From staff nurse to nurse practitioner in India: A reflective account of clinical growth, identity development, and system barriers

The nurse practitioner (NP) role in India is emerging within a health care system historically structured around physician-centered hierarchies and task-based nursing models. This reflective narrative describes my professional transition from a staff nurse to an NP in Critical Care (NPCC), emphasizing the interconnected dimensions of clinical growth, role identity development, and systemic challenges in the Indian context. Drawing on lived experiences and supported by national and international literature, this account highlights the transformative learning trajectory-from task-oriented bedside nursing to advanced clinical reasoning, diagnostic interpretation, and shared decision making expected of NP practice. The transition was shaped by steep learning curves, limited institutional readiness for NP integration, inconsistent preceptorship, role ambiguity, and restricted autonomy, all of which echo barriers reported across India's NPCC implementation. The narrative also explores personal and professional identity evolution, including the shift from functional nursing duties to an advanced practice mindset grounded in evidence-based care, patient advocacy, and leadership. Persistent challenges, such as unclear scope-of-practice policies, resistance from hierarchical structures, and absence of dedicated NP positions in many hospitals, reflect systemic gaps requiring urgent policy action. Despite these barriers, the NP role demonstrated significant potential for strengthening critical care delivery, enhancing clinical outcomes, and addressing workforce shortages. This reflective account underscores the need for legislative clarity, structured preceptorship models, institutional role integration, and ongoing professional development to ensure successful NP role expansion in India. The insights contribute to global dialogues on advanced practice nursing and emerging NP roles in low- and middle-income countries.