AbstractAimsThe aims of the study were to describe the processes used to introduce advanced practice nursing roles and factors that facilitated or hindered role implementation, examine the time advanced practice nurses (APNs) spend in role activities and how these activities relate to domains of advanced practice nursing and examine how implementation processes influenced APN integration within healthcare teams.DesignA multiple case study was conducted.MethodsFive cases were included, representing the four population areas approved for advanced practice nursing in France. Data were collected from January to March 2021 using observation, interview and document analysis methods. Data were examined using thematic analysis.ResultsParticipants included APNs (n = 5), nurses/allied health providers (n = 5), physicians (n = 5), managers (n = 4) and decision‐makers (n = 4). Stakeholder engagement and leadership provided by decision‐makers, managers, physicians and APNs facilitated role implementation. Poor stakeholder role understanding, uncertain role funding, and the COVID‐19 pandemic hindered role implementation. APNs spent the most time in clinical activities. Participants perceived the integration of APNs within the healthcare team and their impact on patient care to be positive.ConclusionStakeholder engagement and organizational and APN leadership facilitated the implementation of the roles, especially related to team‐based patient care. Further efforts are needed to strengthen APN involvement in non‐clinical activities and address role barriers.Implications for nursing and patient careSystematic and system‐wide approaches are needed to improve role clarity, role autonomy and health systems integration of APNs. Research should examine patient perspectives about APNs in France.ImpactThe results highlight how policies can create favourable conditions for advanced practice nursing role implementation in France. Internationally, this study serves as a reminder to APNs and nurse leaders about the strategies for and importance of implementation evaluation to support the optimal development of advanced practice nursing roles.Reporting MethodThe study reporting followed the Consolidated Criteria for Reporting Qualitative Research.Patient or Public ContributionNo Patient or Public Contribution.