Nursing is a progressive, innovative profession that provides an opportunity for many career prospects and promotions. Given there are a multitude of work positions in the NHS, role transition offers many opportunities for career advancement in healthcare. The development of roles such as advanced clinical practitioner (ACP) allows health professionals to remain predominantly clinical by becoming experts in their fields (Health Education (HEE), 2022). Many health professionals consider these roles more attractive and better for career advancement than solely management positions.
Nevertheless, managers are needed in health. Proficient, effective managers are crucial to the NHS's ability to provide high-quality services in the face of growing demand for care. It is recognised that developing and educating future managers in the NHS is key to collaborative and accomplished working (Hulks et al, 2017). This results in high-quality health and care standards being maintained for the population (NHS Leadership Academy, 2013).
In recent years, though, the importance of good management has been somewhat overlooked in preference for a focus on leadership (NHS Leadership Academy, 2013). This has been compelled by themes identified in reviews such as the 2013 Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis, 2013), the Dalton review (Department of Health and Social Care, 2014) and The Future of Leadership and Management in the NHS report (The King's Fund, 2011).
There is confusion concerning the boundaries between leadership and management roles (Wood, 2021). Although not synonymous in the workplace, the terms leadership and management are frequently used interchangeably in health. Management in health care has been described as consisting of six critical tasks: planning; allocating resources; co-ordinating the work of others; motivating staff; monitoring output; and taking responsibility for the process for the operations that underpin the delivery of care (Jones et al, 2022). Leadership involves self-awareness, resilience and the capacity to inspire and motivate, qualities that can be exhibited by staff at all levels (NHS Leadership Academy, 2013). A good manager should embody both leadership and management qualities to handle the logistical and administrative aspects of their role effectively while also leading their team with vision and empathy.
In the current healthcare context, managers must deliver high-quality care while often dealing with short staffing, financial constraints and new technologies. Additionally, they are frequently blamed for the NHS's delays, waste and inefficiencies (Jones et al, 2022), and have to battle these within a complex and everchanging political environment (The King's Fund, 2011).
Management has also been deemed unappealing as a career pathway by nurses; they generally choose their career because they want to work with patients rather than line manage, oversee team development and monitor performance. Historical studies suggest that junior staff perceive moving into specialist clinical roles as a more desirable career progression (Wise, 2007), with management positions viewed as underpaid and lacking true decision-making powers (Sherman, 2005).
Traditionally, nurses transition from staff nurse to manager positions, and more recent literature suggests that this role change can be stressful and challenging (Manion et al, 2021, Chau et al, 2022; Doherty et al, 2022), with an increased risk of burnout (Oxtoby, 2022). This is perhaps related to the lack of widespread education and training on management skills (NHS Leadership Academy 2013; Oxtoby, 2016; Jones et al, 2022), particularly within nursing education.
There is also the perception that the manager role is more focused on administration than on patient care (Royal College of Nursing, 2024). However, with an emphasis on management training for advanced practitioners and research indicating that ACPs are effectively trained and skilled (Wood, 2021), this solid foundation equips ACPs for proficiency in management roles (Fothergill et al, 2022). With these changes, management roles may become less intimidating for future junior staff.
Growing your own workforce through role transition is one approach to address staffing need or development. The transition into management may be less daunting if staff who already possess management skills are encouraged to take on these positions.
The ACP role has been defined within the Multi-professional Framework for Advanced Clinical Practice in England (MPF) (HEE, 2017). This refers to the four pillars of advanced practice: clinical practice; education; research; and – pertinent to the topic of this article – leadership and management. Each pillar has a set of underpinning capabilities that all ACPs are expected to be able to demonstrate. As an example, ACPs are expected to:
‘Demonstrate team leadership, resilience and determination, managing situations that are unfamiliar, complex or unpredictable and seeking to build confidence in others.’
Previous commentators have also noted that ACPs' management dominions include clinical, professional, health system and health policy (Heinen et al, 2019) and that they aim to improve patient, personal and organisational outcomes (Kouzes and Posner, 2022). It is recognised that ACPs bring experience and a diverse skill set to their work (Hooks and Walker, 2020).
The hypothesis for this review is therefore that ACPs are in an ideal position to transition into management roles because of the prerequisites for their everyday work. By exploring the evidence base surrounding this topic, this study will investigate whether ACPs could have an easier transition into a management role than other staff and should be encouraged for the future of healthcare management.
Methodology
This was a mixed-method narrative review that drew upon a range of published material to go beyond simple commentary or opinion, using interpretation and critique to provide a summary on the topic of ACPs as potential managers.
A systematic literature search was performed using multiple core databases and citation searching to ensure the search was thorough and efficient. The search strategy used an amalgamation of subject headings and accessible text terms, and individual database thesaurus searches. Boolean operators, truncation and phrase searching allowed searches to be precise and relevant. The MeSH database was also consulted to improve the quality and validity of a review. The STARLITE (sampling strategy, type of study, approaches, range of years, limits, inclusion and exclusions, terms used, electronic sources) was used as a framework to record the search strategy) (Booth et al 2006) (Appendix 1, online).
This review used a deductive approach to thematic analysis using the six critical tasks of management identified by Jones et al (2022). NVivo software was used to store and code the articles against the six critical tasks. Through the iterative process of reading and re-reading the articles, they were aligned to the six critical tasks, which were treated as themes.
In analysing the articles, their link to the MPF (HEE, 2017) was also explored (Table 1). This technique enabled the management tasks to be directly linked to the ACP role and how each theme can be connected to ACPs' expected capabilities. Not all themes could be linked to each of the four pillars of the MPF as evidence was lacking. The quality of the articles was appraised using the Mixed Method Appraisal Tool (Hong et al, 2018). Key features of the quality of existing evidence are included in the results below.
| Theme | Advanced clinical practitioner capabilities* | Articles where discussed |
|---|---|---|
| Planning | Clinical practice: 1.5, 1.9, 1.10 |
Higgins et al (2014); McDonnell et al (2015); Lamb et al (2018); Heinen et al (2019); Evans et al (2020); Bailey et al (2021); Guibert Lacasa and Vázquez-Calatayud (2022) |
| Allocating resources | Clinical practice: 1.9 |
Higgins et al (2014); Lamb et al (2018); Heinen et al (2019); Evans et al (2020); Bailey et al (2021) |
| Co-ordinating the work of others | Clinical practice: 1.1, 1.9 |
Nieminen et al (2011); Higgins et al (2014); McDonnell et al (2015); Lamb et al (2018); Heinen et al (2019); Evans et al (2020); Bailey et al (2021); Guibert-Lacasa and Vázquez-Calatayud (2022); Hulse (2022) |
| Motivating staff | Clinical practice: 1.3 |
Higgins et al (2014); McDonnell et al (2015); Lamb et al (2018); Heinen et al (2019); Evans et al (2020); Fothergill et al (2022); Guibert-Lacasa and Vázquez-Calatayud (2022); Hulse (2022) |
| Monitoring output | Clinical practice: 1.4, 1.6, 1.8, 1.9 |
Higgins et al (2014); McDonnell et al (2015); Heinen et al (2018); Lamb et al (2018); Bailey et al (2021); Hulse (2022) |
| Taking responsibility for the process | Clinical practice: 1.1, 1.3, 1.6, 1.8, 1.9, 1.10, 1.11 |
Higgins et al (2014); McDonnell et al (2015); Lamb et al (2018); Heinen et al (2019); Evans et al (2020); Lawler et al (2020); Fothergill et al (2022): Guibert-Lacasa and Vázquez-Calatayud (2022) |
Ethical approval
All activity conducted for this research was complied with relevant laws and institutional guidelines issued by the University of Essex where this library-based study was conducted.
Results
Eleven articles are included in this review. These are Nieminen et al (2011), Higgins et al (2014), McDonnell et al (2015), Lamb et al (2018), Heinen et al (2019), Evans et al (2020), Lawler et al (2020), Bailey et al (2021), Fothergill et al (2022), Guibert-Lacasa and Vázquez-Calatayud (2022) and Hulse (2022). The PRISMA flow chart (Figure 1) (Page et al, 2021) highlights recorded exclusions with their reasons. This was primarily because of duplication, where the full text of articles was unavailable and if studies were narrative reviews or not classed as empirical research. All articles said research or governance ethics approval had been sought.
There was a common theme of using purposive and convenience sampling combined with small sample sizes. Five studies used a questionnaire for data collection where response bias and reliance on self-report may have led to erroneous research findings (Lawler et al, 2020; Bailey et al, 2021; Fothergill et al, 2022; Guibert-Lacasa andVázquez-Calatayud, 2022; Hulse et al, 2022). However, all articles emphasise rigour in data analysis collection and refer to the steps taken to reduce bias and improve the quality of the research undertaken.
The articles are multinational, and include research from Canada, Ireland, Finland, the UK, and multiple countries in Guibert-Lacasa and Vázquez-Calatayud's (2022) systematic review. Comparing healthcare services in different countries is not straightforward as it is difficult to make like-for-like comparisons.
Planning
Planning is a fundamental principle in the multiprofessional framework for advanced practice; this is to ensure that the right people with the right skills are available to deliver a sustainable health service. Seven out of the 11 articles evidence ACPs planning. This evidence ranges from indirect care activities (Bailey et al, 2021) to planning and establishing strategy groups to guide and develop service transformation (Evans et al, 2020). Several articles highlight that indirect and direct clinical care activities require planning.
According to Bailey et al (2021), in a given hour within a typical working week for Canadian nurse practitioners, managing planned discharges took an average of 14.7% of their time and planning and managing a treatment plan took 22.7%. The ability to plan care adaptable to patient needs and service demands is essential to the core function of the ACP role according to Higgins et al (2014). In both the Lamb et al (2018) and McDonnell et al (2015) research, it was emphasised patients' overall care was improved because of better planning.
Furthermore, Evans et al (2020) established that ACPs plan and develop strategy groups for quality initiatives and Heinen et al (2019) reviewed evidence that ACPs collaborate with health professionals to plan improvement opportunities. As an example of this, Guibert-Lacasa and Vázquez-Calatayud (2022) refer to a study where participants identified and planned a safety or quality initiative to improve hospital patient flow. The study by Lamb et al (2018) acknowledges that planning care with patients and educating them will improve overall outcomes and satisfaction.
In addition, the research by Bailey et al (2021) found that up to 43.1% of a working day can be spent on educating students. This requires planning the students' working day and considering the skill set they require to care for the patients for whom they are responsible. Up to 9% can be spent on planning and providing teaching sessions.
Bailey et al (2021) also found that 6.9% of a working day involved planning or implementing research, although this is contradicted by Evans et al's (2020) study, which found research capabilities or research-related activities were limited.
Allocating resources
Higgins et al (2014) proposed that a core function of an ACP is to respond to patient and service demand by allocating the appropriate resources. Lamb et al (2018) agree and promoted goal-oriented care and empowerment through self-management of conditions. They proposed that ACPs facilitate independence and autonomy by capitalising on opportunities to educate patients about medications, new therapies and disease progression. Through such patient education, resources can be focused on person-centred, individualised care. Bailey et al (2018) found that 2.1% of ACPs' daily activity was focused on attending conferences and seminars. Allocating this resource enables ACPs to maintain their evidence-based approach by keeping their techniques and knowledge up to date, which can only positively impact patients.
Higgins et al (2014), Lamb et al (2018), Bailey et al (2019), Heinen et al (2019) and Evans et al (2020) all highlight a direct link between cost-effectiveness and ACP employment, particularly in preventing a future decline in patients' conditions that could progress to them requiring higher levels of care, incurring a greater cost to the NHS. This is supported by Heinen et al (2019), who accentuate the links made between ACPs and economics, policy and finance. All agree that, by allocating the right resources, patient care is made more cost-effective.
Co-ordinating the work of others
Both NHS Improving Quality (2014) and the MPF (HEE, 2017) recommend a collaborative approach when co-ordinating the work of others. Collaboration improves communication and working relationships and aims to provide a better experience for people who use health services.
Co-ordinating the work of others is evidenced in nine out of the 11 articles. All recognise that ACPs co-ordinate the work and activities of the multidisciplinary team to ensure care is of a high standard and patient centred. Bailey et al (2021) worked out that this took up 22% of the working day. In Evans et al's (2020) research, for which ACPs, GPs and practice managers were interviewed about the job roles of ACPs working in nine GP practices within one UK region, 11% of ACPs reported management responsibilities. This included practice partner tasks and managing a team of nurses, which involved co-ordinating their roles in the surgeries.
Heinen et al (2019) proposed that ACPs enhance group dynamics when co-ordinating the work of others and are in a better position to manage group conflicts within their organisation. Lamb et al (2018) and Nieminen et al (2011) also established that ACPs co-ordinate teams by working with colleagues, such as physicians, which builds credibility and respect. This is reinforced by Hulse (2022) and McDonnell et al (2015), who agree that multiprofessional teamwork bridges gaps between professional boundaries, resulting in a higher quality of care.
Guibert-Lacasa and Vázquez-Calatayud (2022) cite a strategy called REJOICE (respect, empathy, optimism, individuality, collaboration and expression) to enhance collegiality among inpatient teams. By co-ordinating the work of others, this strategy includes activities such as sharing experiences, participating in committees and recognising a colleague who had improved someone's day. These activities resulted in a shared vision, enhanced communication and unified decision-making.
Heinen et al (2019), Evans et al (2020), Bailey et al (2021), Guibert-Lacasa and Vázquez-Calatayud (2022) and Hulse (2022) concluded that ACPs in their studies were involved in educational support or mentorship of other staff. Higgins et al (2014) recommend that, through effective co-ordination, ACPs can change clinical practice through formal education of the multidisciplinary team. McDonnell et al (2015) support this, adding that ward nurses see ACPs as a reliable source of knowledge and expertise.
Furthermore, through co-ordinating the work of other team members, Heinen et al (2019) found that ACPs are in an ideal position to monitor standards in practice to improve care. McDonnell et al (2015) concurred, finding that, because vigilance is enhanced, practitioners could pick up shortfalls or omissions in care while co-ordinating other tasks.
Motivating staff
Motivated employees feel supported by their managers; they are engaged with their work and continually inspired by the people around them. The NHS People Plan 2020/21 (NHS England, 2020) recognises that motivation and morale are essential for a healthy workforce. Eight out of the 11 articles evidence motivating staff.
In Evans et al's (2020) research, ACPs were found to have improved morale across a practice as they shared their skills and helped others to carry workloads. This is supported by Higgins et al (2014), who state that creating an environment of collegiality and promoting clinical excellence will have positive ramifications for the ongoing professional development of the ACP role. Higgins et al (2014) also emphasise that ACPs have positive personal attributes such as ‘having a vision, ability to influence and being open to change’. Heinen et al (2019) in addition noted that ACPs create an environment where team members are listened to. Evans et al (2020) propose that all these qualities provide insight into progressive career pathways and help motivate staff by raising professional career aspirations and opportunities.
Lamb et al (2018) suggested that an essential part of leadership is being central to the team; not only does this build integrity, but also it is a way to show how to lead by example and how to respond to challenging situations. In their review, Guibert-Lacasa and Vázquez-Calatayud (2022) proposed that fostering relationships with other professionals motivates staff to take an active part in their organisation. This encourages a future generation of nurse leaders (Heinen et al, 2019) and enhances the quality of care, satisfaction, and retention of nurses (Higgins et al, 2014).
Nearly half of the articles recognised that ACPs motivate staff through coaching and facilitating learning for others. McDonnell et al (2015) highlighted that the relationship between junior doctors and ACPs directly impacts competence and motivation. Junior doctors valued the clinical expertise of the ACPs, and their daily support and advice. One doctor stated:
‘They have been at the job for quite some time, so they are pretty clued in. It is helpful to look through their summary and what they write in the notes, see their thought process, and decide what to do from there.’
Evans et al (2020) highlighted that ACPs run regular staff meetings to support and educate junior team members, and the feedback received is positive and motivating. Fothergill et al (2022) agreed and stated that this can influence ongoing development. Although within the discrete area of advanced paediatric nurse practitioners, Hulse (2022) reported an overwhelming 92%–97% of respondents highlighted the essential role ACPs had in capitalising on teachable moments for staff while nurturing a trusting and continuous relationship. Heinen et al (2019) also stressed that encouraging advanced nurse practitioners to foster and translate research into practice motivates future ACPs to engage in these practices, which has positive repercussions for future research.
Monitoring output
Monitoring output is evidenced in six out of the 11 articles. Bailey et al (2021) described how ACPs monitor treatment plans to ensure care is appropriate and patient centred; they found ACPs spent an average of 13.9% on collecting and analysing data to ensure patients were receiving the best care. This allows clinical output to be measured and monitored, enriching patients' trust in their service and care. The work by Higgins et al (2014), McDonnell et al (2015) and Hulse (2022) support these findings, emphasising that monitoring the production of clinical services enables streamlining of care provision, which positively impacts patient safety and outcomes.
Higgins et al (2014) and Heinen et al (2019) found that ACPs engage in teaching services to ensure that treatment and services benefit the patient and service. In addition, Heinen et al (2019) found that ACPs contribute to developing, implementing, and scrutinising organisational performance standards to ensure that benefits are delivered. They also reported that ACPs provided leadership by liaising with other health services to optimise outcomes for patients, clients and communities. Higgins et al (2014) agreed and stated that ACPs engage with professional organisations at a national and international level to enhance services.
Taking responsibility for the process
Responsibility is an obligation to complete a task or oversee the output of others you may be directly in charge of (Brown, 2021). This core function is required to improve the systems and processes that underpin the delivery of patient care (Jones et al, 2022). Evans et al (2020), Lamb et al (2018), Lawler (2020) and McDonnell et al (2014) all note that ACPs take responsibility for care processes by having clear rationales for clinical decisions, with alterations being made depending on clinical need. ACPs will negotiate on patients' behalf to ensure that the system meets their needs (Lamb et al, 2018) and prevent future decline through optimising patient engagement (Heinen et al, 2019). Evans et al (2020) state that this links directly to accountability and sets clear professional boundaries.
Higgins et al (2014) explain that ACPs take responsibility for the care process through practice development and clinical practice via educating the multidisciplinary team to ensure optimal patient care delivery. Lamb et al (2018) also established that ACPs recognise other staff members' skills and contributions, taking responsibility for patient care by guiding and directing these staff to ensure that patient care remains of a high standard.
The reviews undertaken by Higgins et al (2014) and Guibert-Lacasa et al (2022) found growing recognition that ACPs are well positioned in clinical teams and organisations to lead on agendas for healthcare reform. By taking responsibility for this process, they are ideally placed to influence policy at local and national levels. Heinen et al (2019) also highlighted that ACPs frequently influence at strategic levels to create and share an organisational vision on quality improvement, leading to change and promoting enhancements that affect healthcare status. Fothergill et al (2022) found that ACPs are involved in the economic evaluation of practice-based research associated with quality improvement. By taking responsibility for this process, ACPs can work to improve systems that reinforce the quality of patient care.
Discussion
With the massive drive to encourage, nurture and develop future NHS managers, this review has aimed to explore whether ACPs should be encouraged into management positions. This tested the hypothesis that ACPs can transition into management positions with relative ease because of the pre-existing management responsibilities they have in practice. The fact that management skills are a prerequisite for an ACP role is evidenced in the MPF (HEE, 2017), which sets out the core responsibilities of an ACP's role and identity.
The themes presented in this review are considered the six critical tasks of a manager (Jones et al, 2022), and the literature reviewed has proved that ACPs already take on all of these management responsibilities in their work. Analysing the data using the four pillars of advanced practice has further evidenced how management responsibilities are intertwined throughout ACPs' advanced practice. The literature agrees that ACPs have multifaceted, autonomous, transferable skills (Morley et al, 2022), are the linchpin in a team (Williamson et al, 2012) and can shape healthcare reform (Wood, 2021), improve patients' outcomes and address the rise in demand on health services (Woo et al, 2017). So, if ACPs have all these skills, why is there an overall lack of evidence in the literature of ACPs transitioning into managers?
A significant factor is that ACPs want to stay in clinical practice (Fothergill et al, 2022). Management is perceived as administrative, and the ACP pathway enables practitioners to remain patient facing. Complex autonomous decision-making within a clinical setting supplies a challenge and an opportunity to flourish as an ACP. The ability to demonstrate core proficiencies in an area of specific clinical competence can therefore be seen as a more attractive option than management, which may take the practitioner away from direct patient care (Hooks and Walker, 2020).
Management roles are frequently associated with additional job stresses and expectations of working excess hours. It has been reported that ACPs experience better job satisfaction and greater retention than managers (Hooks and Walker, 2020), whereas numerous managers report risks of burnout, exhaustion and mental fatigue (Membrive-Jiménez et al, 2020). This perhaps explains why management may be viewed as an unattractive pathway.
ACPs are renowned for excelling in the workplace through positively impacting healthcare services (Stewart-Lord et al, 2020), lowering patient mortality (Wong et al, 2013) and influencing nursing job satisfaction and retention (Ma et al, 2015). Hooks and Walker (2020) found similar results, evidencing cost savings, reduced length of hospital stay and enhanced patient experience. ACPs have a reputation for improving patient care (Heinen et al, 2019). Traditionally, many of those who excel in clinical practice are propelled into management because they stand out in clinical roles (Sandhu, 2023).
However, Leicher and Collins (2016) suggest that clinical and management skills do not always overlap and being good at one only sometimes translates into being proficient at a similar standard in the other. A critical error of senior management is the expectation that a simple job title change imbues the new manager with all the skills required to transition from an ACP to a manager. Clinical abilities cannot simply be expected to be transferable to management skills.
ACPs are considered visible role models (Evans et al, 2020). This is evidenced in the ‘motivating staff’ theme, where ACPs are seen to inspire staff by raising professional career aspirations and opportunities. If ACPs are not seeing peers being supported into and thriving in management positions, it gives the impression that this route is not for them and therefore not valued in practice. This will result in fewer ACPs accepting or seeking out these roles. Although the majority of (but not all) ACPs are nurses, evidence in the literature shows that the voice of nurse leaders is often absent from the highest levels of strategic public health and national response (Kiger, 2021) and their representation in governments and boardrooms is negligible (Anders, 2021).
The development of general managers in the UK is another example, where staff with non-clinical backgrounds were deemed a better fit to manage clinical services. Developing and nurturing clinical staff into general management roles did not use to be considered (Lewis, 2016). This is now viewed as a historic mistake (Hunt, 2016) and a drive to encourage more clinical staff into management positions has occurred. Despite the evidence suggesting that nurses are not given these opportunities in the ‘taking responsibility for the process’ theme, Heinen et al (2019) state that ACPs are influencing at strategic levels regarding quality improvement and change initiatives. Higgins et al (2014) and Guibert-Lacasa andVázquez-Calatayud (2022) support this, both finding that there is growing recognition that ACPs are ideally placed to lead on healthcare reform and policy at local and national levels.
Although there is a plethora of evidence that ACPs are not becoming managers, instances can be found in clinical practice today. The primary researcher (EA) of this article is one such example. Her colleagues quoted many reasons for not becoming a manager, citing burnout, increased hours and, most memorably, being regarded as an accordion (pulled in all directions by staff and senior management). However, the challenge of a different role, learning new skills and the ability to do things right for her team made the role attractive. It has been a challenge and has relied on skill acquisition and development.
Several well-established learning theories and educational frameworks aim to describe this transition. Benner's (1984) well known novice-to-expert theory depicts a five-stage learning journey and is, arguably, the best description of how role transition plays out in practice. Acquiring the new skills required for a management position is comparable with the novice-to-expert continuum, and the transition from being experienced in a previous role to a novice in the next requires not only a period of adjustment but also significant support (Lawler et al, 2020). This model has been criticised as not stemming from quantitative research (Altmann, 2007) but it can be used in many areas of healthcare and supplies a realistic lens through which to view role transition.
Recommendations
Of the 11 articles included in the final analysis of this mixed-method narrative review, most originated from the UK. Further international and longitudinal research is needed to examine the role of the ACP as a manager.
Most of the articles reviewed focused on leadership rather than management qualities. Future research solely focused on ACPs' management skills, rather than leadership and management, may draw additional conclusions about why ACPs do not frequently transition into this role.
The NHS needs efficient and effective managers. This review has outlined how ACPs have proficiency in the critical management skills proposed by Jones et al (2022). However, it has been noted that only a few ACPs may consider a career in management. Increasing numbers of ACPs are being trained or employed in healthcare environments and ambitious growth targets have been set within the NHS Long Term Workplace Plan for ACPs (NHS England, 2023).
This review should be used as a guide to help future ACPs consider a career in management, and to provide reassurance to future managers that they already have many of the skills required to take on these roles after working as an ACP.
Conclusion
ACPs are in an ideal position to take on future managers' roles in healthcare. However, the evidence in the literature suggests that this role transition is rarely seen in practice.
Using Jones et al's (2022) description of the six critical tasks of a manager, the literature has verified that ACPs can demonstrate that they are already taking on these tasks in their roles as practitioners.
Further research and exploration into this role transition are recommended to encourage and develop future managers in healthcare who will not only be able to understand the complexities of managing the care of patients but use their skills and knowledge to become efficient managers who can run departments or organisations functionally and cohesively.