Nurses' and nurse leaders' perceived expectations and obstacles: an interview study

Nurses are increasingly expected to lead themselves in order to ensure high-quality care, cope with workplace challenges, and sustain their own well-being in a rapidly changing healthcare environment. Effective self-leadership, however, requires reflection, support, and appropriate organizational structures. This study examines nurses' and nurse leaders' perceptions of the expectations placed on nurses' self-leadership as well as the obstacles that hinder it.

A qualitative interview study was carried out. One individual interview and nine focus group interviews were conducted between December 2024 and February 2025, representing various units across different parts of a Wellbeing Services County in Finland. In total, 17 registered nurses and 12 nurse leaders participated in the study. Inductive content analysis was used to analyze data.

Four main themes regarding the expectations for nurses' self-leadership were identified: strong professional self-esteem, ability to work independently, taking care of one's own work well-being, and open collaboration to achieve goals. In addition, three main themes were recognized to describe the obstacles to self-leadership: external work-related constraints, insufficient support for self-leadership, and personal factors.

Self-leadership in nursing is a complex phenomenon shaped by both individual and organizational factors. Expectations and obstacles related to nurses' self-leadership are often reflected in everyday clinical practice, and strengthening self-leadership can support nurses in taking greater ownership of their profession. However, self-leadership is not solely an individual attribute; it is also influenced by collective practices and structural conditions. A more supportive nursing practice environment can be developed by identifying organizational structures and workplace cultures in which nurses' self-leadership is insufficiently supported.