Integrating Advanced Practice Nurses into the Health System: Views from Nurses and Healthcare Managers – A Qualitative Study

Background Amid the growing complexity of healthcare, Advanced Practice Nurses are increasingly recognized worldwide for enhancing access to care, improving patient outcomes, and boosting system efficiency. Despite the pivotal role that nurses occupy within the Lithuanian healthcare system, the potential of Advanced Practice Nurses remains largely unrealized, due to the absence of clearly defined formal roles and structured pathways that would enable Advanced Practice Nurses to practise autonomously and apply their advanced competencies to their full extent. This study aimed to examine the perspectives of selected nurses and healthcare managers on the integration of Advanced Practice Nurses into health system. Methods A qualitative descriptive design employing semi-structured interviews was utilised in Lithuania with Advanced Practice Nurses (n=6) and healthcare managers (n=6). Participants were recruited based on inclusion criteria. The interviews covered six main topics. The average duration of the interviews was 67.5 minutes. Data were analyzed using thematic analysis. Results The analysis yielded twelve themes each for the nurses and healthcare managers. The results indicated that Advanced Practice Nurses and healthcare managers have differing perspectives on how Advanced Practice Nurses should be integrated, yet both regard it as a necessary evolution of the health system. Motivations were both personal and professional, driven by a commitment to holistic, patient-centred care and the desire to apply advanced clinical knowledge autonomously. Managers perceived successful integration as dependent on role clarity, mutual trust, and professional autonomy. Integration barriers are chiefly structural and cultural—unclear legislation, insufficient funding, low public awareness, and professional resistance—but can be addressed through policy reform, education, public engagement, and investment in collaborative models. Conclusions There is a clear and increasing need for Advanced Practice Nurses to strengthen healthcare, alleviate physician workload, manage chronic conditions, and expand access in underserved regions. Advanced Practice Nurses demonstrate strong motivation to apply their competencies and assume broader roles, yet this is constrained by limited institutional pathways, recognition, and role definition. Further national-level research is needed in Lithuania to assess the effectiveness, safety, patient satisfaction, health outcomes, service utilization, and economic impact of Advanced Practice Nurse-led care. Clinical trial number Not applicable.