Actionable companion · Leadership practice and organizational learning
From leadership research to district action: Development, implementation, and evaluation of a train-the-trainer program for emerging nurse leaders in China: a 12-year longitudinal study
AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.
Evidence and transfer
Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.
Original authors’ abstract, reproduced under the source license:
Background Despite being the largest group of health care professionals, nurses represent a neglected human resource in China, especially in leadership, education, and public health. The aim of this study was to develop and evaluate a Train-the-Trainer (TTT) model to build leadership capacity among emerging nurse leaders in South China, using a comprehensive assessment and evaluation immediately after, at 6-month, and 12-year post-TTT. Methods A mixed-methods approach was employed starting with a needs assessment to guide the development and implementation of the curriculum in the TTT programs. Three tailored courses were developed. Outcomes were assessed using pre- and post-training surveys on participants’ knowledge, attitudes, practices (KAP), along with self-reported capability improvements. Multivariate analysis of variance (MANOVA) and paired t-tests were employed to assess the TTT impact. Cascading effects were assessed through reports of TTT activities and institutional changes. A p-value < 0.05 was considered as statistically significant. Results A total of 180 emerging nurse leaders (middle career) from 136 institutions in Guangdong (GD) Province participated in the TTT program, with support from the Guangdong Province Department of Health. The course participants showed significant short-term improvement in KAP and self-reported competencies in the three courses, with sustained gains observed at 6 months and 12 years post-training (all p < 0.05). The cascading effect of the program was substantial at both 6-month and 12-year post-TTT, with 180 participants disseminating knowledge and delivering further training to about 25,000 healthcare professionals in the Province. Conclusions The TTT program proved to be a scalable, sustainable model for developing nurse leadership and strengthening system capacity in China. In the global shortage of nurses, more than ever, we need to prepare emerging leaders to advance nursing practice and build a quality nursing workforce contributing to China’s national health reform.
Study methods
This study employed mixed-methods to assess the implementation and outcomes of the TTT program. The evaluation combined quantitative and qualitative approaches to capture changes in participants’ competencies, leadership development, and the broader impact on nursing practice. Data were collected through pre- and post-training assessments, participant feedback, and follow-up interviews over 12 years to evaluate both learning outcomes and knowledge transfer within healthcare institutions.
Limitations
No passage was selected automatically. Inspect the complete source before adopting a practice.
A 90-day district inquiry
- Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
- Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
- Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
- Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.
Board decision brief
Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.
Attribution and reuse
Jing Chen; Guowen Zhang; Agnes Tiwari; Sophia Siu Chee Chan. Development, implementation, and evaluation of a train-the-trainer program for emerging nurse leaders in China: a 12-year longitudinal study. BMC Medical Education (2025-11-26). https://doi.org/10.1186/s12909-025-08280-7
Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.