IJNHCR

Introduction

The Nursing and Midwifery Board of Ireland (NMBI) [1] stipulates that Advanced Nurse Practitioners (ANPs) are autonomous, expert practitioners and supports this by identifying six domains of competence; Professional Values and Conduct, Clinical Decision Making, Knowledge / Cognitive, Communication / Interpersonal, Management / Team, Leadership / Professional. The competences for Clinical Nurse Specialist (CNS) as described by the Office of the Nursing and Midwifery Services Directorate (ONMSD) [2] align with these NMBI standards by establishing five competences, clinical focus (direct care and indirect care), patient/client advocate, education and training, audit and research, leadership in clinical practice. The Sláintecare programme provides the direction for healthcare reform and delivery in Ireland, and it highlights the vital role ANPs and CNS’ will play in its success [3].

Evidence Review

This is a mixed method study; (1) Review of Evidence and (2) Survey and thematic analysis of findings.

Main bibliographic databases searched to review evidence

The main data bases searched included CINAHL-Cumulative Index to Nursing and Allied Health Literature, Medline, Psycinfo and Embase via Ovid. The evidence review reveals that there is limited research on the ‘Specialist Nurse Buddy Model’ and its potential impact on both the understanding of specialist nurse roles and succession planning for the recruitment and development of such positions.

The main areas identified included:

Succession Planning

Succession planning is a strategic, systematic process to ensure the right nurses with the right skills are prepared to step into ANP and CNS roles when vacancies arise, ensuring continuity of safe, highquality patients care that is critical to organization development. According to Mirzaee et al. [4] succession planning is defined as a means “to prepare and nurture a capable and talented workforce to meet future staffing demand”. In addition, Rothwell [5] cautions that without succession planning “organizations will have difficulty maintaining leadership continuity or identifying appropriate leaders when a change in business strategy is necessary”. Several key factors underline the need to implement a succession planning training program for nurses to prepare them for leadership roles. These factors include an aging workforce, nursing turnover, shortages, and more responsibilities and expectations placed on nurses. These factors are a global challenge and require universal best practices to face them.

Hegney et al. [6] further supports a structured succession planning utilizing a model called, TRANSPEC. It describes transition into specialty nursing as a phased, time-dependent process shaped by the interaction of the nurse’s professional and personal self, the availability of formal and informal transition processes, and a sense of belonging within the practice context. Importantly, limited organisational focus on the pre-entry phase can weaken recruitment and retention into specialty roles, reinforcing the need for proactive identification and development of potential candidates rather than relying on ad hoc progression [7]. Evidence from peer mentoring programme implementation shows that mentoring can strengthen professional development, improve satisfaction, and support sustained engagement by offering targeted guidance and support alongside existing supervision structures [8].

Professional development for staff

Louth Hospitals Nursing Strategy, [9] emphasizes the importance of ongoing professional development of staffs and creation of positive practice environment within the organization. The hospital group structures support individual nurses on their leadership journey through Professional Development Planning (PDP) framework, mentorship programs and HSE leadership and management courses primarily focusing on role establishment, competency development, and governance. There is limited evidence of a formal, standardised succession planning model specifically designed to prepare nurses for future specialist or ANP roles across services [10-12].

Clinical leaders within the Specialist Nursing Executive Council (SNEC) of the hospital identified a need for a more formal and supportive structure to strengthen succession planning for specialist and advanced practice nursing roles within the organisation in conjunction with The Pathway to Excellence. Although CNSs and ANPs contribute substantially to clinical leadership, service development and quality improvement, progression into these roles is often informal and inconsistent, which can undermine workforce planning, preparedness for role demands, ultimately resulting in a risk to service provision [13]. In response to these identified gaps, this project aims to introduce a structured succession planning model for specialist and advanced practice nursing roles. The model will enable early identification of high-potential nurses, provide coordinated development and mentoring supports, and embed succession planning within SNEC governance to strengthen leadership continuity and the sustainability of specialist and advanced practice nursing roles.

sláintecare in practice

The application of sláintecare in practice in the Irish healthcare system places additional demands to deliver timely access to quality care for all [3]. The Nursing profession plays a vital role in the reform of health care delivery.   Clinical nurse specialists (CNS) and advanced nurse practitioners (ANP) have been identified as central to this implementation, and the empowerment of nurses is essential for the effective delivery of health policy reform. Attaining the sláintecare reform depends on an adequately staffed nursing workforce. This is reinforced within the Health Service Executive (HSE) Corporate Plan [14], where there is an intensified focus on clinical career pathways that facilitate the provision of highquality care closer to home.  Succession planning is fundamental to safeguarding current maturing CNS and ANP posts. 

Mentoring

Mentorship is the primary mechanism for succession planning, ensuring not only that roles are future-proofed but also advance to meet evolving population healthcare needs [11]. Mentoring is defined as a nurturing process designed to promote both personal and professional development, creating a synergetic relationship aimed at advancing career progression and providing dual satisfaction for both mentor and mentee [15-19].

Internationally, emerging models within healthcare employ hybrid approaches that amalgamate formal and informal mentorship, peer mentoring, and virtual mentoring secondary to technological progression.  However, formal mentorship provides structure with protected time and space [20-23].  Both Kayko et al. [24] and Gusar et al. [25] indicate that one-to-one mentoring approaches have a greater impact on the quality of mentoring support.

Successful formal mentorship pathways contain clear objectives, structured frameworks, and regular interactions [26,27].  Key characteristics of effective mentorship pathways include appropriate mentor selection, safeguarding compatibility with the mentee, and access to resources to support practice [28,23,29]. Martina et al. [15] note that the period of mentorship programmes varied significantly, with findings demonstrating that programmes lasting six months to one year generate the most positive outcomes in competency, confidence, and job retention.

Baker et al. [26] found that mentees reported enhanced skill development and a foundation to pursue advanced roles, which is associated with increased job satisfaction and reduced turnover rates in both nursing and midwifery professions.  Additionally, Hoover et al. [30] & Perumal and Singh [28] found that mentees improved clinical skills, having a positive impact on patient care outcomes. Challenges for mentors included time constraints in addition to patient caseload and clinical duties [22].  

Informal mentorship offers flexible, yet valuable support, particularly when combined with formal systems, allowing healthcare organisations benefit from dual mentoring approaches.

Luck et al. [31] in a ‘peer buddy’ programme discuss horizontal mentorship for registered nurses with the aim of having an individual career pathway for specialist positions that is streamlined, expanding individual scope of practice, thus promoting achievement of relevant postgraduate qualifications. Findings supported horizontal mentoring as being a costeffective approach involving minimal resources and insignificant interruption to clinical services.

Succession planning has been used in healthcare and particularly in nursing as a formalised process in developing nurses into leadership and specialist roles to address the gap in the nursing workforce, thus maintaining high-quality evidence-based care [32,33].  Chima et al. [34] advocate a crucial need for proactive and evidence-based workforce planning strategies to ensure that the health system remains resilient, equitable and can meet the needs of the Irish population.  Specific competencies held by ANPs and CNS’s can provide sufficient direction to further develop the nursing profession clinically, professionally and in health reform domains [35]. 

Throughout the literature, the need for robust strategies for staff retention and succession planning has been discussed, with programmes facilitating staff mentoring to address staffing issues discussed in the nursing literature, with specific programmes being developed and used to retain newly graduated staff in nursing with positive effects [36]. Similarly, in Maryland, USA, one programme was developed to support the transition of newly registered nurse practitioners to their roles to address retention of staff in these new positions [37].

The TRANSPEC © model developed in Australia effectively demonstrated how these initiatives positively support the transition of generalist nursing staff to specialist areas for effective recruitment.  This model highlights that the transition depends on enablers to learning, and a ‘pre- entry’ stage, before the transition to a specialist role.  The authors advise that when developing staffing strategies, organisations should recognise all stages of transition in such approaches [6]. Furthermore, Chamberlain et al. [7] verify that this model is designed to address workforce shortages and support the development of novice nurses into expert specialists over time.

Irish research has been scarce until recently; Giltenane et al. [38] shared findings from a mixed-method study on the experiences of Irish nurses engaged in a mentoring programme. Both the mentor and mentee completed online surveys following training.  A major limitation of this study being the phase 2 focus groups had no mentees present, thus leaving the results biased to mentors alone. However, the results demonstrate that mentoring can be significant in workforce development in Ireland as a strategy to improve staff retention and professional development.

Moreover, succession planning supports professional development and career progression within nursing, which can increase job satisfaction, retention, and engagement in the organisation. Thus fosters an environment for professional development and advancement as staff feel supported in their career aspirations, and organisations need to nurture this culture of professional development. A systematic review by Vlerick et al. [29], designed to summarise evidence in relation to the aims, characteristics, and effectiveness of mentorship programmes for specialised nurses and advanced practice nurses, reported positive outcomes on job retention, job satisfaction, clinical skills and overall confidence improvement. Of note, recommendations included that mentoring programmes for expert nurses should be considered as ‘complex interventions’ requiring such elements as work shadowing, peer mentorship, and training in role expansion.

Mentoring and succession planning are crucial strategies for developing nursing leadership, particularly in advanced practice roles such as CNS and ANP. These strategies not only support individual professional growth but also strengthen organisational resilience by building a pipeline of competent future leaders. However, despite their recognised importance, their implementation is hindered by multiple barriers and challenges, while certain facilitators can enhance effectiveness.

A major barrier to mentoring in nursing is the lack of protected time and resources. Nurses often face high clinical workloads, irregular shifts, and staff shortages, limiting their ability to engage in mentoring activities [38]. Similarly, nurses seeking shadowing may be unable to secure protected time during working hours, leading many to undertake shadowing informally or unpaid, which can disproportionately affect nurses with caring responsibilities, including financial and time constraints [39,40].   Moreover, mentors themselves frequently report role strain, as mentoring is typically undertaken in addition to clinical and administrative responsibilities. Similarly, succession planning is often reactive rather than proactive, with leadership gaps addressed only when vacancies arise rather than through systematic identification and development of potential successors [41,42].

Organisational culture also presents challenges. While mentoring and shadowing can enhance awareness of ANP roles, they may be insufficient to address wider concerns related to their role accountability within the global context. ANPs practise with a high degree of clinical autonomy and are professionally accountable for advanced clinical decisions in accordance with the Nursing and Midwifery Board of Ireland (NMBI) standards (NMBI) [1]. Perceived uncertainty regarding medico-legal responsibility and professional accountability may discourage nurses from pursuing ANP roles, even where mentoring or shadowing support is available [43,44].

Integration challenges further reduce effectiveness. Mentoring and succession planning are often implemented independently, resulting in fragmented strategies. Mentoring may develop individuals without a clear organisational pathway for progression, and succession planning may identify potential leaders without providing the necessary developmental support. The lack of formal evaluation frameworks exacerbates this issue, making it challenging to assess the long-term impact on leadership continuity and service delivery [45].

Despite these barriers, the literature identifies several facilitators that enhance the effectiveness of mentoring and succession planning. Organisational commitment is critical: when leadership prioritises professional development, allocates resources, and protects time for mentoring, participation and engagement improve substantially [38].

Structured mentoring programmes with clear role definitions, competency frameworks, and alignment with succession plans promote equity and transparency in accessing advanced practice pathways [45]. Additionally, individual motivation and engagement are key enablers, as nurses who actively seek shadowing often demonstrate readiness for advanced practice education and competency development [23,46].

Formalised succession planning frameworks also facilitate role readiness by linking mentorship to leadership competency development and career progression pathways. Early identification of high-potential nurses, combined with targeted mentoring, ensures that advanced roles are filled by prepared candidates, reducing service disruptions and enhancing retention. Additionally, fostering a positive mentoring culture, characterised by trust, mutual respect, and open communication, encourages participation and strengthens the impact of both mentoring and succession initiatives [40,41].

Methodology

Research Design: Survey

A review of the literature reveals that there is limited research on the succession planning model – ‘Specialist Nurse Buddy Programme’ and its potential impact on both the understanding of specialist nurse roles and succession planning for the recruitment and development of such positions. The development of the survey was informed by an extensive literature review covering peer support models, buddy systems, preceptorship, and mentorship frameworks. Findings from the pilot study indicated that the original instrument lacked sufficient open-ended questions to fully capture participants’ experiences and their perceptions regarding the model’s potential influence on career trajectories.

Consequently, an additional question was incorporated; Question 12, ‘Do you think your participation in this model would encourage you to pursue a career in a specialist or advanced practice role?’ (Appendix 1).

The study utilised a qualitative descriptive research design to gain a comprehensive understanding of the experiences, perceptions, and meanings associated with participation [47] in the model. A qualitative approach was deemed appropriate, as it facilitated indepth exploration of participants’ experiences during the programme and their resulting outcomes. An appropriately structured survey was developed and piloted with initial participants. The questions were designed to elicit detailed accounts of the experiences gained with inclusion of comment prompts; for example, ‘Do you think your participation in this model would encourage you to pursue a career in a specialist or advanced practice role?’ and ‘Please identify the strengths or positive elements of your experience’?

Study aim

The aim of the study was to evaluate the effectiveness of the model in enhancing nurses’ understanding of the specialised roles of Advanced Nurse Practitioners (ANPs) and Clinical Nurse

Specialists (CNSs), as well as to consider how this experience could inform succession planning within the hospital.

Study Setting, Sample and Population/ Participants

The study was conducted at a regional Level 3 Hospital in the Republic of Ireland, where there are forty-seven Registered Advanced Nurse Practitioners and fifty-five Clinical Nurse Specialists employed across numerous nursing divisions.

Sample size

Demographics and data using a survey with open ended questions for qualitative analysis was collected from Nov 2024-January 2026.

26 participants of various grades, ages, races, and sexes enrolled to participate in the ‘Specialist Nurse Buddy Programme’, six participants are awaiting placement dates, One participant has completed the programme but left the organisation and 19 remaining participants completed the programme and survey (Appendix 1). All participants worked in different divisions of the hospital (Table1). Inclusion and exclusion criteria are presented below.

Table 1: Demographics.

Table 2: Title: Survey Data Capture.