The National Health Service is widely applauded as the highest quality healthcare system in the world (Grint and Holt 2011). However, there have been many changes to healthcare provision in the UK in the last eight years. These included the introduction of the Health and Social Care Act (2012) in response to rising costs and increasing clinical delivery demands on the National Health Service (NHS). Later the Mid Staffordshire Public Inquiry (HM Government 2013) identified failings in leadership throughout the NHS. These failings were linked to leadership lacking clear definition across all professions within the healthcare team (HM Government 2013). Within the nursing profession, the role of the Advanced Nurse Practitioner (ANP) is seen as part of the solution to this leadership dilemma. In this study, eight London-based ANPs were interviewed to explore how they define, understand, express and enact their leadership practice. Using an instrumental and collective case study methodological approach, each participant ANP was considered individually and then comparatively. The findings were focused around five themes. How the ANP viewed their leadership role and whether this was from within or at the forefront of the multidisciplinary team, their ‘placement on the leadership pyramid’. The leadership position the ANPs often adopted was empowering and ‘motivating the team’. The ANPs had a strong nursing identity, which, at times, they would relate to, by ‘retreating to the safety of the nursing profession’. Influences upon the ANP’s expressed understanding of leadership included their relationship with medical colleagues and whether the ANP, ‘assumed and accepted medical hierarchy’. The impact of the ANP role on improving healthcare relates clearly to ‘ANPs impact on patient outcomes’. ANPs have a pivotal leadership role in current healthcare provision. The participant ANP’s demonstrable leadership, enables nursing and the multi-professional team, in meeting the increasingly complex needs and expectations of patients
