Medical staff's cognition and experience of specialist nurse practice in critical care unit: a qualitative study

Background: Specialist nurses represent an important pathway through which registered nurses transition toward advanced practice nurse roles, and their development and clinical practice are essential for addressing contemporary healthcare challenges. However, in countries such as China, substantial gaps remain in the training and practical implementation of specialist nurses. Despite more than two decades of specialist nurse training in China, systemic issues such as unclear role definitions, insufficient designated positions, and limited decision-making authority continue to constrain their clinical practice. Objective: To investigate healthcare professionals' perceptions and experiences of specialist nurse practice in ICU to identify their roles, impacts, challenges, and suggestions for improvement. Setting: A 25-bed ICU in a tertiary hospital in central China has been conducting under the specialist nurse practice model for six months. Participants: A purposive sampling survey recruited 18 nurses (14 ICU registered nurses and 4 specialist nurses) and 3 ICU physicians, all with more than one year of ICU work experience. Methods: A qualitative descriptive design using semi-structured interviews was adopted. Findings: Three major themes emerged from the analysis: 1) being a versatile and core force; 2) leading nursing quality and professional transformation; and 3) facing challenges and pursing a path to growth. Conclusion: Specialist nurses play a pivotal role in ICU nursing, driving quality improvement and professional development. However, systemic barriers such as resource constraints and role ambiguity limit their full potential. Addressing these challenges through workflow optimization, clear role definition, and policy reforms is crucial for advancing specialist nurse practice globally.