Abstract
Advanced practitioners (APs; nurse practitioners, physician associates, clinical nurse specialists, advanced degree nurses, and pharmacists) are vital in providing high-quality, specialized patient care, particularly in oncology. Despite the tremendous value that APs bring to health-care systems, an aging workforce, turnover, and burnout underscore the urgent need for structured leadership succession planning. Nursing and pharmacy data reveal that 30% to 50% of leaders plan to retire within 5 years, yet few organizations have formal processes to replace them. Without proactive planning, there is a risk that clinical expertise, leadership continuity, and program stability will be lost. Advanced practitioner–specific succession planning is especially critical due to the unique clinical and operational roles that APs play in health-care systems outside of patient care, such as in quality improvement and clinical program development. A comprehensive framework includes aligning succession planning with organizational strategy, defining leadership roles, assessing the risk of future vacancies, and securing executive support, as well as talent identification focusing on diversity and inclusion. Clear career pathways and structured leadership training further strengthen the path from staffing to leadership. Barriers to succession planning include organizational resistance to career development pathways, limitations in funding, unconscious bias, and fear of talent loss. Addressing these challenges demands executive sponsorship, transparent hiring and promotion processes, and a culture that normalizes leadership development. In oncology—where APs are central to care coordination—the absence of succession planning threatens care continuity and program development. Institutions must adopt structured, inclusive succession planning models to maintain patient-centered care and ensure a resilient future AP leadership workforce.
References
Al Hajri, A. K. (2024). Succession planning and leadership development in nursing: A bibliometric analysis (2000–2023). Nursing Research and Practice, 2024, Article 6191008, 1–13. https://doi.org/10.1155/2024/6191008
Alwazzan, L. (2024). Leadership development in medicine: A review. Cureus, 16(7), Article e65028. https://doi.org/10.7759/cureus.65028
Aon Hewitt. (2013). Best in class succession management. https://www.aon.com/attachments/human-capital-consulting/2013_Best_in_Class_Succession_Management_White_Paper.pdf
Ashghali-Farahani, M., Salehi, T., & Mirzaee, M. (2025). Content analysis of succession planning in nursing management: A qualitative study. BMJ Leader, 9(1), 22–30. https://doi.org/10.1136/leader-2024-000973
Beaton, M., Edwards, A., Vogel, W., Mistry, H., Kottschade, L., Toth, S., Johnson, D., & Koniarczyk, H. (2025). Supporting administrative time for advanced practitioners: A comprehensive approach. Journal of the Advanced Practitioner in Oncology, 16(4), 143–148. https://doi.org/10.6004/jadpro.2025.16.4.3
Broyhill, B., Dugan, E., Valente, C. P., & Patel, E. (2023). A systems-based approach to advanced practice registered nurse leadership integration and operations. Nurse Leader, 21(3), e11–e16. https://doi.org/10.1016/j.mnl.2022.10.004
Chen, D., Amerine, L. B., & Kernan, W. (2025). Pharmacy executive and mid-level manager perceptions of leadership in contemporary health-system pharmacy. American Journal of Health-System Pharmacy, 00, 1–24. https://doi.org/10.1093/ajhp/zxaf264
Cunningham, T., & Crosby, H. (2023). A comprehensive model to support a resilient workforce. Nurse Leader, 21(3), 370–374. https://doi.org/10.1016/j.mnl.2023.02.005
Dappa, A. B. (2019). Succession planning practices among nurse managers at Korle Bu Teaching Hospital [Thesis, University of Ghana]. Afribary. https://afribary.com/works/succession-planning-practices-among-nurse-managers-at-korle-bu-teaching-hospital
Ellinger, L. K., Trapskin, P. J., Black, R., Kotis, D., & Alexander, E. (2014). Leadership and effective succession planning in health-system pharmacy departments. Hospital Pharmacy, 49(4), 369–375. https://doi.org/10.1310/hpj4904-369
Goodreads Inc. (n.d.). Wayne Gretzky quotes. https://www.goodreads.com/quotes/170690-a-good-hockey-player-plays-where-the-puck-is-a
Hartsell, Z., & Noecker, A. (2020). Quantifying the cost of advanced practice provider turnover. Sullivan Cotter. https://www.physicianleaders.org/news/quantifying-the-cost-of-advanced-practice-provider-turnover
Hills, L. (2024). Healthcare leadership succession planning: 25 strategies. Healthcare Administration Leadership & Management Journal, 2(4), 149–156. https://doi.org/10.55834/halmj.6061925734
Incredible Health. (2021). 34% of nurses plan to leave their current role by the end of 2022. https://www.incrediblehealth.com/wp-content/uploads/2022/03/IH-COVID-19-2022-Summary-1.pdf
Kamali, A., Hosseini, S. M., Alimohammadzadeh, K., & Khamseh, A. H. S. (2024). Talent identification and succession planning strategies for the appointment of nursing unit managers: A systematic review. Journal of Education and Health Promotion, 13, Article 485, 1–17. https://doi.org/10.4103/jehp.jehp_2087_23
Kurtin, S. (2023). Advanced practitioners in hematology and oncology: A call to action. Journal of the Advanced Practitioner in Oncology, 14(Suppl. 3), 5–7. https://doi.org/10.6004/jadpro.2023.14.7.9
Kurtin, S., Grande, C., May, M., Edwards, A., Wei, S., Hoffner, B., & Vogel, W. (2023). Advanced practitioners in hematology and oncology: State of the workforce. Journal of the Advanced Practitioner in Oncology, 14(Suppl. 3), 8–16. https://doi.org/10.6004/jadpro.2023.14.7.10
Lerman, C., Hughes-Halbert, C., Falcone, M., Gosky, D. M., Jensen, R. A., Lee, K. P., Mitchell, E., Odunsi, K., Pegher, J. W., Rodriguez, E., Sanchez, Y., Shaw, R., Weiner, G., & Willman, C. L. (2022). Leadership diversity and development in the nation’s cancer centers. Journal of the National Cancer Institute, 114(9), 1214–1221. https://doi.org/10.1093/jnci/djac121
Morris, M., Wood, F., & Dang, D. (2020). Development and evaluation of a nurse leadership succession planning strategy in an academic medical center. The Journal of Nursing Administration, 50(7/8), 378–384. https://doi.org/10.1097/NNA.0000000000000904
National Institutes of Health. (n.d.). Succession planning: A step-by-step guide. U.S. Department of Health and Human Services.
Pang, K. R., & Mark, B. A. (2018). The academic nursing leadership shortage: An urgent call to action. Journal of Advanced Nursing, 74(8), 1735–1737.
Tucker, C. A. (2017). Succession planning for nursing leaders in a college of nursing [Doctoral dissertation, University of Nevada, Las Vegas]. UNLV Theses, Dissertations, Professional Papers, and Capstones. https://oasis.library.unlv.edu/thesesdissertations/3051
Tucker, C. A. (2020). Succession planning for academic nursing. Journal of Professional Nursing, 36, 334–342. https://doi.org/10.1016/j.profnurs.2020.02.002
Warden, D. H., Hughes, R. G., Probst, J. C., Warder, D. N., & Adams, S. W. (2021). Current turnover intention among nurse managers, directors, and executives. Nursing Outlook, 69(5), 875–885. https://doi.org/10.1016/j.outlook.2021.04.006
White, S. J., & Enright, S. M. (2013). Is there still a pharmacy leadership crisis? A seven-year follow-up assessment. American Journal of Health-System Pharmacy, 70(5), 443–447. https://doi.org/10.2146/ajhp120258
Yudianto, K., Sekawarna, N., Susilaningsih, F. S., Ramoo, V., & Somantri, I. (2023). Succession planning leadership model for nurse managers in hospitals: A narrative review. Healthcare, 11(4), Article 454. https://doi.org/10.3390/healthcare11040454
