# Integrating advanced practice nurses into the health system: views from nurses and healthcare managers – a qualitative study

## TL;DR

This study explores how to better integrate Advanced Practice Nurses into Lithuania's healthcare system by examining perspectives from nurses and healthcare managers.

## Contribution

The study provides new insights into the challenges and opportunities for integrating APNs in Lithuania through qualitative analysis of stakeholder perspectives.

## Key findings

- APNs and healthcare managers agree on the need for APN integration but have differing views on how to achieve it.
- Structural and cultural barriers like unclear legislation and professional resistance hinder APN integration.
- APNs can strengthen healthcare delivery in primary care and underserved regions if institutional support is improved.

## Abstract

Despite the pivotal role that nurses occupy within the Lithuanian healthcare system, the potential of Advanced Practice Nurses (APNs) remains largely unrealized due to the absence of clearly defined formal roles and structured pathways supporting autonomous practice and full use of advanced competencies. This study aimed to examine the perspectives of selected nurses and healthcare managers on the integration of APNs into the health system.

A qualitative descriptive design employing semi-structured interviews was utilised in Lithuania with Advanced Practice Nurses (n = 6) and healthcare managers (n = 6). Participants were recruited based on inclusion criteria. The interviews covered six main topics. The average duration of the interviews was 67.5 min. Data were analyzed using thematic analysis guided by a qualitative descriptive framework, informed by role theory and health workforce integration perspectives.

The analysis yielded twelve themes each for the nurses and healthcare managers. The results indicated that Advanced Practice Nurses and healthcare managers have differing perspectives on how Advanced Practice Nurses should be integrated, yet both regard it as a necessary evolution of the health system. Motivations were both personal and professional, driven by a commitment to holistic, patient-centred care and the desire to apply advanced clinical knowledge autonomously. Managers perceived successful integration as dependent on role clarity, mutual trust, and professional autonomy. Integration barriers are chiefly structural and cultural—unclear legislation, insufficient funding, low public awareness, and professional resistance—but can be addressed through policy reform, education, public engagement, and investment in collaborative models.

Advanced Practice Nurses are perceived by nurses and healthcare managers as having the potential to strengthen healthcare delivery, particularly in supporting primary care, managing chronic conditions, and improving access in underserved regions. Although APNs demonstrate strong motivation to expand their roles, this potential is currently constrained by limited institutional pathways, role clarity, and recognition. Further national-level research in Lithuania is needed to evaluate the clinical, organizational, and economic impact of Advanced Practice Nurse–led care.

Not applicable.

The online version contains supplementary material available at 10.1186/s12912-026-04427-z.