Refining and validating a conceptual model of Clinical Nurse Leader integrated care delivery

Abstract

Aims. To empirically validate a conceptual model of Clinical Nurse Leader integrated care delivery. Background. There is limited evidence of frontline care delivery models that consistently achieve quality patient outcomes. Clinical Nurse Leader integrated care delivery is a promising nursing model with a growing record of success. However, theoretical clarity is necessary to generate causal evidence of effectiveness. Design. Sequential mixed methods. Methods. A preliminary Clinical Nurse Leader practice model was refined and survey items developed to correspond with model domains, using focus groups and a Delphi process with a multi-professional expert panel. The survey was administered in 2015 to clinicians and administrators involved in Clinical Nurse Leader initiatives. Confirmatory factor analysis and structural equation modelling were used to validate the measurement and model structure.

An integrative review of leadership competencies and attributes in advanced nursing practice

“…Sample sizes were relatively small, ranging from 6‐50 respondents and consisted of nurse leaders (Bahouth et al, ; Goldberg et al, ; O'Rourke & Higuchi, ), experienced nurses (Bender, Williams, Su, & Hites, ; Carryer et al, ; Gardner et al, ; Kalb et al, ; Leggat, Balding, & Schiftan, ; Nieminen, Mannevaara, & Fagerström, ) and APN or CNL students (Ailey, Lamb, Friese, & Christopher, ; Gerard, Grossman, & Godfrey, ; Leggat et al, ; Nieminen et al, ; Sievers & Wolf, ).…”

“…Multiple research designs were used. These included surveys, interviews, and focus groups to describe experiences on integrating NPs and CNSs into hospitals (Bahouth et al, ; O'Rourke & Higuchi, ; Sievers & Wolf, ) and expressed clinical competences (Nieminen et al, ), a case study on an education program for CNLs (Ailey et al, ), exploring the effect of a mentor program of NP students on developing leadership competencies (Leggat et al, ), piloting an assessment for performance review of NPs and CNSs (Kalb et al, ) and multi‐method research to develop shared competencies and educational standards for APNs (Bender et al, ; Carryer et al, ; Gardner et al, ; Goldberg et al, ). Eight were descriptive studies on (experiences with) educational programs for CNLs or CNSs (Ailey et al, ; Baernholdt & Cottingham, ; Gerard et al, ; Goldberg et al, ; Leggat et al, ; Maag, Buccheri, Capella, & Jennings, ; Sievers & Wolf, ; Thompson & Nelson‐Marten, ) Baernholdt and Cottingham (Baernholdt & Cottingham, ) also reported on the development of the CNL role in practice.…”

“…Eight were descriptive studies on (experiences with) educational programs for CNLs or CNSs (Ailey et al, ; Baernholdt & Cottingham, ; Gerard et al, ; Goldberg et al, ; Leggat et al, ; Maag, Buccheri, Capella, & Jennings, ; Sievers & Wolf, ; Thompson & Nelson‐Marten, ) Baernholdt and Cottingham (Baernholdt & Cottingham, ) also reported on the development of the CNL role in practice. Six studies explicitly described leadership competencies (Bender et al, ; Gardner et al, ; Gerard et al, ; Goldberg et al, ; Kalb et al, ; Nieminen et al, ). Furthermore, studies focused on knowledge (Ailey et al, ; Carryer et al, ), leadership skills (Baernholdt & Cottingham, ; Maag et al, ; Thompson & Nelson‐Marten, ) and leadership attributes (Bahouth et al, ; Sievers & Wolf, ).…”

“…For eight out of 15 studies, quality could not be determined on the basis of quality appraisal tools for research (Data S2), five studies scored positive on all five MMET domains (Bender et al, ; Carryer et al, ; Goldberg et al, ; Nieminen et al, ; O'Rourke & Higuchi, ), one study scored positive on four out of five domains (Leggat et al, ) and one study scored positive on one domain (Bahouth et al, ).…”

Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study

“…Despite promising early data, until recently clinical nurse leader practice and the mechanisms by which CNL‐integration into care delivery leads to reported outcomes were underspecified, with no clear understanding of what CNL practice ‘is’, or the pathway leading to reported outcomes (Williams & Bender, ). To reduce this significant knowledge gap, a multi‐disciplinary team worked to develop (Bender, , ), refine (Bender et al., ) and empirically validate (Bender, Williams, Su, & Hites, ) a CNL Practice Model conceptualizing the model's characteristics and hypothesizing their mechanisms of action. In these studies, CNL practice was validated as an ongoing process of continuous clinical leadership, whereby clinical nurse leaders continuously enact four core practices: (1) facilitate effective ongoing communication, including the creation of multi‐modal communication tools and rounding structures; (2) strengthen intra and inter professional relationships by establishing a network of multi‐professional microsystem partners; (3) create and sustain teams by bringing people from all disciplines and departments affected by care processes to work together and improve them; and (4) support staff engagement via an ongoing, consistent supportive presence, the provision of resources based on in‐the‐moment needs, and by empowering staff to perform to their full scope of practice and identify and create solutions for patient care needs.…”