{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:45:27Z","timestamp":1791949527576,"version":"4.3.4"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T00:00:00Z","timestamp":1775347200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>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\u2013Alles model that integrates observable competencies with deeper motivational, ethical and personality\u2010based attributes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Integrative review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two\u2010stage evidence identification process informed by theoretical reflection and existing evidence on nursing leadership and management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>A literature search was conducted in targeted databases such as PubMed, Scopus, Web of Science, CINAHL and extended to Google Scholar and grey literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Nursing<\/jats:title>\n                    <jats:p>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\u2013Alles model reconceptualizes leadership as a multidimensional construct that balances visible skills with underlying drivers such as motivation, self\u2010awareness and value alignment, offering a more comprehensive basis for leadership development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nursing leadership should be understood as a relational and value\u2010based 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>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\u2010making. The hybrid model provides concrete guidance for educational programmes, competency\u2010based curricula and organisational strategies aimed at preparing future nurse leaders to manage complexity, promote collaboration and improve patient care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This manuscript followed the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses extension for Scoping Reviews guidelines (PRISMA\u2010ScR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>This study did not include patient or public involvement in its design, conduct or reporting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.70600","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T06:27:48Z","timestamp":1775456868000},"page":"9662-9672","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Redefining Nursing Leadership: A Multilevel Competency Framework for Future Healthcare Challenges"],"prefix":"10.1111","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9026-8434","authenticated-orcid":false,"given":"Aleix","family":"Fontanals\u2010Jimenez","sequence":"first","affiliation":[{"name":"Society, Health, Education and Culture Research Group (GESEC), Department of Nursing and Physiotherapy University of Lleida  Lleida Spain"},{"name":"Healthcare Research Group (GRECS) Institute of Biomedical Research in Lleida (IRBLleida)  Lleida Spain"},{"name":"Social Determinants and Health Education Research Group (SDHEd) Hospital del Mar Research Institute  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9233-1776","authenticated-orcid":false,"given":"Marta","family":"Trapero\u2010Bertran","sequence":"additional","affiliation":[{"name":"Healthcare Research Group (GRECS) Institute of Biomedical Research in Lleida (IRBLleida)  Lleida Spain"},{"name":"Health, Education and Culture Research Group (GESEC), Department of Economics and Business, Universitat de Lleida  Lleida Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-3314","authenticated-orcid":false,"given":"Montserrat","family":"Gea\u2010S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Society, Health, Education and Culture Research Group (GESEC), Department of Nursing and Physiotherapy University of Lleida  Lleida Spain"},{"name":"Healthcare Research Group (GRECS) Institute of Biomedical Research in Lleida (IRBLleida)  Lleida Spain"},{"name":"CIBER Fragility and Healthy Aging (CIBERFES), Instituto de Salud Carlos III (ISCIII)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4778-9769","authenticated-orcid":false,"given":"Esther","family":"Insa\u2010Calder\u00f3n","sequence":"additional","affiliation":[{"name":"Social Determinants and Health Education Research Group (SDHEd) Hospital del Mar Research Institute  Barcelona Spain"},{"name":"Hospital del Mar Nursing School (ESIHMar), Universitat Pompeu Fabra\u2010Affiliated  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,5]]},"reference":[{"key":"e_1_2_16_2_1","volume-title":"Ache Healthcare Executive 2024 Competencies Assessment Tool","author":"ACHE","year":"2024"},{"key":"e_1_2_16_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.profnurs.2024.08.001"},{"key":"e_1_2_16_4_1","volume-title":"Diccionario de comportamientos: gesti\u00f3n por competencias: c\u00f3mo descubrir las competencias a trav\u00e9s de los comportamientos","author":"Alles M.","year":"2005"},{"key":"e_1_2_16_5_1","volume-title":"Charge Nurse vs. Nurse Manager: What's the Difference? 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