Self-perceived clinical leadership among European nursing students: A six-country cross-sectional study

To compare self-perceived leadership competencies among undergraduate nursing students in six European countries and examine whether between-country differences persist after adjustment for key demographic and educational characteristics.

Leadership is essential for team effectiveness, quality of care, and patient safety. Although newly qualified nurses are expected to demonstrate leadership, it remains unclear whether leadership development opportunities are consistent across European educational and clinical contexts.

Cross-sectional survey.

A convenience sample of 1195 undergraduate nursing students from Ireland (N = 65), Italy (N = 100), Poland (N = 151), Portugal (N = 656), Slovakia (N = 129), and England (N = 94) completed the validated EL-SALI instrument, which measures Strategic Thinking, Emotional Intelligence, Impact/Influence, and Teamwork Skills. Analyses included a one-way ANOVA with post hoc comparisons and a multivariable linear regression controlling for age, gender, and year of study.

Significant between-country differences were found in total scores and in all four leadership dimensions. Variations were most pronounced in Emotional Intelligence and Teamwork Skills. For Impact/Influence, England scored significantly higher than all other countries, which clustered closely together. In adjusted analyses, country remained a significant predictor of total scores; England retained higher scores than Portugal, whereas Italy scored lower. Slovakia showed a non-significant trend toward higher adjusted scores.

Differences in self-perceived leadership competencies among European nursing students suggest variation in how leadership development is embedded within undergraduate programs. Given existing regulatory frameworks, these findings underscore the need for systematic evaluation and greater curriculum alignment to ensure consistent integration of leadership development across academic and clinical training environments, thereby strengthening future practitioners' preparedness.

This study's cross-sectional design, convenience sampling, and reliance on self-report measures limit causal inference and generalizability, leaving it vulnerable to cultural reporting biases. Additionally, cross-national demographic imbalances and the absence of formal measurement invariance testing necessitate cautious interpretation of comparative leadership scores.