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Redefining Nursing Leadership: A Multilevel Competency Framework for Future Healthcare Challenges
Aleix Fontanals-Jimenez1,2,3, Marta Trapero-Bertran2,4, Montserrat Gea-Sánchez1,2,5
1Society, Health, Education and Culture Research Group (GESEC), Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
Journal of Advanced Nursing
|April 6, 2026
Summary
Nursing leadership is often narrowly defined by management skills. A new hybrid model redefines leadership as a multidimensional practice, integrating visible skills with deeper attributes for enhanced development.
Area of Science:
- Nursing
- Healthcare Management
- Leadership Studies
Background:
- Nursing leadership definitions are fragmented, often conflating leadership with management.
- Existing frameworks overlook crucial non-managerial attributes like ethics and relational skills.
Purpose of the Study:
- To address conceptual ambiguity in nursing leadership.
- To propose a multilevel competency framework for nursing leadership.
- To introduce the hybrid Iceberg-Alles model integrating observable and underlying attributes.
Main Methods:
- Integrative review methodology.
- Two-stage evidence identification process.
- Literature search across major databases (PubMed, Scopus, Web of Science, CINAHL) and grey literature.
Main Results:
- Current nursing leadership concepts are fragmented and managerially focused.
- The proposed hybrid Iceberg-Alles model reconceptualizes leadership as multidimensional.
- This model balances visible competencies with intrinsic drivers like motivation and values.
Conclusions:
- Nursing leadership is a relational, value-based process across all practice levels, not just formal roles.
- The model enhances conceptual clarity and offers a transferable framework for diverse healthcare settings.
- Broadening leadership scope reduces ambiguity, elevates nursing's contribution, and strengthens professional influence.
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