Feasibility and acceptability of advanced practice nursing in Lebanon: A convergent parallel mixed-methods study

Lebanon is facing a severe health system and workforce crisis, characterized by nurse emigration, service fragmentation, and a rising burden of chronic diseases. Advanced practice nursing may help strengthen access, continuity, and quality of care; however, these roles are not formally established in Lebanon.

To assess the feasibility and acceptability of introducing APN roles in Lebanon, identify perceived barriers and enabling conditions, and inform policy and implementation planning.

Convergent parallel mixed-methods study informed by the participatory, evidence-based, patient-focused process for advanced practice nursing framework.

Hospitals and primary care centers in Lebanon.

Health professionals, adult service users, and key stakeholders involved in or affected by APN implementation.

Quantitative data were collected using structured questionnaires administered to health professionals and adult service users and analyzed descriptively using proportions with 95% confidence intervals (Cls) and exploratory subgroup comparisons. Qualitative data was generated through key informant interviews and focus groups with relevant stakeholders and analyzed thematically. Quantitative and qualitative findings were integrated during the interpretation stage using a side-by-side comparison of convergence, complementarity, and divergence.

Most health professionals supported the introduction of advanced practice nursing roles (87.7%; 95% CI 81.4-92.1), and almost all anticipated benefits for chronic disease management and care coordination (99.3%; 95% CI 96.2-99.9). Most service users reported a willingness to receive follow-up from an advanced practice nurse (97.1%; 95% CI 89.9-99.2), and 92.6% (95% CI 83.9-96.8) anticipated improved access in underserved areas. Qualitative findings reinforced perceived benefits for prevention, continuity of care, and equity, while identifying major implementation barriers, including the absence of a clear legal and regulatory framework, unresolved scope-of-practice and reimbursement issues, limited public and professional awareness, insufficient educational pathways, and anticipated resistance from some physicians.

Stakeholders regarded advanced nursing practices in Lebanon as acceptable and potentially beneficial, particularly for chronic disease care and access in underserved areas. However, implementation may require regulatory clarification, investment in master-level education, interprofessional engagement, and context-sensitive policy planning.

Stakeholders in Lebanon support advanced practice nursing, but legal, educational, and system barriers still limit implementation.