The Influence of Perceived Physician Guidance and Trust on Early‐Career Nurse Practitioners’ Clinical Leadership: A Cross‐Sectional Mixed‐Methods Study
- 1Department of Educational Development and Research School of Health Professions Education Faculty of Health Medicine and Life Sciences Maastricht University Maastricht the Netherlands maastrichtuniversity.nl
- 2Research Centre for Interprofessional Collaboration in the Community Zuyd University of Applied Sciences Heerlen the Netherlands zuyd.nl
- 3Catharina Hospital Eindhoven the Netherlands catharinaziekenhuis.nl
Abstract
Background: 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.
Related
- The influence of transformational leadership on job satisfaction and employee performance: a moderated mediation analysis of intrinsic motivation and perceived calling in Sierra Leone.
- The influence of migration status on perceived discrimination among older adults in India: a nationwide cross-sectional study
- Empowering leadership and work engagement among university faculty members with affective commitment and perceived insider status as parallel mediators
- General practitioners' willingness and perceived barriers and facilitators to 'prescribing' potassium-enriched salt in China: an explanatory sequential mixed methods study.
- Associations of perceived benefits, cost burden, and sociodemographic factors with cervical cancer screening by regular physician status among Korean women
BibTeX
@article{zhang2026influence,
title = {{The Influence of Perceived Physician Guidance and Trust on Early‐Career Nurse Practitioners’ Clinical Leadership: A Cross‐Sectional Mixed‐Methods Study}},
author = {Guoyang Zhang and Hester W. H. Smeets and Carolin Sehlbach and Frank W. J. M. Smeenk and Renée E. Stalmeijer},
journal = {Journal of Nursing Management},
year = {2026},
month = nov,
doi = {10.1155/jonm/1900444},
url = {https://doi.org/10.1155/jonm/1900444},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The Influence of Perceived Physician Guidance and Trust on Early‐Career Nurse Practitioners’ Clinical Leadership: A Cross‐Sectional Mixed‐Methods Study
AU - Guoyang Zhang
AU - Hester W. H. Smeets
AU - Carolin Sehlbach
AU - Frank W. J. M. Smeenk
AU - Renée E. Stalmeijer
PY - 2026
DA - 2026/11/03
JO - Journal of Nursing Management
DO - 10.1155/jonm/1900444
UR - https://doi.org/10.1155/jonm/1900444
AB - Background: 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.
SN - 0966-0429
SN - 1365-2834
ER -