Conceptualizing clinical nurse leader practice: an interpretive synthesis.

Miriam Bender

doi:10.1111/jonm.12285

Abstract

The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study's findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success.

Highlights

The Institute of Medicine’s Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards
An interpretive synthesis design was used to integrate methodologically diverse clinical nurse leader (CNL) practice narratives into a conceptual understanding of CNL practice
As one CNL put it: ‘It is necessary for the unit based and/or setting based CNL to become absorbed in the unit/setting culture . . . working side by side with staff’ (Swan 2011, p. 28)

Summary

Introduction

The American health-care system as currently structured, with its disciplinary ‘silo’ approaches to patient care, is characterised by fragmented care delivery systems lacking formal interprofessional collaborative processes (Porter-O’Grady et al 2010, Baernholdt & Cottingham 2011) This lack of collaboration has resulted in hierarchical care patterns that prevent clinicians from fully translating their abilities, knowledge and motivation into optimal care performance (Bartels 2005). Professional, policy and educational organisations have recognised the need to transform the health care workplace to better provide patient centred and team oriented care (Interprofessional Education Collaborative 2011) As part of this transformation, The American Association of Colleges of Nursing (AACN) spearheaded the development of the clinical nurse leader (CNL), a Master’s-prepared registered nurse (RN) educated to coordinate patient care through collaboration with the healthcare team at the microsystem level (AACN 2007). Numerous reports have documented the development, implementation and outcomes of these CNL partnerships (for a review see Bender 2014)

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