Reflections of Master of Nursing Specialist Students in an Advanced Practice Nursing Course: A Qualitative Research Study

ABSTRACT

Aim

To explore the learning experiences of Chinese Master of Nursing Specialist (MNS) students as expressed in reflection reports produced in response to an Advanced Practice Nursing course; to clarify their understanding of the roles played by, the core competencies of, and the career development prospects of Advanced Practice Nurses (APNs).

Background

Health systems both in China and worldwide are increasingly facing pressure from ageing populations and the growing burden of chronic diseases. Given the shortage of skilled nurses, APNs are critical for optimizing care. High‐quality education underpins role standardization, professional identity and innovation in practice.

Design

A qualitative descriptive design was adopted.

Methods

We analysed the course reflection reports produced by 43 first‐year MNS students to explore their learning experiences and perceptions of professional identity and career development through semantic network and qualitative content analyses.

Results

The core words revealed by the semantic network analysis included ‘nursing’, ‘practice’, ‘specialty’ and ‘nurses’. Four themes and nine subthemes were extracted from the reflection reports.

Conclusion

MNS students grasp partial APN core competencies and prefer clinical specialization but lack sufficient understanding of coaching–consultation, ethical decision‐making and evidence‐based practice. Curriculum optimization using Gibbs's reflective cycle and improved cross‐curriculum assessment can remedy such deficits. It is essential to strengthen the synergy between clinical research and practice, foster international collaboration and expand the APN practice scope. Equally important is the development of a localized APN training pathway through a multifaceted care network adapted to the Chinese context.

Implications for Nursing

Educators could integrate Gibbs's reflective cycle into the curriculum of APN and establish long‐term university–hospital partnerships to develop the professional capabilities of APNs, particularly their capacity to address the complex health needs of ageing populations.

1. Introduction and Background

The global health system faces challenges as a result of an ageing population and an increasing chronic disease burden. China has rapidly transitioned into an ageing society, which thus requires continuous care and highlights deficiencies in elderly health and chronic disease management in the current health system (Bao et al. 2022). Despite the establishment of a three‐tier (community–county–provincial/national) medical service network to address the increasing demand for health services and resource imbalances among elderly individuals, shortages of skilled professionals and an inadequate quality control system have resulted in notable variations in quality of care across facilities. In this context, advanced practice nurses (APNs) are pivotal in bridging resource gaps and increasing the quality of care (News Brief 2024; Jezequel et al. 2025). APNs offer comprehensive health management and education, improve patients’ compliance and satisfaction (Kraiem 2024; Whitfield et al. 2024), and act as coordinators to ensure that patients receive holistic and uninterrupted care (Schwingrouber et al. 2024). They are integral to transitional and ongoing care processes (Schuetz Haemmerli et al. 2021), and their professional value has been widely acknowledged (Lin 2023; Toso et al. 2024). A Canadian study confirmed that APNs can effectively address the health needs of patients and communities, particularly in resource‐limited areas (Splane et al. 2023). Although China currently lacks unified standards for APNs, West China Hospital is actively training APNs to establish specialized outpatient clinics and implement patient follow‐up management, among other responsibilities. The collaboration between a specific hospital in China and Peking University in training APNs has been reported to increase the quality and safety of patient care. These findings indicate that thoughtfully designed educational and medical service systems can improve service quality and enable APNs to better provide patient‐centred service for patients and communities (Mackavey et al. 2025). Furthermore, the education of APNs is essential for efforts to ensure alignment between role positioning and the innovation of nursing models (Acorn 2021). It also plays a significant role in the process of enhancing the professional identity and retention rates of APNs (Splane et al. 2023).

The global consensus concerning APN preparation emphasizes postgraduate education as a foundational requirement—a position that was strongly supported by Canga‐Armayor (2024) and is fully in line with the International Council of Nurses’ (ICN) 2020 APN framework (Sulosaari et al. 2023). The Master of Nursing Specialist (MNS) programme in China is an advanced course of academic and professional study that is designed to cultivate high‐level professionals who are equipped with research‐oriented thinking and specialized expertise, thereby building upon their existing nursing licences and clinical experience. Moreover, APN training serves as a pathway for career advancement following the completion of the MNS programme or extensive clinical work experience. This training includes additional on‐the‐job education and a qualification certification, thus enabling nurses to become top experts who are capable of independently addressing complex clinical challenges. Together, these two processes create a progressive continuum ranging from ‘high‐level generalists’ to ‘top specialists’. However, the education of APNs in China, which is characterized by a ‘practice‐first and hierarchical advancement’ approach, began at a relatively late point. A significant milestone in this context was the collaboration between Southern Medical University and Hong Kong Polytechnic University in 2005 to introduce an APN training programme based on postgraduate education. In 2007, the Health Department of Guangdong Province and the Hospital Authority of Hong Kong collaborated to provide specialized nurse training (Wu and Li 2025). These initiatives laid a foundation for the introduction of the MNS in China in 2010, thus signalling the initiation of specialized nurse training with postgraduate education as the focal point in the country.

The Advanced Practice Nursing course is an irreplaceable element of the core curriculum used to educate APNs. This course is a key measure not only for meeting the global consensus on postgraduate education for APNs but also for addressing the limited alignment between local nursing education practices and academic qualifications. Senior nursing talent who are capable of engaging in complex case management and multidisciplinary collaboration can also be cultivated through the implementation of a teaching model that combines theory with clinical practice to fill the gap in senior nursing talent in the context of the ageing population. Furthermore, the curriculum explicitly defines the role orientation and career trajectory of APNs. This clarity reinforces students’ professional identity and commitment to the specialty (Swenson et al. 2025). The concept of full‐life‐cycle nursing and primary service advocated by APNs can also support the Healthy China strategy. This notion can help the medical system optimize the quality of care and mitigate the uneven distribution of resources (Mackavey et al. 2025); it thus has multiple implications with regard to talent training, industry upgrading and medical reform. In addition, the analysis of Chinese nursing postgraduates’ views concerning the Advanced Practice Nursing course provides a localized sample of practice‐first and hierarchical advancements (Wu and Li 2025) for nursing education in a non‐Western context, and the feedback provided by these students regarding blended teaching and multidisciplinary case teaching can improve global curriculum design. In addition, the combination of students’ learning experience with their reflections on their specialty, career, and professional development in the context of advanced nursing practice can help the international community identify and address common pain points in APN training by providing a practical reference for efforts to cope with global health issues such as the ageing population and chronic disease management. China's experience with large‐scale APN training can also promote the establishment of international nursing education standards that can account for global differences in medical systems and in the need to scale education. Furthermore, it can provide a Chinese perspective on the development of APNs through an approach that combines education, policy, clinical practice and research collaboration to improve APN training at the global level.

At present, the Advanced Practice Nursing course in China relies on a blended teaching mode that guides students to complete the process of theoretical knowledge learning independently before class. The course involves in‐depth analysis and discussion of real cases with the goal of deepening students’ understanding of relevant theory. This approach helps students apply their theoretical knowledge to practical scenarios. After class, students are required to answer extended‐thinking questions in combination with cases. Clear requirements for the design of this course are stipulated in the national postgraduate training programme. The course content and teaching methods meet the core competence requirements of APNs and cover clinical practice, training, scientific inquiry and ethical decision‐making (Wu and Li 2025). Therefore, this course design is in line with national policies and industry standards and provides support for the ‘Healthy China’ strategy by emphasizing the key links that characterize the whole life cycle of nursing.

2. Aim of the Study

Gibbs's reflective cycle was employed to explore the learning experiences and reflections of MNS students in the Advanced Practice Nursing course and to provide a basis for reforming teaching content and improving teaching methods to promote the development of clinical nursing. The findings of this research offer insights for enhancing curriculum development and advancing APN education both in China and worldwide.

3. Design and Methods

3.1. Study Design and Participants

In this study, an interpretative qualitative approach was used. The research team consisted of six members, including one professor who had more than 10 years of educational experience and was familiar with the teaching of the Advanced Practice Nursing course, as well as four postgraduate students in the field of nursing.

The participants in this study were first‐year MNS students at a medical university in Fujian Province, China. Prior to their participation, all individuals signed written informed consent forms. The researchers distributed assignments via an online learning platform and asked the participants to submit written reflections after they completed the course. Among the participants, 40 were female, and 3 were male. The students’ ages ranged between 24 and 30 years. They had all earned bachelor's degrees and successfully completed the written portion of China's National Postgraduate Entrance Examination. Following rigorous second and third rounds of reevaluation and corresponding interviews, they were accepted into universities as full‐time MNS students. During their undergraduate studies, they completed an 8‐month clinical internship that covered departments such as internal medicine nursing, surgical nursing, obstetrics and gynaecology nursing, paediatric nursing, operating room nursing and emergency nursing. They also passed the Chinese Nurse Practising Qualification Examination and became qualified to practise as nurses. All of them had completed prerequisite courses, such as Nursing Research and Introduction to Clinical Nursing. They possessed professional basic knowledge and clinical skills and had developed critical thinking and evidence‐based practice abilities. To ensure the participants’ privacy, all the identifying information collected from S1 to S43 was encrypted.

3.2. Assessment Instrument

3.2.1. Semantic Network Analysis

Following the conclusion of the course, we collected the participants’ reflection reports and used the ROST Content Mining System version 6.0 software to conduct a semantic network analysis. This analysis was conducted to identify the themes of interest as well as the core discussions among the students.

3.2.2. Reflection Reports

After the participants completed the course, every participant was required to complete one reflection report. These reports detailed the significant events that occurred during the participants’ internships and articulated the personal emotions that they experienced in response to these events. Participants integrated these emotions with the theoretical content of the course and insights drawn from classroom case studies, thus allowing them to analyse the factors that contributed to their feelings and synthesize the lessons that they had learned from their experiences. They were also prompted to reflect on the knowledge that they had acquired. The data were uploaded and saved to an AI learning platform (www.chaoxing.com).

3.3. Data Analysis

3.3.1. Semantic Network Analysis

An analysis of high‐frequency words in the text was conducted to identify the most frequent key noun phrases. After these core terms were organized and consolidated, and irrelevant words that did not contribute to the main discussion were eliminated, we produced a semantic network analysis map of the core vocabulary. This map visually represents the relationships among the most significant concepts that emerged from the reflection reports.

3.3.2. Analysis of Reflection Reports

In total, 43 reflection reports were collected from the participants. All the researchers investigated the authenticity of the data with respect to data collection, organization and analysis. Initially, the researchers were personally involved in the process of organizing the data by engaging in repeated readings and immersing themselves in the data with the goal of obtaining a comprehensive understanding of this material. The data were then analysed and coded on the basis of Gibbs's reflective cycle, and relevant categories and topics were extracted. To guarantee the integrity and authenticity of the data, a compiled manuscript was returned to the participants to solicit comments and/or corrections. The entire process of data analysis was conducted in Chinese, and the results were ultimately translated into English.

3.4. Establishment of Trustworthiness

Previous studies have reported (Cypress 2017; Beck 2009) that researchers can use Lincoln and Guba's criteria, including credibility, dependability, confirmability and transferability, to ensure the trustworthiness of qualitative research. All the nursing graduate students who participated in this study had previous clinical rotation experiences, thus ensuring that they could report their genuine experiences with and perspectives on clinical events; this approach increased the credibility of this study. Dependability is related to the stability of the data across various temporal and spatial contexts (Beck 2009). The collection of data from students’ reflection reports, which was conducted via an online learning platform, ensured the confirmability of the data collection process. Confirmability refers to the objectivity or neutrality of the data and thus indicates the uniformity of independent individuals’ relationships with or interpretations of the data (Beck 2009). The application of Gibbs's reflective cycle to the process of reflection and data analysis rendered the structure of the writing intelligible. Additionally, the researchers conducted independent analyses and coded the textual data. Any discrepancies that emerged during the analysis process were addressed through discussion with the corresponding author. Transferability pertains to the implications of the results of a study with respect to other groups in analogous circumstances and is also known as applicability; it thus focuses on the extendibility of the data (Beck 2009). The use of Gibbs's reflective cycle in this qualitative study was equally pertinent to analogous fields of research that employ identical research methods.

3.5. Ethical Issues

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (World Medical Association 2022). All the data collected in the study were anonymized, coded and analysed to ensure participant confidentiality. All the data were anonymized or de‐identified prior to collection, storage and analysis to minimize the risk of personal privacy disclosure. Oral informed consent to use any interview data was obtained from the participants. Moreover, the students were informed that neither participation nor nonparticipation would affect their course performance, academic progress or any form of academic assessment throughout their nursing programme. They were also informed of their right to withdraw from the study at any point. As the study does not involve any commercial interests, it is eligible for exemption from ethical review. Therefore, it received ethical approval from the Bioethics Review Committee of Fujian Medical University. The document containing the ethical review opinion was released on 28 July 2026.

4. Results

4.1. Results of the Semantic Network Analysis of the Reflection Reports

A total of 43 reflection reports were collected, and all the content of these reports was included in the analysis. On this basis, a total of 129 core words were identified (Figure 1). Analysis of node frequency distribution revealed ‘nursing’, ‘nurses’, ‘practice’ and ‘specialty’ as the high‐frequency core nodes within the semantic network. The area occupied by these nodes was significantly larger than that occupied by other nodes. Thus, these nodes were identified as the central hubs. These nodes constituted the primary focus of the reflection reports. The remaining entries exhibit both direct and indirect connections to these four key terms. These terms are either directly associated with the outermost entry or linked to the eight outermost entries through the intermediary terms ‘hospital’ and ‘study’. As the second‐most frequently linked terms, ‘hospital’ and ‘study’ serve a bridging function. The connection counts for the outermost eight entries are as follows: ‘clinical’, ‘patient’ and ‘operation’ each has between 10 and 12 connections, whereas ‘advanced’, ‘developing’, ‘knowledge’, ‘outpatient services’ and ‘ability’ each has fewer than 10 connections. Collectively, these entries form the elements of the network semantic analysis conducted in this research.

FIGURE 1.

Semantic network analysis of core words.

4.2. Results of the Analysis of the Reflection Reports

This article summarizes various reflections on the clinical learning experience of MNS students. The four themes and nine subthemes are summarized in Table 1.

TABLE 1.

Themes and subthemes.

Themes	Subthemes	Semantic network analysis of core words	Gibbs's reflective cycle
From theory to practice: transformation and deepening of understanding in advanced practice nursing	Bridges between theory and practice	The development of advanced practice nursing	Description
			Feelings
		Study
		Knowledge
	Integration of curriculum cases and clinical practice	Specialty	Description
		Practice	Feelings
		Study
High‐capacity advanced nursing teams	APNs’ comprehensiveness	Nurses	Feelings
		Patients	Evaluation
		Knowledge
		Advanced
	Road of scientific research and innovation of APNs	Operation	Evaluation
		Clinical	Analysis
Reflection of students on the road to awakening	Deep insight into the value of APNs	Knowledge	Evaluation
		Specialty	Analysis
		Outpatient
	Self‐exploration and awakening of learners	Advanced	Analysis
		Ability
		Knowledge
Nurses’ future avenues	Social needs of APNs	Hospital	Conclusion
		Outpatient services	Conclusion
	The value of APNs gradually increases	Advanced
	Clarification of future career directions	Advanced	Action plan
		Nursing
		Knowledge

4.2.1. Theme 1: From Theory to Practice: Transformation and Deepening of Understanding in ‘Advanced Practice Nursing’

4.2.1.1. Bridge Between Theory and Practice

Students typically established a closed cognitive loop characterized by a ‘theoretical foundation–practice deepening’ sequence. The specialized nursing knowledge acquired in the classroom could be validated through clinical study. Abstract theories were thus transformed into actionable professional behaviours, thereby facilitating the internalization and reconstruction of knowledge.

S1: Clinical observations have given me a deeper understanding of the theoretical knowledge of the ‘Advanced Practice Nursing’ course. I appreciate the importance of patient‐centred care, hygiene management, and teamwork, as well as the need for continuous learning and updating of knowledge and skills.

S2: I realize that patient differences and emotional needs are critical to health care. After the patient's condition and life background are understood in depth, the importance of developing a personalized care plan can be understood. It is also a practical embodiment of the patient‐centred care concept emphasized in the ‘Advanced Practice Nursing’ course.

S3: Clinical observations have made me realize that many unexpected situations arise in practice and that solving them requires a deeper understanding of expertise. Medical knowledge is not limited to only books but also combined with practical operations and clinical observations to better understand and apply it.

4.2.1.2. Integration of Curriculum Cases and Clinical Practice

Clinical observation enables students to address the individual differences and complexities of patients, thus improving their understanding of the disparities between theoretical knowledge and clinical practice. This experience encourages a transition from passive acceptance to active engagement, thereby fostering the development of critical thinking and self‐reflective awareness.

S1: When I watch PICC, I have the following two experiences. First, as an APN, I can constantly explore my professional field. Second, there are many patients who come and go in the specialist consultations every day, and we can also see the huge workload, so we do not dare to neglect it, and we do not dare to stop working all the time.

S2: Through clinical observation, I have learned that nursing practice requires the constant updating of knowledge and skills.

In addition, the students were aware of the importance of technological innovation and humanistic care in the process of observing APNs’ practices.

S2: During communication with the patient, she gave us a vivid description of her course of disease and the difficulties she faced in her daily life. This has increased my understanding of the effects of lymphedema on my patient's physical and mental well‐being. We should pay more attention to the humanistic care of such patients.

S15: What impressed me most was the humanistic care for the patients. During the whole operation process, the teacher would always communicate with the patients to alleviate their fear and anxiety.

4.2.2. Theme 2: High‐Capacity Advanced Nursing Teams

4.2.2.1. Comprehensiveness Among APNs

Students established a three‐dimensional cognitive framework that included APN technology, humanity and collaboration through clinical observation. An APN not only requires solid specialist knowledge and empathic care but must also master interdisciplinary skills and play the role of a coordinator within the team.

S8: In my clinical observations, I have seen close collaboration between nurses and other members of the healthcare team, such as physicians and pharmacists. This makes me deeply realize the importance of TEAMWORK…. Nurses must not only have professional technical operation ability but also profound humanistic care literacy. Only by combining technology with humanistic care can we provide patients with real quality nursing services.

S26: PICC insertion is a major life change for the patient, so the nurses must fully and meticulously teach each patient how to take care of themselves and how to deal with possible complications. During this process, I felt the nurses’ high sense of responsibility and professionalism towards patients.

S35: The ‘Advanced Practice Nursing’ course also highlights the importance of teamwork and interdisciplinary collaboration.

4.2.2.2. Pathways for Scientific Research and Innovation Among APNs

The innovative case of trocar‐type tunnel PICC catheterization enabled students to realize the practical value of scientific research thinking, which challenged the traditional view that nurses merely implement doctors’ advice. ​

S3: The operation involves a large material cost, and ordinary families may not be able to afford it. To solve this problem, the teacher found another new method, namely, trocar tunnel PICC placement, which not only offers certain advantages on the basis of the previous method but also greatly reduces the cost.

S24: I realized that only by practising in clinical practice can we find problems, then come up with solutions based on these problems and continue to innovate in clinical practice, like the innovation of the trocar‐type tunnel PICC in the case. It not only reduces the work pressure on nursing staff but also helps to reduce the pain and discomfort of the patients. However, it is not so simple to find problems to solve them, which requires continuous thinking on the part of medical staff and some scientific research.

4.2.3. Theme 3: Students’ Reflections on the Path to Awakening

4.2.3.1. Deep Insight Into the Value of APNs

The experience of clinical observation has become an important opportunity to encourage some nursing students to deepen their insights from a professional understanding to a value‐based identity. Through close contact with APNs, students not only experience a deep sense of professional achievement and identity on the basis of this role but also realize that multidisciplinary collaboration, evidence‐based practice and technological innovation are indispensable core competencies of APNs. This reflective process transforms APNs from resilient frontline nursing practitioners into concrete career role models from students’ perspective.

S12: As a specialist nurse, I feel more value and a sense of achievement as a nurse. Nursing is a job that can affect the life of another person. As a professional nurse, I certainly feel satisfied and happy when I help patients regain their health. It is also part of the value of the ‘Advanced Practice Nursing’ course.

S37: For APNs, not only are higher educational (master's) requirements and rich theoretical knowledge reserves required but also skilled and systematic clinical nursing ability and thinking are needed. Specialist nurses provide high‐level nursing services to patients by focusing on a specific medical field through professional training and accumulated experience.

4.2.3.2. Self‐Exploration and Awakening Among Learners

Through self‐reflection, some students identified their deficiencies in terms of scientific research thinking, professional skills, team communication and other aspects, and they consciously began to formulate targeted improvement plans. Some students also proposed the development path of ‘deep cultivation in a specialized field’, thereby overcoming their previous understanding that administrative promotion is the only way up.

S34: After participating in the clinical experience, I have a concrete prototype of APNs, and I also have a clearer understanding of my own ability and cognitive deficiencies and a clearer direction for effort.

S35: Such experiences have deepened my understanding of the value and meaning of specialty nursing and have inspired me to devote myself more enthusiastically to this field of responsibilities and challenges.

S38: In my later studies and life, I will conscientiously complete the study of relevant courses, have a certain scientific research ability, master more profound professional knowledge and skills, accumulate more clinical practice experience, better identify and solve patients’ clinical problems, and learn to better communicate with teachers, classmates and family members.

4.2.4. Theme 4: Future Avenues for Nurses

4.2.4.1. Social Needs of APNs

Through clinical bedside observation and communication with teachers, some students came to realize that although the current role played by APNs in China remains in the development stage, the development of the APN role is inevitable because of the urgent need of society for APNs and the necessary improvements in the nursing profession and the level of nursing education.

S1: I am more deeply aware of the current social demand for specialized nursing clinics and should continue to expand training and guidance in this area. …The development of APNs is an inevitable trend because of the current demand for medical services, social and patient expectations for services, the evolution of professional nursing services, and the improvement of nursing education.

S29: APNs are among the most important forces in the field of health care in today's society, as the profession has undergone expanding demand with the development of society. APNs play an important role in the treatment of patients. They should undertake both clinical nursing work and scientific research work and provide quality care to patients through the concept of individualization and groups on the basis of the continuous development of nursing models.

4.2.4.2. The Value of APNs Gradually Increases

Through in‐depth communication with clinical teachers and self‐reflection, students realized that APNs are not only leaders in terms of clinical technology but also key decision‐makers in the health service system. Accordingly, their professional value is continuously increasing.

S7: The APN's role is to be a provider of advanced practice nursing, a clinical leader in her specialty, leading the care team to provide the best care, and a service innovator who uses evidence to update services to ensure quality. In the process of nursing development, APNs can improve the quality of nursing services, improve the clinical practice of nursing staff, and promote the development of the nursing discipline.

S15: Advanced care practitioners are able to work effectively with multidisciplinary teams to coordinate patient care plans and ensure the cooperation of various professionals to deliver comprehensive medical services.

4.2.4.3. Clarification of Future Career Directions

Some students identified a new career direction through self‐reflection, thereby shifting from ‘general ward nurses’ to ‘specialist specialists’, from ‘single technology’ to the development of a composite ‘scientific research–management–collaboration’ ability, and from ‘linear promotion’ to ‘specialized training’.

S18: As an MNS student, I should combine book knowledge with clinical practice in further studies and master not only the advanced and cutting‐edge specialist nursing knowledge in books but also solid nursing operation ability, interpersonal communication and team cooperation ability in clinical exercise, and more to learn the ability of nursing research. Become an APN to serve the health of broader people and contribute to the development of a nursing career! Practice your own Nightingale spirit!

S25: The emergence of APNs suggests that we can also develop advanced nursing, deepen our knowledge in a certain field of nursing, and even become nursing experts in this field.

S33: For the development of a sustainable APN talent reserve pool, we need to fully identify existing pending issues, deliberate on feasible solutions, boost specialized nursing development, attract well‐qualified advanced practitioners to the nursing workforce, and provide patients with comprehensive, high‐standard nursing services.

5. Discussion

On the basis of a semantic network analysis, the researchers identified ‘nursing’, ‘practice’, ‘occupation’ and ‘nurses’ as the core keywords in the reflection reports. These terms exhibited significant associations with concepts such as ‘learning’, ‘hospital’ and ‘clinical’. Building on this foundation, the research identified four themes and nine subthemes. This analysis revealed that students consider APNs from multiple perspectives, including understanding, emotional resonance, professional responsibility and future career development. Additionally, these considerations notably influence their values and employment outlook.

At the beginning of the course, students reported limited personal understanding of the roles and competencies of APNs. On the basis of the ‘theory–practice–reflection’ closed‐loop learning model embedded in the Advanced Practice Nursing course, students gradually developed a systematic and comprehensive understanding of their roles. Reflective learning enabled students to recognize that the role played by an APN extends beyond effectively addressing nursing challenges through their robust professional knowledge and skills; it also encompasses the provision of empathetic care and the cultivation of strong communication abilities. This understanding is closely in line with the ICN definition of an APN (Wheeler et al. 2022). Furthermore, a semantic network analysis revealed high‐frequency terms such as ‘nursing’, ‘practice’, ‘study’ and ‘specialty’, which further echo students’ self‐reported learning experiences and cognitive gains. The reflective reports produced by students demonstrated that the observational learning of innovative clinical techniques such as cannula‐needle tunnel PICC catheterization helped them recognize the value of scientific research and interdisciplinary teamwork in clinical nursing practice. Moreover, students explicitly reflected on their personal competency gaps with professional APNs in terms of scientific research thinking, clinical communication and collaborative practice. From students’ perspectives, the teaching content and pedagogical approaches of the Advanced Practice Nursing course helped them bridge the gap between theory and practice and enhanced their personal understanding of the professional characteristics and practical value of APN work. Students can define their career paths more clearly or adapt their plans, thereby playing a positive role in promoting the future development of the APN role. Therefore, the research team maintains that the integration of Gibbs's reflective cycle into course teaching might help students understand the nursing profession and plan their own career development paths.

A variety of mature APN core competency frameworks have been established worldwide, as represented by Hamric's advanced practice nursing model and Ackerman's strong advanced practice model. This study adopted the 2020 ICN Guidelines for Advanced Practice Nursing as its core competency evaluation framework, since these guidelines cover direct clinical nursing practice, mentoring and health education, evidence‐based practice, leadership and system‐level management, interprofessional collaboration, ethical practice, and research innovation integration (International Council of Nurses 2020). In accordance with the development of advanced nursing practice in China, Chinese APNs should possess six core competencies, including direct clinical practice, coaching and consultation, clinical leadership, ethical decision‐making and clinical research, thus indicating that scientific research ability and self‐development involve dedication, a sense of responsibility and scientific ethics (Wu and Li 2025). The students’ reflections demonstrated that their understanding of APN clinical practice, cross‐team collaboration and professional development was not only in line with the recognized core competence framework of APNs both in China and elsewhere but also conformed to the current development status and specialized trend of APNs in China, particularly in terms of clinical and professional growth. Notably, however, the students did not mention abilities such as coaching and consultation (health education, teaching), clinical leadership, ethical decision‐making (practice of moral and professional norms) and evidence‐based practice. Although these abilities are involved in current teaching practices, owing to the insufficient depth of classroom guidance and the reality that nurses in China have not yet generally obtained the right to prescribe, students still have only a vague understanding of the roles played by APNs in scenarios such as consulting and guiding patients and making ethical decisions. Such subjectively perceived cognitive limitations reflect insufficient in‐depth interpretation of relevant professional competencies in current teaching practice, as well as the practical barriers resulting from the incomplete implementation of APN prescription rights and the limited professional authority of APNs in China. Moreover, students’ limited reflective engagement with APNs’ evidence‐based practice competencies may be the result of two interrelated factors: the relatively short duration of clinical placements in current curricula and insufficient opportunities to engage in meaningful, hands‐on processes during learning. In response to this speculation, on the one hand, practical connections such as clinical observation and case operation should be added to the course design; on the other hand, during the clinical practice stage of students’ studies for professional master's degrees, targeted evidence‐based skills training (such as evidence retrieval and clinical problem transformation) should be strengthened. A bridge consisting of clinical practice reflection and research topic incubation should be established for on‐campus scientific research practices. For instance, students can be guided to distil research directions from the nursing challenges that they encounter in clinical practice, thereby effectively cultivating their evidence‐based thinking and application awareness.

The students’ reflection reports also mentioned that APNs share a sense of identity and achievement with respect to their careers. The students were amazed at the APNs’ proficient and prompt application of their professional and comprehensive clinical knowledge and skills to solve problems. They were also deeply moved by the APNs’ humanistic care, which elicited a strong sense of resonance. These findings are highly consistent with the concept of ICN. APNs can influence their own sense of professional identity through vocational experiences and their understanding of their roles (Wheeler et al. 2022). One student reported that ‘nursing is a job that influences another life’, which echoed an assertion by the ICN that an ‘APN is the concentrated embodiment of the value of the nursing profession’ (International Council of Nurses 2020). Therefore, strengthening students’ emotional resonance—as reflected in a stronger professional identity—can not only increase their enthusiasm for the nursing profession but also enhance their confidence in their future career development (Mukherjee et al. 2024).

Notably, the reflection reports provided by some students revealed that their inherent professional cognition is changing. In the context of the traditional stereotype that MNS graduates are engaged mainly in administrative and educational work, students exhibited a subjective willingness to pursue specialized development as clinical APNs. Students’ self‐reflections also suggested that sustained participation in high‐level clinical nursing practice and continuous international learning to absorb mature foreign APN training and research experience are conducive to their specialized career growth. In addition, the students’ reflection reports revealed a nuanced, subjective understanding of societal needs pertaining to advanced nursing practice. Thus highlighting both their commitment to delivering high‐quality, individualized care and their growing awareness of personalized career pathways as APNs. In light of these self‐articulated career aspirations and developmental expectations, targeted policy interventions, such as tailored incentive mechanisms, structured mentorship programmes, and robust institutional support for professional advancement, can be strategically implemented to guide graduate students towards intentional, evidence‐informed role development and specialization as APNs.

The APN training model employed in the United States is the most mature and standardized model. At its core, it features a nationally defined advanced practice registered nurse role, which usually requires a master's or doctoral degree and the completion of a strict national certification and offers a wide range of independent practice authority, including diagnosis and prescription rights, in most states. The model employed in the United Kingdom is more flexible. According to this model, the role of advanced clinical practitioner (ACP) is not limited to a nursing background. However, it also requires a master's‐level education, and these nurses practise on the basis of a national competency framework. ACPs have broad responsibilities and represent an important part of primary care. In contrast to the well‐established APN training systems observed in the United States and the United Kingdom, China lacks unified legal norms and professional positioning standards for APN practice. Considering a combination of students’ subjective reflections and positions with the current status of advanced nursing development in China, it is necessary to identify specialized nurse training as a core focus for development and implement localized APN development policies that are compatible with the Chinese healthcare system. The development strategy should align with the Chinese medical system's fundamental principle, namely, ‘emphasizing professionalism before progression’. In response to the issues of an ageing population at the global level and the increasing demand for chronic disease management, a collaborative service network that covers hospitals, communities and professional healthcare institutions can be constructed to diversify students’ future career paths in grassroots and community nursing on the basis of a combination of advanced experience at the international level and localized development characteristics.

On the basis of these reflective perceptions, considering students’ current understanding of APNs, the core ability frameworks for APNs at both the domestic and international levels, and cultivation practices in China, three targeted policy suggestions are proposed. First, the core ability framework for APNs should be enhanced by addressing the deficiencies in students’ understanding of APNs’ abilities, refining the logic of general ability cultivation, and enhancing the cross‐scenario transferability of the theoretical system in line with specialization trends. Second, education and training policies should be enhanced by maintaining a trajectory that emphasizes on‐the‐job training and clinical practice, standardizing training processes, consolidating distinctive practical experiences and establishing a reproducible and scalable training model. Third, practice and support policies should be optimized by relying on the principle of hierarchical progression and steadily advancing the implementation of the prescription rights system for APNs. In the context of an uneven distribution of global medical resources, China's APN model can hopefully serve as a reference for regions that feature underdeveloped medical and nursing services and provide a path for regions that lack the nursing‐related human resources required to develop APNs.

5.1. Limitations

The research subjects were exclusively recruited from a university in China. When this research is applied to other regions in China or at the international level, differences in cultural backgrounds and medical teaching practice models across different regions must be considered. Specifically, the time and content of bedside observation should be adjusted in accordance with the characteristics of clinical teaching in the target area, the actual abilities of students and the requirements of APNs in each area to ensure the presence of the teaching effect and the validity of the conclusions. Furthermore, this study relied solely on student reflection reports for analysis, thereby omitting the viewpoints of teaching instructors and clinical instructors. This approach entails certain limitations in terms of understanding the whole picture of the teaching model and evaluating the practical application effect. To enhance the applicability of this research in different educational contexts, the addition of multisource data, such as daily records collected from teachers, in‐depth interviews with teachers and classroom observation data, is suggested to facilitate a multiperspective and multilevel analysis of the teaching process and to enhance the strength and applicability of the results.

6. Implications for Nursing and Health Policy

6.1. The Integration of Gibbs's Reflective Cycle: Educational Reforms and Safeguards for the Development of APN Talent

In this study, Gibbs's reflective cycle was integrated into the APN curriculum, thereby generating positive learning perceptions that were repeatedly reported by students in their reflective writing. Students documented in their reflections that this reflective report helped them re‐examine gaps in their understanding of the core competencies of APNs. Students’ reflective texts also echoed the international concept of ‘clinical practice throughout the entire educational process’ (L Mackavey et al. 2024), which is in line with learners’ self‐stated goal of reducing the disconnect between theoretical knowledge and clinical experience.

Thus, the following recommendations are made: (1) this framework should be incorporated into APN education curriculum standards, and (2) a diversified and multidimensional clinical practice module should be developed to meet the needs of APNs in terms of cognitive transformation and core competence training, including coaching and consultation (health education, teaching), clinical leadership, ethical decision‐making (the implementation of moral and professional norms) and evidence‐based practice.

The specific measures are as follows: The Nursing Management course focuses primarily on the development of leadership skills. A module that is oriented towards leadership practices for APNs can be incorporated into this course. Real‐world cases, such as those involving interdisciplinary team collaboration and clinical nursing quality control, may be selected to design and simulate management tasks. This design enables students to complete simulated decision‐making and resource allocation operations from the perspective of an APN, which, according to students’ reflections, can help translate abstract leadership theories into operable clinical skills—a key learning gain that was repeatedly mentioned in multiple students’ reflection reports.

The Advanced Evidence‐Based Nursing course fosters the ability to engage in evidence‐based practice. In this course, students are encouraged to enhance their clinical practicality by using the issues identified through the reflective reports produced as part of the Advanced Practice Nursing course as materials for evidence‐based research. This process guides students through comprehensive training, ranging from problem identification to solution application and feedback, while prompting them to integrate evidence‐based thinking into clinical case discussions and practical operations. This approach facilitates the immediate transition from evidence‐based method learning to clinical practice application. In their reflective reports, students reported that they lacked structured opportunities to translate clinical difficulties into research topics, which represents the core rationale underlying this training adjustment.

The development of ethical decision‐making skills, which are grounded in moral and professional norms, is central to the Nursing Ethics course. Additionally, the cultivation of guidance and coaching abilities, particularly in health education and teaching, is embedded in the Advanced Practice Nursing course. The impact of teaching reform within a single course is inherently limited. These abilities were not mentioned in the reflection reports produced by most students. These students have not yet developed a comprehensive understanding of these abilities. To address this limitation of the student reflections, cross‐curricular joint case workshops can be established. These workshops, which focus on complex clinical scenarios such as multidisciplinary management of elderly chronic diseases and critical specialized nursing, are co‐taught by teachers of multiple disciplines and start with clinical observation records obtained from the Advanced Practice Nursing course. Under the guidance of their instructors, students can complete a closed‐loop task chain, which includes identifying clinical problems, analysing underlying causes, screening evidence‐based research topics, designing intervention plans, conducting clinical practice, evaluating implementation effects and reflecting on and optimizing schemes. This training mode encourages students to integrate interdisciplinary knowledge and skills to address authentic clinical difficulties.

On the basis of these results, our research team has made the following suggestions. The traditional single‐course assessment model can be transcended through the reconstruction of a cross‐course comprehensive assessment and evaluation system that focuses on the core competencies of APNs. This assessment format could combine ‘process‐oriented assessment and summative practical assessment’. Process‐oriented assessment could track students’ participation and achievements in case workshops, and the summative practical assessment could use real clinical cases as the basis for students to independently design evidence‐based solutions. Such an evaluation could be conducted collaboratively by on‐campus faculty and frontline APN staff in hospitals to ensure that the assessment criteria are closely aligned with the competency requirements of clinical APN roles.

Three supportive safeguarding suggestions are proposed, but further assessments involving relevant stakeholders, regulators and empirical evidence are necessary. (1) Schools can collaborate with hospital nursing management departments to establish APN education funds. These funds can support systematic training for APN teaching staff, improve teachers’ abilities in terms of evidence‐based practice and reflective teaching, and thereby help students improve their self‐perceived evidence‐based practice skills. (2) The development of virtual simulation practices that use digital technology to simulate complex clinical scenarios should be promoted. This measure addresses the limitations of traditional clinical observations and provides students with repeatable, highly realistic opportunities for practice. (3) Other Chinese universities should learn from the experience of the West China School of Nursing, Sichuan University. For example, they should offer courses such as A Global Perspective on Advanced Nursing Practice during International Curriculum Week, including lectures by outstanding global nursing experts; they should also institutionalize such activities. By organizing cross‐border online courses and facilitating student exchange internships, a global academic exchange platform for teachers and students can be developed to facilitate the cross‐border dissemination of APN educational concepts and practical experiences.

6.2. Implications for Scientific Research: Cultivating Evidence‐Based APN Competence, Clinical‐Research Synergy and International Collaborative Innovation

The reflection reports revealed that the innovative scientific research abilities and evidence‐based practice of most students are not strong. On this basis, the research team has made the following educational suggestions. In terms of scientific research, in the clinical practice stage associated with a professional master's degree, evidence‐based skills training should be strengthened, students should be guided through the process of transforming clinical reflection into scientific research topic selection, and students’ evidence‐based practice ability should be improved to lay a foundation for the establishment of a virtuous cycle in which problems that emerge in clinical practice are discovered, problems pertaining to scientific research are solved, and scientific research achievements are fed back to clinical practice to promote the transformation of APNs from clinical practitioners into clinical researchers.

Furthermore, the feasibility of the following suggestions requires further assessment by relevant stakeholders and regulatory agencies. Chinese universities and research institutions should collaboratively establish research centres with established international APN partners. Such collaboration should focus on innovative solutions to global health challenges and incorporate successful domestic projects into the health initiatives associated with the ‘Belt and Road Initiative’. This strategy aims to achieve multiple objectives, including international alignment, the contribution of Chinese solutions and support for the development of APNs in co‐construction countries.

6.3. Policy Recommendations for APN Clinical Practice: The Expansion of Autonomy and the Development of an Integrated Care Network

Although the core findings of this study originated from the students’ reflective reports, the following discussion highlights broader policy considerations. The feasibility of these considerations requires further evaluation by relevant stakeholders and regulatory bodies.

The lack of prescription rights represents a significant distinction in the development of APNs between China and other countries at the current stage. Against this backdrop, Relevant authorities may consider gradually expanding the scope of APNs’ independent practices to encompass chronic disease management, follow‐up care and medication guidance, and the inclusion of APN services in medical insurance schemes is a noteworthy direction for future policy exploration to take better advantage of the practical value of advanced nursing practice.

Moreover, supportive measures, including economic incentives, optimized professional title policies and two‐way talent exchange programmes, can be developed to facilitate the deployment of APNs in community and senior care settings. Moreover, the construction of a three‐tiered hospital–community–elderly care institutional nursing collaboration network warrants ongoing policy discussion. Within such a potential framework, hospital‐based APNs could develop individualized care plans, community APNs could take responsibility for continuous follow‐up and rehabilitation counselling, and APNs working in elderly care facilities could provide targeted professional care to disabled older adults. Furthermore, role connections across tiers could be realized on the basis of shared electronic health records and routine remote video consultation.

7. Conclusion

In this study, post‐class reflection reports on the Advanced Practice Nursing course from MNS students were analysed, and qualitative content analysis and semantic network analysis were employed to elucidate the cognitive evolution of learners regarding advanced nursing practice, the disparity between their professional competencies as APNs and their self‐assessment, and their career development orientation. On the basis of the MNS students’ reflection reports and semantic network analysis, this study reveals the multidimensional perceptions of postgraduate nursing students regarding advanced nursing practice. The students demonstrated an understanding of core APN competencies, including clinical practice and interteam collaboration, developed emotional resonance with the profession and shifted their career aspirations towards clinical specialization. Nevertheless, they exhibited notable cognitive deficiencies in coaching–consultation, ethical decision‐making and evidence‐based practice. These deficiencies were mainly a result of factors such as teaching depth and the practical status of APN professional authority in China. By adopting Gibbs's reflective cycle for curriculum optimization, this study proposes educational reforms such as reconstructing cross‐curriculum comprehensive assessment systems and building teaching support platforms. It also suggests strengthening the synergy between clinical research and practice and promoting international research collaboration. From a policy perspective, gradually expanding the APN scope of practice and establishing an integrated care network covering hospitals, communities and elderly care institutions are recommended to create a localized talent development pathway for APNs that is compatible with China's healthcare system.

Author Contributions

Made substantial contributions to conception and design, or acquisition of data or analysis and interpretation of data: DL and JBL. Involved in drafting the manuscript or revising it critically for important intellectual content: DL and JBL. Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content: DL, JBL, JCZ, MMF and YTL. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: DL, JBL, JCZ, MMF and YTL

Funding

The authors have nothing to report.

Conflicts of Interest

The authors report that there are no competing interests to declare.