Estonia develops progressively from competence-driven self-improvement toward collective, value-based and organisational leadership. Students increasingly see themselves as catalysts for cultural change and protectors of equitable care. These findings highlight the need for educational strategies, mentorship and regulatory environments that foster leadership formation rather than expecting leadership to emerge solely through clinical experience.
Description
The audience will learn how APN students evolve from clinical practitioners to confident leaders, and how educational, organisational, and policy factors shape sustainable leadership identity in advanced nursing practice.