The concept of clinical leadership

Clinical leadership in nursing students: A concept analysis

OBJECTIVES

To undertake a concept analysis of clinical leadership in nursing students.

DESIGN

Concept analysis.

DATA SOURCES

A comprehensive search was conducted using the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline and PsychINFO using the following search terms: clinical leadership AND management AND preregistration OR pre-registration OR undergraduate AND nursing student* OR student nurse*.

REVIEW METHODS

Nursing student clinical leadership was explored using the eight-step process of concept analysis proposed by Walker and Avant (2014).

RESULTS

The defining attributes included effective interpersonal communication skills, contemporary clinical knowledge and being a role model to others.

CONCLUSION

This concept analysis provides a definition of clinical leadership in nursing students. It will support understanding of the concept and how it is enacted in clinical placement settings.

Enablers and barriers to clinical leadership in the labour ward of district hospitals in KwaZulu-Natal, South Africa

Introduction and background

Like many health systems in low-income and middle-income countries, the South African health system has failed to decrease both maternal and perinatal mortality significantly, especially in district hospitals. Inappropriately trained healthcare providers and poor clinical leadership are repeatedly linked to healthcare providers’ preventable factors contributing to most maternal and perinatal deaths. Clinical skills of healthcare providers have been largely addressed, while clinical leadership remained neglected. One strategy implemented recently to support clinical leadership is the introduction of District Clinical Specialist Teams (DCSTs). Clinical leadership in the labour ward of district hospitals in KwaZulu-Natal (KZN) is conceptualised as an emergent phenomenon arising from dynamic interactions in the labour ward and the broader health system, converging to attain optimal patient care.

Aim

To evaluate the enablers and barriers to clinical leadership in the labour ward of district hospitals.

Method

Iterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was applied. In-depth interviews were carried out with the midwifery members of the DCSTs in KZN. The emergent enablers and barriers to clinical leadership were presented and discussed at a workshop with broader midwifery representation, leading to a final classification of enablers and barriers to clinical leadership.

Results and conclusion

Enablers and barriers to clinical leadership arise as a result of emergent dynamic interactions within the labour ward and the broader health system, located at policy, organisational, team and individual healthcare provider levels, with the policy context as the overriding factor framing the implementation of clinical leadership.

Midwife conceptualizations of clinical leadership in the labor ward of district hospitals in KwaZulu-Natal, South Africa

BACKGROUND

In South Africa, inadequately skilled health care providers and poor clinical leadership are continually linked to preventable perinatal and maternal mortality, which calls for improved clinical skills among health care providers and for strong clinical leadership at the bedside. Very little has been done to ensure clinical leadership at the bedside in the labor ward of district hospitals. One strategy implemented has been the appointment of District Clinical Specialist Teams, introduced to improve the quality of maternal and child health care in district hospitals and clinics through the provision of clinical leadership as an outreach activity. However, the strengthening of clinical leadership at the bedside remains neglected. Further, clinical leadership in the literature is not conceptualized in the same way across settings.

AIM

To explore midwife conceptualizations of clinical leadership in the labor ward of district hospitals in KwaZulu-Natal.

METHODS

Iterative data collection and analysis, following the Corbin and Strauss grounded theory approach, was implemented. In-depth interviews were carried out with the midwifery members of the District Clinical Specialist Teams in KwaZulu-Natal. The emergent theoretical framing of clinical leadership was presented and discussed at a workshop with broader midwifery representation, leading to a final proposition of the conceptualization of clinical leadership among midwives.

RESULTS

The emergent conceptualization of clinical leadership comprised five major dimensions: the definition of clinical leadership, the context in which clinical leadership takes place, the conditions related to clinical leadership, the actions and interactions involved in clinical leadership, and the effects of clinical leadership.

CONCLUSION

Clinical leadership is an emergent phenomenon arising from dynamic interactions in the labor ward and the broader health system, which converge to attain optimal patient care. Clinical leadership is not being understood from a traditional hierarchical perspective, as vested only in a positional leader.

Linking Nurses' Clinical Leadership to Patient Care Quality: The Role of Transformational Leadership and Workplace Empowerment

Background

While improving patient safety requires strong nursing leadership, there has been little empirical research that has examined the mechanisms by which leadership influences patient safety outcomes.

Aim

To test a model examining relationships among transformational leadership, structural empowerment, staff nurse clinical leadership, and nurse-assessed adverse patient outcomes.

Methods

A cross-sectional survey was conducted with a randomly selected sample of 378 registered nurses working in direct patient care in acute care hospitals across Ontario, Canada. Structural equation modeling was used to test the hypothesized model.

Results

The model had an acceptable fit, and all paths were significant. Transformational leadership was significantly associated with decreased adverse patient outcomes through structural empowerment and staff nurse clinical leadership.

Discussion

This study highlights the importance of transformational leadership in creating empowering practice environments that foster high-quality care. The findings indicate that a more complete understanding of what drives desired patient outcomes warrants the need to focus on how to empower nurses and foster clinical leadership practices at the point of care.

Conclusion

In planning safety strategies, managers must demonstrate transformational leadership behaviors in order to modify the work environment to create better defenses for averting adverse events.

The Staff Nurse Clinical Leader at the Bedside: Swedish Registered Nurses' Perceptions

Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses' perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses (n = 15). Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients' best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers' professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.

In command of care: clinical nurse leadership explored

Who are the clinical nurse leaders? What are the qualities and characteristics of clinical nurse leaders? Why are they seen as clinical leaders and what might their experiences of clinical leadership be? This paper outlines a research project that sought to explore these questions. The research involved surveying registered/qualified nurses from D to H grade ( n= 830) who staffed 36 clinical areas in one acute NHS Trust in the English Midlands. Only 188 questionnaires were returned, but the data proved a rich source of information about clinical leadership, the attributes of clinical leaders and who might be recognised as a clinical leader. F-grade sisters were seen as strongly associated with the role. The questionnaire was followed by interviews with 42 qualified nurses from D to H grade on four clinical areas in the same NHS Trust, and these were followed by eight further interviews with nurses identified from the interviews as clinical nurse leaders. The results demonstrate that clinical leaders appeared to be present at all nursing levels and in considerable numbers, but they were often not the most senior nurses and their approach to clinical leadership was based upon a foundation of care that was fundamental to their values and beliefs or view of nursing and care. The study also indicated that the type of clinical area had an influence on who might be seen as a clinical leader. The attributes of clinical leaders appeared to be clinical competence, clinical knowledge, approachability, motivation, empowerment, decision-making, effective communication, being a role model and visibility.

In command of care: Toward the theory of congruent leadership

This is the second of two papers that discuss clinical leadership in the light of a research study which explored who the clinical nurse leaders are, what the characteristics and qualities of clinical leaders might be, why some nurses are seen as clinical leaders and what their experiences might be (Part 1 (Stanley, 2006)). Outlined are contemporary views about leadership and nursing, with emphasis on transformational leadership. Also explored is the new theory of congruent leadership. It is proposed that congruent leadership is a theory best suited for understanding clinical leadership because it is defines leadership in terms of a match (congruence) between the activities, actions and deeds of the leader and the leader's values, principles and beliefs.

Staff nurse clinical leadership: a concept analysis

PURPOSE

The purpose of this article is to provide a concept analysis of staff nurse clinical leadership (SNCL). A clear delineation of SNCL will promote understanding and encourage communication of the phenomenon. Clarification of the concept will establish a common understanding of the concept, and advance the practice, education, and research of this phenomenon.

METHODS

A review of the literature was conducted using several databases. The databases were searched using the following keywords: clinical leadership, nursing, bedside, staff nurse, front-line, front line, and leadership. The search yielded several sources; however, only those that focused on clinical leadership demonstrated by staff nurses in acute care hospital settings were selected for review.

FINDINGS

SNCL is defined as staff nurses who exert significant influence over other individuals in the healthcare team, and although no formal authority has been vested in them facilitates individual and collective efforts to accomplish shared clinical objectives.

CONCLUSION

The theoretical definition for SNCL within the team context will provide a common understanding of this concept and differentiate it from other types of leadership in the nursing profession. This clarification and conceptualization of the concept will assist further research of the concept and advance its practical application in acute care hospital settings.

Clinical leadership characteristics confirmed

Aims

This paper compares the results of two studies conducted by the same researcher into the attributes and characteristics of clinical leaders.

Background

The two studies used an almost identical questionnaire; however, they were conducted 6 years apart, in different counties, with different health care staff (nurses and paramedics), made up of very different gender ratios. The initial study was larger and focused on more than describing clinical leader attributes; however, this was the principle focus of the second study.

Findings

The findings from both studies offer very similar results and describe clear insights into the attributes health professionals seek in clinical leaders. The research findings are remarkably similar given the differences in professional group, gender variations, country differences and time span.

Conclusions

Leaders are followed because there is a match between the leaders values and beliefs and their actions. People identify with the leaders values and follow them if they are reflected in the leaders’ actions. Clinical leader characteristics are approachability, clinical competence, being supportive, acting as mentors or role models, being visible in practice, directing and helping people, inspiring confidence, having effective communication skills and behaving with integrity. Vision and creativity were less evidently sought or identified as a clinical leader characteristic.

Congruent leadership: values in action

AIM(S)

To discuss the significance of an appropriate leadership theory in order to develop an understanding of clinical leadership.

BACKGROUND

Leadership theories developed from management and related paradigms, particularly transformational leadership, may be ineffective in supporting nurses to gain insights into clinical leadership or to develop and implement clinical leadership skills. Instead, congruent leadership theory, based on a match between the clinical leaders' actions and their values and beliefs about care and nursing, may offer a more firm theoretical foundation on which clinical nurses can build an understanding of and capacity to implement clinical leadership or become clinical leaders. Evaluation The information used is drawn from the contemporary literature and a study conducted by the author.

KEY ISSUE(S)

Leadership can be better understood when an appropriate theoretical foundation is employed.

CONCLUSIONS

With regard to clinical leadership, congruent leadership is proposed as the most appropriate theory.

IMPLICATIONS FOR NURSING MANAGEMENT

It is important to recognize that leadership theories based on a management paradigm may not be appropriate for all clinical applications. Education should be aimed specifically at clinical leaders, recognizing that clinical leaders are followed not for their vision or creativity (even if they demonstrate these), but because they translate their values and beliefs about care into action.

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

BACKGROUND

Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians.

AIM

The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making.

KEY ISSUES

Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians.

CONCLUSIONS

Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

Recognizing and defining clinical nurse leaders

This article addresses the issue of clinical leadership and how it is defined. The concepts and definitions of clinical leadership are considered as well as the results of new research that suggests that clinical leaders can be seen as experts in their field, and because they are approachable and are effective communicators, are empowered to act as a role model, motivating others by matching their values and beliefs about nursing and care to their practice. This is supported by a new leadership theory, congruent leadership, proposed as the most appropriate leadership theory to support an understanding of clinical leadership. Congruent leaders (clinical nurse leaders) are followed because there is a match between the leader's values and beliefs and their actions.