Bone Abstracts

Background: Leadership is increasingly recognised as essential for improving healthcare quality, safety, service delivery, and patient outcomesparticularly within Fracture Liaison Services (FLS), where effective secondary fracture prevention relies on coordinated, proactive care. FLS Specialist Nurses possess the clinical expertise, patient-facing insight, and system-level understanding to act as leaders within multidisciplinary teams. Specialist Nurses remain underrepresented and under-recognised in formal leadership roles, limiting their career progression and their ability to fully contribute to high-performing services.

Aim: This systematic review aimed to identify the barriers and enablers influencing Specialist Nurses progression to leadership roles.

Methods: A systematic literature review using PRISMA guidelines was conducted using structured searches of key healthcare databases. Ten studies meeting the inclusion criteria were critically appraised and synthesised using reflexive thematic analysis.

Findings: Four themes emerged: personal factors, support, resource availability, and role definition. Motivation, emotional intelligence, communication skills, and specialist experience were associated with leadership potential but were not sufficient in isolation. Organisational and managerial supportespecially mentorship, recognition of specialist expertise, and involvement in strategic decisionswas crucial for leadership development. Limited time, funding, and access to professional development restricted progression. Inconsistent role titles and unclear expectations further reduced visibility and hindered effective use of specialist skills.

Conclusion and Implications for Practice: The findings highlight that while individual capability is essential, the leadership development of FLS Specialist Nurses depends on supportive organisational cultures, adequate resourcing, and clear, standardised role frameworks. Addressing these barriers is vital to strengthening FLS leadership and thereby enhancing outcomes in secondary fracture prevention. Empowering FLS nurses to lead will contribute to more consistent, high-quality services and improved patient care.