The global landscape of the evolving nurses' roles and core competency in primary healthcare: An expanding umbrella review

International journal of nursing studies, 171, 105177. 2025
Yu, D. S. F.*, Chen, F., Li, A. R., Wong, C. W. Y., Chen, J., Zhan, S., Chan, S. W. C., Holroyd, E., Chair, S. Y., Sim, C. Y., & Wong, W. C. W.

Abstract

Background: A transformative primary healthcare system that delivers effective, efficient and equitable care services is imperative to tackle the ever-emerging challenges to population health such as the surging major lifestyle risks, mental health issues, the burden of chronic care and novel infectious diseases. Nurses, as one of the major service stakeholders in this global agenda, needs to proactively seek role advancement and competency development in primary healthcare. This process can be facilitated by seeking a comprehensive understanding of the global landscape of nurses' roles and competencies in primary healthcare.

Objective: To identify nurses' roles and competencies in PHC from a global perspective, and to explore how different nurses' roles evolve in different healthcare systems over time.

Design: Umbrella review.

Methods: A comprehensive search was conducted in nine databases from 1980 to April 2, 2025. We included all types of review papers published in English or Chinese, with the aim of exploring the changing roles of nurses in PHC. Two reviewers independently screened search records, conducted quality appraisals, and extracted data from the included reviews. An integrative framework of core competencies for primary care nurses was developed, based on the prescriptions of different health authorities from around the world, to guide the synthesis of data on nurses' roles in PHC. Data extraction and integration from the original studies in each review were performed to identify role differentiation among nurses of different ranks. Stacked area charts were created to visualize the evolvement of nurses' role in PHC over time.

Results: A total of 54 reviews published over two decades were identified. The nurses' roles covered eight domains: professional practice, case management, communication and collaboration, health promotion and education, legal, ethical and safety, professional development and research, leadership, and administrative actions. Over the decades, nurses' roles have expanded from conducting primary care practice to engaging in research, interdisciplinary communication, and quality assurance, with landmark years for such changes identified. Role differentiation across nursing ranks was noted, with advanced practice nurses (APN) more engaged in professional development, research, and leadership functions. A dearth of research conducted in low- and middle-income countries was observed.

Conclusions: This expanding umbrella review delineates the scope and evolvement of nurses' roles in primary healthcare from a global perspective. The findings provided important insights to inform the advancement of nurses' competency frameworks, advanced role specialization, pre-registration nursing education in primary healthcare.

Systematic review registration: This review has been registered in PROSPERO (identification number: CRD42024544197).

Keywords: Advanced practice nurse; Competencies; Primary healthcare; Registered nurse; Umbrella review.

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(*Corresponding Author)