Exploring Agency, Autonomy and Authority Among Lead Tissue Viability Nurses: A Qualitative Study.

AIM: To understand Lead Tissue Viability Nurses' agency, autonomy and authority to perform their role. BACKGROUND: Lead Tissue Viability Nurses need both clinical autonomy and organisational authority to improve wound care, patient safety, and cost-effectiveness. Their role goes beyond bedside care to include strategic decisions shaping policy, resources, and quality initiatives. Despite this, the role is often misunderstood and under-recognised. This study, based on the four pillars of advanced nursing practice-clinical practice, education, research, and leadership-examines the challenges they face. DESIGN: A qualitative study. METHODS: Interviews with six Lead Tissue Viability Nurses working in large tertiary care organisations. A thematic analysis was undertaken. RESULTS: The results aligned with the four pillars of advanced nursing practice. Six sub-themes emerged, reflecting the skills, knowledge, and influences involved, and critically, the challenges faced in meeting role expectations: Clinical Practice-working with clinical specialties (a); Education-supporting generalist nurses (b); Leadership-collaborating with dressing companies (c) and national bodies (d); Research-partnering with clinicians (e) to implement national guidance (f). CONCLUSION: Our study highlights the restricted agency that constrains their capacity to meet the complex demands of the role. Their specialised knowledge frequently remains unacknowledged and underutilised, while their contributions are often marginalised within organisational discourse. To attain the level of recognition commensurate with this senior nursing position, their distinct professional and organisational identity should be clearly articulated. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Lead Tissue Viability Nurses should be acknowledged for their advanced practice role, reflecting the specialist expertise and leadership they bring to patient care. Additionally, they must be granted the agency, autonomy and authority necessary to implement best practice. IMPACT: Ensuring that Lead Tissue Viability Nurses can execute their duties effectively and achieve high-quality outcomes will directly influence patient care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution at this stage, as this study was about exploring the nurses' organisational role from their perspective.