Impact of clinical leadership in advanced practice roles on outcomes in health care: A scoping review

Abstract

Aim To undertake a scoping review of the literature exploring the impact of clinical leadership in advanced practice roles in relation to patient, staff and organisational outcomes. Background An increasing number of publications as well as job specifications have identified clinical leadership as a cornerstone of advanced practice roles. However, it is unclear whether embedding clinical leadership in such roles has led to improvements in patient, staff or organisational outcomes. Therefore, identifying the extent to which clinical leadership in advanced practice roles relates to patient, staff and organisational outcomes is needed. Method A scoping review examining the relationship between clinical leadership in advanced practice roles and health care outcomes. Searching in SCOPUS, PubMed, Psychinfo and CINAHL Plus and Web of Science identified 765 potential articles. Independent selection, data extraction tabulation of findings and analysis were completed. Results Seven studies were identified that met the inclusion criteria. Only studies reporting on nurses in advanced practice roles were included; no studies were identified that reported on the advanced practice roles of allied health professionals. The results indicate that there is no objective evidence of the impact of advanced practitioners’ clinical leadership on patient, staff or organisational outcomes. Conclusion There is a paucity of objective evidence to identify the extent to which clinical leadership is enacted in advanced practice roles. The review indicates a need for closer alignment of AP clinical leadership policy aspirations and formal operational leadership opportunities for APs. Implications for Nursing Management Nurse managers have a key role in supporting and equipping APs with leadership competencies and opportunities to enable both capability and capacity building of such roles. Nurse managers should involve APs in health care leadership at an organisational level to maximize their contribution to health, quality practice environments and health care reform. Additionally, a distinct involvement in staff development, change, operational strategic decisions and policy development should be part of the AP role, which is facilitated by management.

A comparative study of clinical leadership needs analysis (CLeeNa) as perceived by nurses

“…Nurse managers positively influence patient care in developed and developing countries (Hassan et al, 2020; McCarthy et al, 2019a, 2019b; Stanley et al, 2017; Stanley & Stanley, 2018). This influence will positively reflect universal patient safety and risk management, as evidenced by decreased restraint use, medication errors, patient mortality, and hospital‐acquired infections (Duignan et al, 2020; Wong et al, 2013). Worldwide, leaders are essential exemplars for their nurses; they have to set the culture of learning and support (McCarthy et al, 2019b).…”

“…• Clinical nurse leaders contribute to efficient nursing care; therefore, training leadership courses should be designed towards enhancing clinical leadership in nursing. (Duignan et al, 2020;Stanley et al, 2017;Stanley & Stanley, 2018).…”

“…Developing transformational and relational leadership reinforces organisational strategies and improves patient outcomes. Clinical leadership enhances nurses' outcomes such as job satisfaction, patients' outcomes such as patient satisfaction, and organisational outcomes such as medical errors (Duignan et al, 2020).…”

“…Recently, clinical leadership has been identified as an essential embedded element of nursing practice and advanced practice roles (Duignan et al, 2020; Stanley et al, 2017; Stanley & Stanley, 2018). Clinical leadership contributes positively to nurses, patients and organisational outcomes (Stanley et al, 2017; Stanley & Stanley, 2018).…”

Strengthening nursing, midwifery and allied health professional leadership in the UK – a realist evaluation

“…This shift has prompted debate about the need to identify what works well in both formal leadership programmes, as well as in workplace teams and organisations. It is especially important in a pandemic world that NMAHP leadership contributions are visible and valued in all international contexts and literature (Duignan et al , 2020; Bell and Colleran, 2018). UK evaluations of leadership programmes (Hocking et al , 2020; University of Manchester, 2017) is heavily weighted towards the NHS, exclude social care and do not identify: what difference they make in practice longitudinally, whether there is any cost-benefit for system investment, what impact they have on reducing workforce inequalities or on improving patient and staff outcomes. …”