Clarifying Nurse-Physician Dual Leadership in Acute Hospital Settings: A Walker and Avant Concept Analysis

Nurse-physician dual leadership (NPDL) has gained attention in healthcare as a model particularly suited to innovation-driven environments, where the complex demands of leadership may outpace the capacities of a single leader. By combining the distinct yet complementary expertise of nurses and physicians, NPDL offers a hybrid structure that balances the clarity of single leadership with the breadth of shared leadership. Despite its growing presence in healthcare, the concept remains insufficiently defined in the literature.

To clarify the concept of NPDL in acute hospital settings, ensuring consistent terminology and providing a solid foundation for further research, education and practice.

Concept analysis guided by the Walker and Avant 8-step method. A systematic literature search was conducted through PubMed, ScienceDirect and Embase. Keywords included co-leadership, dual leadership and dyad leadership, with and without the prefix 'nurse-physician' and combined with healthcare-related terms. Peer-reviewed articles, books and grey literature, including definitions, attributes, antecedents, consequences and empirical referents, were identified and managed using EndNote. Of 247 identified articles, 23 were included, with eight additional sources retrieved through manual reference list searching.

A definition of NPDL in acute hospital settings is proposed. Four defining attributes were identified: formalised dual leadership structure, joint responsibility, joint decision-making and role complementarity. The analysis also identified five antecedents that were categorised into organisational and relational factors. The consequences of NPDL include stronger leadership, enhanced interprofessional collaboration, improved decision-making and the presentation of a united leadership front.

NPDL can be defined as a collaborative leadership model in which two formal leaders, a nurse and a physician leader, work together as co-leaders, with different skill sets and without a power difference, and they are jointly accountable and responsible for the organisational or unit results.

Clarifying the concept of NPDL enhances future research. It could inform policymakers and support both educators, who provide formal leadership training, and facilitators, who guide professional development through coaching and mentoring, in fostering effective collaboration between nurse and physician leaders.

This study did not include patient or public involvement in its design, conduct, or reporting.