The Common yet Different Journey: Role Transition Among Hospital-Based Advanced Practice Nurses in Mainland China: A Grounded Theory Study.

AIMS: To explore role transition among hospital-based advanced practice nurses (APNs) in mainland China and develop a substantive theory explaining how they move into and enact advanced practice roles. BACKGROUND: APN roles have been introduced internationally to expand nursing practice and improve healthcare delivery. Transition into these roles is challenging because nurses must develop new competencies, assume expanded responsibilities and reconstruct professional identity. This process may be particularly complex in mainland China, where APN roles are largely institutionally based and clinically oriented, with role structures and practice models continuing to evolve. In this emerging APN context, examining how nurses adapt to and enact advanced practice roles provides important insight into the processes underlying role transition. However, empirical evidence on APN role transition in mainland China remains limited. METHODS: A constructivist grounded theory approach was used. Purposive and theoretical sampling recruited 33 APNs in mainland China. Data were collected through longitudinal and retrospective interviews. Data analysis involved initial, focused and theoretical coding, supported by constant comparison and memo-writing. Synchronic and diachronic strategies examined patterns and changes over time. RESULTS: The core category "the common yet different journey" emerged, reflecting common transition stages, different transition trajectories and distinct transition outcomes. Four transition stages were identified: role confusion, role exploration, role integration and continuous development. APNs moved through these stages along five trajectories: sequential, leap, back-and-forth, stagnant and divergent, corresponding to role maturity, role stagnation, or role divergence. Individual, organisational and social conditions shaped these trajectories through a recursive process of role appraisal, adaptive negotiation and recognition feedback. CONCLUSIONS: This study offers a contextually grounded explanation of role transition among hospital-based APNs in mainland China. The findings show that APN transition is a dynamic process shaped by interactions between individual development and contextual conditions. IMPLICATIONS FOR NURSING MANAGEMENT: The substantive theory provides a basis for understanding APN role transition. Managers should provide staged and tailored support. Mechanisms to document and evaluate APN contributions are needed to strengthen organisational recognition and inform APN role and policy development.