Clinical Leadership Competencies Research Articles

The development and evaluation of a pediatric nurse preceptor education program in a children’s hospital

Purpose: This study aimed to develop and evaluate the effectiveness of a preceptor educational program in a children’s hospital. The program’s impact was assessed by measuring improvements in clinical competency, communication competency, and leadership competency.Methods: Four day pediatric nurse preceptor education program was developed using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model. A single-group pretest-posttest design was employed to assess the program’s effects with seventeen participants who were newly trained preceptors. Additionally, participant satisfaction with the program was measured.Results: Following the implementation of the program, significant improvements were observed in clinical competency (Z=-3.62, <i>p</i><.001), communication competency (Z=-2.77, <i>p</i>=.006), leadership competency (Z=-2.08, <i>p</i>=.038), other competence (Z=-2.64, <i>p</i>=.008), and total competency (Z=-3.52, <i>p</i><.001) among participants. The overall satisfaction score was 4.41±0.62 on a 5-point scale.Conclusion: The pediatric nurse preceptor educational program significantly enhances the overall nursing competencies of preceptor nurses in a children’s hospital. Further research is needed to evaluate the effects of this preceptorship on newly graduated nurses.

Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey

BackgroundThe Australian Royal Commission emphasizes the importance of registered nurse leadership in providing safe, high-quality care to older adults in Residential aged care. Nurse leadership has important ramifications for effective multidisciplinary care as well as recruitment and retention of the aged care workforce. Registered nurse leadership plays a crucial role in enhancing resident outcomes in Residential aged care, however there are limited studies examining self-perceptions of confidence and competence of nurses running Residential aged care, particularly after hours. AimTo examine registered nurse leadership via self-reported confidence and competence in Residential aged care. MethodsA cross-sectional research design with ten facilities in Western Australia was used, including a survey tool that relied on the Clinical Leadership Competency Framework. Cronbach's alpha test was used to ascertain internal reliability and replicability. The Strengthening the Reporting of Observational studies in Epidemiology guidelines was used to guide the study. Inferential statistics were used for data analysis. Data collection occurred over a six-month period, involving registered nurses employed by a single Residential aged care provider in Perth, Western Australia. Participants rated their leadership confidence on a 5-point Likert-type scale ranging from 1 (never) to 5 (all the time). FindingsFrom a sample of 100 registered nurses working in aged care after-hours, 90% reported high levels of self-confidence. The survey results showed that those who have more than 10 years of experience reported highest confidence in managing services. Registered nurses over 50 years old self-reported highest confidence in personal qualities, managing, and improving service domains. DiscussionRegistered nurses run residential aged care, and this time of aged care reform provides an opportunity to examine associations between registered nurse leadership and resident outcomes and provide avenues for improvements in working environments and resident experiences. ConclusionThe findings have important implications for Residential aged care providers in establishing effective leadership mentoring programs to support registered nurses in improving their confidence and ability.

Building Clinical Leadership Competencies When Caring for Hospitalized Adults Experiencing Dementia

Purpose and Objectives Attempting to improve the experience of hospitalized adults with dementia and reduce patient attendant costs, we addressed hospital nursing staff confidence managing responsive behaviors through education, mentorship, and individualized patient care planning for adults with dementia. Responsive behaviors (such as pacing, calling out) is a term used to describe behaviors demonstrated by a person with dementia as a way of responding to something negative, frustrating, or confusing in their social and physical environment. Description of Project Under time restraints, we performed a rapid environmental scan and developed internal clinical resources and a learning strategy that informed a quality improvement initiative that focused on dementia care of hospitalized patients. Outcome Using quantitative and qualitative evaluation methods, the interventions increased confidence, competency, and leadership in clinical nursing leaders and improved person-centered care planning practices. The cost of patient attendant usage for this patient population decreased by 28% in 1 year. Conclusion This intervention, which was not a copyrighted program associated with administration costs, improved hospital-based dementia care and staff confidence in dementia care and reduced annual costs associated with patient attendant useage.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. Prospero ID CRD42021292290.

Helping medical undergraduate students to understand healthcare costs.

Developing clinical leadership competencies in medical students ideally would be an experiential process. One crucial leadership competency in the UK Faculty of Medical Leadership and Management leadership framework, is ‘managing services’; a key aspect of this is being aware of healthcare costs. This is challenging within the crowded MBBS curriculum, with students naturally focused on their emergent diagnostic and clinical management skills. A pre-existing epidemiology assessment at St George's University of London (SGUL), the case analysis project (CAP), requires first year clinical students to investigate the sensitivity and specificity of screening and diagnostic tests and the treatment evidence base for a patient condition they have encountered clinically. To give students an appreciation of the cost of healthcare, this innovative extension of the project required that students additionally estimate the costs of both their chosen diagnostic tests and treatment. The students are provided with a tailored form of the English National Cost Collection for the NHS,1 an annually published spreadsheet of average costs for every test and treatment, ranging from phlebotomy to heart transplantation. The resource was downloaded, irrelevant content removed, and a simple costing methodology created, ignoring the database's subtle categorisations such as 'case complexity'. Students were directed to the British National Formulary for drug costs. A pre-recorded lecture and worked examples were prepared on the SGUL online learning platform, demonstrating the use of the tailored spreadsheet, and other resources, in estimating costs. Students are supported with their project by clinical and epidemiological tutors in two separate small group tutorials. A training session and access to student resources were provided to tutors, as this was unfamiliar content for them. During implementation, student queries which tutors could not answer were escalated to the CAP clinical academic lead. The tutor training session generated improvements in presentation of material and offered an opportunity to pilot the intervention with educators. Keeping the task simple, and our focus on developing clear training resources for students and tutors, were successful approaches as there were few student queries requiring escalation. Delivering the tutorials required no additional tutor time. Nearly all students costed investigations and treatments correctly. Tutors reported lively and engaged discussions around healthcare costs and encouraged students to use this resource in their future discussions and learning around health economics. The innovation was successful in achieving an appreciation of health service costs for medical students and giving them the opportunity to practise scholarship relating to a crucial leadership competency. Two challenges encountered by students were the different terminology used for tests in the database compared with clinical terms and locating the test or treatment, both issues were resolved within the tutorials. Finally, an important limitation is that the costings in the NHS database do not take account of ‘care’ provision, admission duration, costs for co-morbidities or indirect costs such as building maintenance/utilities. However, these limitations could be a focus for further expansion of this educational intervention, thus continuing the development of our future clinical managers and leaders.

KEPEMIMPINAN KLINIS DOKTER UMUM DI RUMAH SAKIT KANKER DHARMAIS

Background: Dharmais Cancer Hospital is a special class A cancer hospital which is a reference for the National Cancer Center with multidisciplinary health workers. With the specialist role of the Dharmais Cancer Hospital, general practitioners are also involved in improving the quality of patient care. To encourage this, the clinical
 leadership skills of a general practitioner are also urgently needed.
 Objective: Assess the level of clinical leadership and explore individual and service factors that play a role in clinical leadership in General Practitioners at Dharmais Cancer Hospital.
 Methods: Case study research using quantitative and qualitative data approaches to all general practitioners who serve as doctors on duty at the Dharmais Cancer Hospital. Collecting data using a questionnaire
 using modified instruments from the Clinical Leadership Competency Framework-self-assessment tool, document review, interviews and observations. Quantitative data analysis with frequency distribution
 and qualitative data analysis with thematic analysis.
 Results: Quantitative data shows that the dimensions of service improvement are included in the standard category. Qualitative data shows aspects of clinical leadership that need to be improved,
 including 2 aspects on the dimension of showing self-quality, namely self-management and acting with integrity, 2 aspects on the dimension of working with others, namely encouraging contribution and working
 in teams, 1 aspect on the dimension of managing services, namely managing resources, and 2 aspects on the dimensions of improving services, namely encouraging improvement and innovation and
 facilitating change. The individual factors considered to play a role were the majority at a younger age, the majority of years of service were new, the employment status of the majority were non-PNS not
 permanent, no work experience, no managerial experience, lack of managerial training, and lack of leadership training. Service factors considered to play a role include poor service communication, work
 situations with high workloads, and unclear roles at work.
 Conclusion: General practitioners at the Dharmais Cancer Hospital do not yet have optimal clinical leadership, so management support is needed to improve the clinical leadership of general practitioners.

Correlates and predictors of clinical leadership need analysis (CLeeNA) for nurses: A cross-sectional web-based study.

Clinical leadership is the process of improving different organizational and patient care processes that achieve high-quality and safety of care outcomes. Clinical leadership is about having the appropriate skills and attributes to manage clinical settings. Nurses need to develop managerial and leadership skills; thus, nurses clinical leadership skills should be developed in all clinical settings. The clinical leadership needs of nurses received limited focus; the concept is still not fully understood. This study aimed to assess the correlates and predictors of nurses' clinical leadership needs in Jordan. Using a cross-sectional research design utilizing a purposive sample of 349 nurses were recruited from different hospitals. Pearson correlation coefficients standard multiple linear regressions were mainly used to analyze the data. The "leadership and clinical practice" was the highest mean score of the subscales, while the "financial and service management" was the lowest. At an alpha of 0.05, significant positive moderate correlations were found between nurses' clinical leadership needs and: level of education, age, years of experience in nursing, years of experience in leadership, number of employees under the direct supervision of the leader, and type of the hospitals. At an alpha of 0.01, significant positive weak correlations were found between nurses' clinical leadership needs and: marital status, title, and unit/ward organizational structure. Marital status-separated/divorced/widowed, and years of nursing-4 years or less predicted negatively affect nurses' clinical leadership needs. Meeting the clinical leadership needs of nurses will positively contribute to various clinical settings outcomes. Leadership training is needed to enhance nurses' clinical leadership skills and competencies.

Enhanced model for leadership development for trainees and early career health professionals: insights from a national survey of UK clinical scientists

IntroductionThe importance of shared or distributed leadership in healthcare is recognised; however, trainees, early career professionals and others for whom the exercise of leadership is a recent development report being...

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Kemampuan Kepemimpinan Klinis Perawat Pelaksana Berdasarkan Pendekatan Clinical Leadership Competency Framework dan Faktor-Faktor Determinannya

This study aims to analyze nurses' clinical leadership abilities based on the clinical leadership competency framework approach and its determinants in the inpatient room of Padangsidimpuan Hospital. The research design in this study used a descriptive-analytic correlation. The results showed that there was a significant relationship between the availability of nursing resources, management support, and work environment support with clinical leadership abilities, with a p-value for each variable, namely the availability of nurse resources (p = 0.043), management support (p = 0.000) and support work environment (p = 0.005). Meanwhile, competence has no significant relationship with nurses' clinical leadership ability in the inpatient room of RSUD Padangsidimpuan (p = 0.084). Multivariate analysis shows that management support is the most dominant variable associated with clinical leadership skills, with an Odds Ratio (OR) value of 4.476. In conclusion, nurses' clinical leadership ability must be supported by the availability of nurse resources, work environment support, and management support to obtain quality nursing services.
 Keywords: Determinants, Respondent Characteristics, Clinical Leadership

Efficacy of Application of Clinical Leadership Competencies Program on Charge Nurses Based on Self Need Assessment

Background: Clinical leadership plays a significant role for emphasizing the responsibility of charge nurses and contribute to developing and empowering their leadership capacity. Competent charge nurse need to be aware of the enablers, opportunities, strategic points and cultures of work environment they were operating. Objective: to study Efficacy of application of clinical leadership competencies program on charge nurses based on self-need assessment. Setting: Tanta Main University Hospital ICUs. Subjects: All (78) charge nurses working at studied ICUs. Tools: Three tools were used, Tool I: Self-assessment of charge nurse development need for clinical leadership skills and capabilities. Tool II: Knowledge assessment on clinical leadership competencies. Tool III: Clinical leadership competency level assessment. Results: Charge nurses 87.2% had high level of needs and importance regarding clinical leadership skills and capabilities development. Preprogram charge nurses 98.7%, 94.9% respectively showed poor level of knowledge and competency of clinical leadership, changed significantly at p < 0.001 post program to be 94.9%, 96.2% respectively. Conclusion: Charge nurses at Main University Hospital ICUs knowledge and competency of clinical leadership were at low level, they were lacking knowledge for developing clinical leadership and have great need for program about clinical leadership competencies to improve their leadership role. Immediately after application of successful clinical leadership competency program, they significantly improved their leadership knowledge and competency. Recommendation: Charge nurses should contribute to clinical leadership development by attendance of formal education programmes, case-conferences, workshops, distance learning, e-learning and self-directed learning.

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

A critical review of the development of advanced practice competency frameworks and their contribution to autonomous practice

Clinical leadership competencies in advanced nursing practice : Scoping review

The competencies of advanced practice nurses (APN) include clinical activity in aspecial field, coaching and consulting, collaboration, leadership, ethical decision-making, and research competence. Clinical leaders initiate and implement changes in the healthcare system and respond to the needs of patients and healthcare institutions. Clinical leadership based on advanced nursing practice can challenge existing management and care structures. The aim of the review is to provide an overview of clinical leadership competencies based on advanced nursing practice. The investigated question deals with which roles and competencies of APN are associated with clinical leadership from anational and international perspective. A systematic search in MEDLINE®(US National Center for Biotechnology Information (NCBI))/PubMed, CINAHL and the Cochrane Library as well as a hand search in library catalogs and journals (April 2019 to January 2020) produced atotal of 235 hits. Eight studies were included in the review and analyzed. Clinical leadership competencies are increasingly a topic of international studies and can be described and recognized in clinical practice on the basis of leadership models, and the role and leadership domains of APNs. Clinical leadership in nursing practice is recognized when APNs independently control treatment processes in complex nursing situations, exert influence, develop and implement change strategies, consult, coach, train, collaborate, and establish aconnection to other health professionals and management. In order for clinical leadership competencies to be effective in nursing care processes, broad support in the multiprofessional team, structural support of the organization and legal legitimation are required. There are hardly any studies in the German-language literature on the relevance, interpretation, and legitimacy of APN clinical leadership. Further research is needed on the interpretation of the roles of APNs, especially clinical leadership competencies, their influence on nursing care processes, leadership structures, and their interaction within the organizational culture.

Registered Nurses’ Self-Assessment of Their Clinical Leadership Knowledge and Competence

Clinical nurses play an important role in the healthcare team. The practice question for this Doctor of Nursing Practice project explored the perceptions of RNs about their clinical leadership knowledge and competencies at a 160-bed rehabilitation hospital in a metropolitan city in the southeast United States. Thirty RNs completed the following three surveys: an 8-question clinical leadership knowledge assessment, a 17-question leadership competency assessment, and a 6-question emotional intelligence self-assessment. Fifty percent or more of clinical nurses believed that they were knowledgeable in identified components of clinical leadership. The leadership competency skills assessment revealed a wide range: from 3–6% of participants who indicated that they were not at all competent to 33–57% of participants who indicated that they felt very competent. Seventy-six percent of the participants felt positive about their emotional intelligence abilities. Recommendations to nursing leadership included workshops for clinical staff RNs on the various components of the Academy of Medical-Surgical Nurses’ model of clinical leadership: clinical practice, environment practice, emotional intelligence, and leadership competencies.

Challenges and Strategies Towards Clinical Leadership Competency: A Qualitative Study

Background and Objectives: Healthcare organizations in terms of providing and maintaining community health have many challenges throughout the world and their proper functioning depends on how well they are managed. Also, the study of the state of Iran healthcare system shows that Iran does not have the proper clinical leadership and needs to made some modifications. The aim of this study was to identify and explain the competence of clinical leadership among the managers of Guilan University of Medical Sciences. Material and Methods: This research is a qualitative research that was done by using content analysis approach. The statistical population was the managers of Guilan University of Medical Sciences in 2019, which selected with the approach of purposeful sampling of 18 senior managers as participants. To obtain reliability and validity of the data, two methods used by reviewing participants and reviewing non-participating experts. Results: After analyzing and combining the data in the form of 264 basic concepts, 5 main categories (specifications, importance, barriers, executive tactics and achievements) and 28 sub-categories classified. Conclusion: Given the importance of leadership competence and the complexity of professional work, the role of the Ministry of Health in determining the management perspective, its implementation and monitoring throughout the country for determining the comprehensive road-map for health is very key and important. At the individual level, educating individuals and equipping Iran health managers with management tools, also to purely specialized generation training, is very key and vital.

Competencies of military nurse managers: A scoping review and unifying framework.

Aim(s)To identify competencies of military nurse managers and develop a unifying framework of military nurse managers’ competencies.BackgroundMilitary nurse managers shoulder multiple responsibilities because of duality roles, and they should possess competencies that enable them to manage human and material resources during peacetime and wartime. Therefore, nursing management within military context is demanding, such that a comprehensive understanding of their competencies is needed for effective military nursing management. Although relevant studies have focused on different military branches and different levels of managers, there is no standard evaluation framework.EvaluationA scoping review of studies focusing on competencies of military nurse managers from seven databases was carried out.Key issuesNine studies were included in this review, and a framework consisting of six domains of military nurse managers’ competencies was identified: clinical expertise, role model, leadership competencies, human competencies, financial competencies and deployment competencies.ConclusionExisting knowledge of competencies of military nurse managers is limited, and a comprehensive understanding of this topic can provide direction for future work.Implications for Nursing ManagementMilitary nurse managers play substantial roles within the military nursing context. A unifying framework can facilitate personnel recruitment and competency measurement, as well as training protocol development.

Lack of Clinical Leadership Competency in Continuing Education

Lack of Clinical Leadership Competency in Continuing Education

How physicians acquire leadership competencies: A systematic review

Background: Health systems around the world have their own unique challenges. Today, competence in clinical leadership is often seen as more important than clinical competence. Given the important role of physicians in health systems, how do they acquire clinical leadership competencies? In this research, valid scientific articles were reviewed for insight. Methods: In this research, databases including Science Direct, ProQuest, PubMed, SCOPUS, and Emerald, as well as Google Scholar, the Scientific Information Database, and Magiran for Iranian articles were searched for valid evidence-based English and Persian articles published between 2010 and 2018 using combination of keywords such as "physician," "leadership," and "competency" singly and in combination with the terms "AND" and "OR" as research strategy. Studies that focused on "physicians leadership competency" were selected. Search results were limited to the years 2010-2018. After reviewing the papers, 18 relevant articles were selected. Results: In the first phase, 350 articles were selected and after careful examination, 18 papers were approved at the final stage. It was found that education and leadership development courses are the most important factor for enhancing managerial competencies for physicians. It should be noted that the researchers found that in Iran research on competence in clinical leadership has also been less relevant than others. Conclusion: It is imperative that managers and planners of medical curricula design courses to develop management skills for physicians. In the post-graduate period, for physicians’ continuing education, courses that address applied management and leadership should be identified and included in the continuing education curricula to address the real needs of the country’s health systems. Leadership development programs can also be useful as projects to be modeled with the help of the world’s top medical universities.

Developing and evaluating clinical leadership interventions for frontline healthcare providers: a review of the literature

BackgroundThe importance of clinical leadership in ensuring high quality patient care is emphasized in health systems worldwide. Of particular concern are the high costs to health systems related to clinical litigation settlements. To avoid further cost, healthcare systems particularly in High-Income Countries invest significantly in interventions to develop clinical leadership among frontline healthcare workers at the point of care. In Low-Income Countries however, clinical leadership development is not well established. This review of the literature was conducted towards identifying a model to inform clinical leadership development interventions among frontline healthcare providers, particularly for improved maternal and newborn care.MethodsA structural literature review method was used, articles published between 2004 and 2017 were identified from search engines (Google Scholar and EBSCOhost). Additionally, electronic databases (CINHAL, PubMed, Medline, Academic Search Complete, Health Source: Consumer, Health Source: Nursing/Academic, Science Direct and Ovid®), electronic journals, and reference lists of retrieved published articles were also searched.ResultsEmploying pre-selected criteria, 1675 citations were identified. After screening 50 potentially relevant full-text papers for eligibility, 24 papers were excluded because they did not report on developing and evaluating clinical leadership interventions for frontline healthcare providers, 2 papers did not have full text available. Twenty-four papers met the inclusion criteria for review. Interventions for clinical leadership development involved the development of clinical skills, leadership competencies, teamwork, the environment of care and patient care. Work-based learning with experiential teaching techniques is reported as the most effective, to ensure the clinical leadership development of frontline healthcare providers.ConclusionsAll studies reviewed arose in High-Income settings, demonstrating the need for studies on frontline clinical leadership development in Low-and Middle-Income settings. Clinical leadership development is an on-going process and must target both novice and veteran frontline health care providers. The content of clinical leadership development interventions must encompass a holistic conceptualization of clinical leadership, and should use work-based learning, and team-based approaches, to improve clinical leadership competencies of frontline healthcare providers, and overall service delivery.

Defining leadership competencies for pediatric critical care fellows: Results of a national needs assessment

Introduction: Physicians in training, including those in Pediatric Critical Care Medicine, must develop clinical leadership skills in preparation to lead multidisciplinary teams during their careers. This study seeks to identify multidisciplinary perceptions of leadership skills important for Pediatric Critical Care Medicine fellows to attain prior to fellowship completion.Methods: We performed a multi-institutional survey of Pediatric Critical Care Medicine attendings, fellows, and nurses. Subjects were asked to rate importance of 59 leadership skills, behaviors, and attitudes for Pediatric Critical Care practitioners and to identify whether these skills should be achieved before completing fellowship. Skills with the highest ratings by respondents were deemed essential.Results: Five hundred and eighteen subjects completed the survey. Of 59 items, only one item (“displays honesty and integrity”) was considered essential by all respondents. When analyzed by discipline, nurses identified 21 behaviors essential, fellows 3, and attendings 1 (p < 0.05). Nurses differed (p < 0.05) from attendings in their opinion of importance in 64% (38/59) of skills.Conclusions: Despite significant variability among Pediatric Critical Care attendings, fellows, and nurses in identifying which clinical leadership competencies are important for graduating Pediatric Critical Care fellows, they place the highest importance on skills in self-management and self-awareness. Leadership skills identified as most important may guide the development of interventions to improve trainee education and interprofessional care.