Enacting clinical leadership in everyday practice: a qualitative descriptive study of specialist nurses

Background Clinical leadership is increasingly recognised as an important aspect of specialist nursing practice, involving professional collaboration, clinical decision-making, and practice improvement. However, little is known about how specialist nurses understand and enact clinical leadership in everyday practice in China. This study explored their understandings and experiences within a tertiary hospital. Methods This qualitative descriptive study involved 16 specialist nurses from a tertiary hospital in China. We recruited participants using maximum variation purposive sampling. Data were generated through semi-structured interviews and analysed using Braun and Clarke’s reflexive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Four themes were identified: (1) understanding and enacting clinical leadership in everyday professional practice; (2) developing clinical leadership within professional and organisational contexts; (3) experiencing tensions in practising clinical leadership; and (4) seeking clearer pathways to practise clinical leadership. Participants described clinical leadership as closely connected to specialist expertise, professional relationships, and workplace contexts. They associated clinical leadership with guiding colleagues, addressing clinical problems, coordinating practice, facilitating communication and collaboration, and contributing to practice improvement. Their accounts also revealed some overlap between clinical leadership, specialist clinical practice, and managerial responsibilities. Professional growth, recognition, relationships, role expectations, workload, organisational support, and opportunities for specialist practice shaped their experiences of developing and practising clinical leadership. Participants also expressed a need for clearer explanations of clinical leadership and more accessible, practical, and interactive learning opportunities. Conclusions Participants described clinical leadership as embedded in everyday professional practice and shaped by professional and organisational contexts, but they did not always clearly distinguish its boundaries from specialist clinical practice and managerial responsibilities. Their accounts highlight the importance of conceptual clarity and accessible learning opportunities for developing clinical leadership. Broader organisational and educational approaches warrant further evaluation across different healthcare settings. Trial registration Clinical trial number: not applicable.