Adaptive leadership in advancing professionalism among clinical nurse educators: A mixed-methods study

OBJECTIVES: To investigate the professionalism among clinical nurse educators and examine how adaptive leadership supports their transition from clinical practice to educational roles. METHODS: A sequential explanatory mixed-methods design, informed by Wheel of Professionalism in Nursing theory and Adaptive Leadership Theory, was conducted between December 2021 and January 2022. Participants comprised registered nurses from teaching hospitals across five provinces and municipalities in China (Shanghai, Zhejiang, Chongqing, Hebei, and Shanxi). Quantitative data were collected through a multi-center cross-sectional survey involving 669 respondents using the Behavioral Inventory for Professionalism in Nursing. Qualitative data were obtained via focus group interviews with 12 purposively selected participants. Data integration was conducted through content analysis, structured around key dimensions of professionalism. RESULTS: The professionalism score was significantly lower among clinical nurse educators than among their managers [11.00 (8.50, 14.00) vs. 15.00 (9.25, 19.50), Z = -4.110, P < 0.001], indicating a discrepancy in perceived professionalism. No significant differences were observed in adherence to the code for nurse, theory-related domains or publication and communication (P > 0.05), whereas significant differences were found across the remaining six dimensions (P < 0.05). Qualitative findings yielded three themes: 1) adaptive alignment with institutional priorities; 2) driving change within complexity; and 3) contributing to social and professional impact. These findings illustrate how adaptive leadership processes shape the development and enactment of professionalism, particularly in navigating role transition and organizational expectations. CONCLUSIONS: Clinical nurse educators demonstrate comparatively lower levels of professionalism than their managers' expectations, with gaps concentrated in multiple practice domains. Adaptive leadership plays a pivotal role in bridging these gaps by enabling clinical nurse educators to respond to complex role demands and evolving institutional contexts. Targeted strategies, including structured training, organizational support, and policy-level interventions, are essential to strengthen professionalism and support sustainable workforce development.