Strengthening the role of the executive nurse director: A qualitative interview study

Daniel Kelly*, Zoe Horseman, Fiona E. Strachan, Sharon Hamilton, Aled Jones, Aisha Holloway, Anne Marie Rafferty, Helen Noble, Joanne Reid, Ruth Harris, Pam Smith

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aim: To explore the challenges and opportunities facing executive nurse directors in the UK and identify factors to strengthen their role and support more effective nurse leadership. 

Design: A qualitative descriptive study using reflexive thematic analysis. 

Methods: Semi-structured, telephone interviews were carried out with 15 nurse directors and 9 nominated colleagues. 

Results: Participants described a uniquely complex role with a broader scope than any other executive board member. Seven themes were identified: preparation for the role, length of time in role, role expectations, managing complexity, status, being political and influencing. Strengthening factors included successful working relationships with other board colleagues, development of political skills and personal status, coaching and mentoring, working within a supportive team culture and having strong professional networks. 

Conclusion: Executive nurse leaders are key to the transmission of nursing values and the delivery of safety and quality in healthcare settings. To strengthen this role, the limiting factors and the recommended shared learning identified here should be recognized and addressed at an individual, organizational and professional level. 

Implications for the profession and patient care: Given the pressure on all health systems to retain nurses, the role of executive nurse leaders needs to be seen as an important source of professional leadership and their value in actioning health policy into practice recognized. 

Impact: New insights have been provided into the executive nurse director role across the UK. Findings have demonstrated challenges and opportunities to strengthen the executive nurse director role. These include recognition of the need for support, preparation, networking and more realistic expectations of this unique nursing role. 

Reporting method: The study adhered to the Consolidated Criteria for Reporting Qualitative Research. 

Patient or public contribution: There was no patient or public contribution.

Original languageEnglish
Pages (from-to)3809-3823
Number of pages15
JournalJournal of Advanced Nursing
Issue number10
Early online date26 May 2023
Publication statusPublished - Oct 2023

Keywords / Materials (for Non-textual outputs)

  • leadership
  • professional development
  • management
  • executive nurse director
  • chief nurse
  • qualitative design


Dive into the research topics of 'Strengthening the role of the executive nurse director: A qualitative interview study'. Together they form a unique fingerprint.

Cite this