2026/04/05 by Aleix Fontanals‐Jimenez, Marta Trapero‐Bertran, Montserrat Gea‐Sánchez +1 · 1 voice
Health Professions · Nursing · #Interprofessional Education and Collaboration #Nursing Education, Practice, and Leadership #Nursing education and management
paper · doi:10.1111/jan.70600
openalex publication_date 2026/04/05 · openalex created_date 2026/04/07 · openalex updated_date 2026/06/11
AIM: To examine the conceptual ambiguity of nursing leadership, particularly in relation to management roles, and to propose a multilevel competency framework that redefines leadership as a core dimension of nursing practice. The paper introduces an innovative hybrid Iceberg-Alles model that integrates observable competencies with deeper motivational, ethical and personality-based attributes. DESIGN: Integrative review. METHODS: Two-stage evidence identification process informed by theoretical reflection and existing evidence on nursing leadership and management. DATA SOURCES: A literature search was conducted in targeted databases such as PubMed, Scopus, Web of Science, CINAHL and extended to Google Scholar and grey literature. IMPLICATIONS FOR NURSING: Current understandings of nursing leadership are fragmented and often limited to managerial skills, overlooking crucial aspects such as ethical commitment, personal values, interpersonal skills and relational capacities. The hybrid Iceberg-Alles model reconceptualizes leadership as a multidimensional construct that balances visible skills with underlying drivers such as motivation, self-awareness and value alignment, offering a more comprehensive basis for leadership development. CONCLUSIONS: Nursing leadership should be understood as a relational and value-based process embedded across all levels of practice, not confined to formal administrative positions. The proposed model enhances conceptual clarity and provides a transferable framework that can be adapted across diverse health systems, roles and organisational structures. IMPACT: Broadening the scope of nursing leadership can reduce role ambiguity, highlight the unique contribution of nurses to healthcare systems, and strengthen the profession's influence in policy and decision-making. The hybrid model provides concrete guidance for educational programmes, competency-based curricula and organisational strategies aimed at preparing future nurse leaders to manage complexity, promote collaboration and improve patient care. REPORTING METHOD: This manuscript followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct or reporting.