Clinical Leadership Development Research Articles

I became a leader by coincidence: specialised nurses as leaders in the field of mental health and substance abuse

PurposeThis study aims to examine nurses’ motivation for leadership and explore important challenges nurses face in leadership positions.Design/methodology/approachSemi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.FindingsNurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.Research limitations/implicationsStudies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.Practical implicationsThe role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).Originality/valueBy identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

Students' perceptions of a UK physiotherapy student-led clinic.

Student-led clinics (SLCs) are a mode of delivery whereby students take responsibility for the delivery of a health service or intervention. SLCs for physiotherapy have a wide range of uses, including enhancement of learning, replacement of clinical placement hours and serving population and community needs. Evidence is emerging globally as to the outcomes of SLCs in physiotherapy, but little exists in the United Kingdom (UK) context. The purpose of this study was to explore student perceptions of running, leading and participating in a UK physiotherapy student-led neurological rehabilitation clinic. A qualitative design using a focus group. Four themes were identified relating to students' perceptions of SLCs associated with the learning environment, self-development, enhanced clinical skill development and reflections on experience at the SLC. The findings of this study suggest that physiotherapy SLCs in a UK context can contribute positively to student experience and skill development, particularly in relation to the learning environment, development of clinical skills, leadership and autonomy. Some aspects related to, for example, student induction and preparation could be further developed. Further research should explore if these findings are applicable in other countries where SLCs are less established. Further research in the UK and globally related to SLC models in different courses and across varying stages is required. Exploration of the SLC as a viable form of clinical placement experience is also warranted.

101: ADVANCED PRACTICE PROVIDER PROFESSIONAL ADVANCEMENT MODEL: PROMOTION AND RETENTION

Introduction: The University of Maryland Medical Center (UMMC) is an urban academic medical center that employs over 300 Advanced Practice Providers (APPs). The Professional Advancement Model (PAM) was developed in 2014 as a pathway to promote APPs based on their contributions of expert clinical practice, leadership, quality improvement, and professional development. APPs consist of Nurse Practitioners (NPs), Physician Assistants (PAs), Certified Registered Nurse Anesthesia (CRNAs), and Certified Nurse Specialists (CNS). Methods: APPs are introduced to a PAM roadmap, mentored by members of the PAM committee, their managers, and seniors on their team. The application cycle is open two times per year. Eligibility requirements include three years of employment with no less than “excelling evaluations” and sign off by respective manager. The APP must meet specified criteria and choose an advancement tract: education, policy, or quality improvement and research. A committee which includes PA/NP staff members, senior members and three APP managers reviews the applications. The Director of APPs signs off on the process. If the APP does not qualify for advancement at the time of review, the team provides feedback and the opportunity for further mentorship. The individual then has the option of resubmitting their application for consideration. Results: The applications are reviewed and evaluated based on established criteria. Over the nine-year period 164 APPs have applied and 139 were promoted resulting in an 84% promotion rate. Of the APPs who were not initially promoted, 52% were promoted after post feedback reapplication. Applicants per cycle range from a low of 4 to a high of 17. The promotion rates per cycle range from 57%-100%. The applicants included nine PAs, one CNS, and 154 NPs. Of the APPs promoted to senior status through PAM, 131 of the 164, 80% are still employed at UMMC. In addition to a leadership role a monetary amount is awarded based on advancement. Conclusions: A PAM model provides a structured process to guide professional growth, development, and promotion. In our experience the PAM program has contributed to retention of expert clinicians. These seniors also contribute to institutional quality improvement, research, practice innovation, and team mentorship.

The MAGNUS Experience: An Opportunity for Renewal, Respite, and Reflection

The nursing literature is replete with accounts of disenfranchised nurses leaving their workplaces to embark on travel assignments, retire early, or seek alternative careers after living through a pandemic not experienced since 1918. Nurse leaders are employing a myriad of strategies to retain staff and recruit new nurses. Investing in professional development activities has been purported as an effective strategy to retain and engage staff. This article describes the evolution of a continuing education course from a clinical leadership development program to an empowerment experience. Responses from participants who completed MAGNUS “post pandemic” are included.

Nurse unit managers’ work and impacts on clinical leadership: A cross-sectional study

<h2>ABSTRACT</h2><h3>Problem/Background</h3> Nurse unit managers are critical to clinical leadership and play an important role in the contemporary context of health care management. Lack of role satisfaction and reports of excessive workloads place this crucial role at risk; it is therefore essential to understand the workplace factors that influence the important work of nurse unit managers, and the stressors that impact their leadership practices. <h3>Aim</h3> To capture and explore nurse unit managers' perceptions of their work and leadership practices within a large, multi-facility tertiary healthcare organisation. <h3>Methods</h3> A cross-sectional study with a convenience sample of nurse unit managers (n=34) in an Australian health service was undertaken. A multi-dimensional instrument included socio-demographics, validated scales (perceived organisational support, work engagement, intentions to stay), purposefully developed scales (administrative workload, clinical leadership profile), and an open-ended question (clinical leadership aspirations). Nurse unit managers' demographics and scales were analysed descriptively; content analysis was used to code the qualitative data. <h3>Findings</h3> Nurse unit managers were clinically experienced, had limited postgraduate education, worked excessive hours, had high administrative loads, and enacted multiple leadership categories. Work engagement was characterised by absorption and dedication, nurse unit managers were ambivalent in their perceptions of organisational support. Nurse unit managers expressed aspirations for clinical leadership and wished to retain their positions in the organisation. <h3>Discussion</h3> Due to the critical role of nurse unit managers within health systems, it is vital that knowledge of nurse unit managers' work and leadership practices are investigated. Nurse unit managers' clinical leadership activities and aspirations require ongoing clarification. Relationships between perceived organisational support, work engagement, and nurse unit managers' intentions to stay need further exploration. The level of post-registration qualification in the workforce needs to be raised. <h3>Conclusion</h3> Increased awareness of leadership realities and workplace factors that influence nurse unit managers could be used for advancing clinical leadership and ongoing role development.

Examining participant perceptions of the UCSF school of pharmacy master preceptor program

IntroductionThe University of California San Francisco School of Pharmacy faculty created the Master Preceptor Program (MPP) to instill best practices in clinical precepting, leadership and professional development, and interprofessional education (IPE). Graduates of the program are encouraged to mentor colleagues at affiliated sites. This study aimed to explore MPP participants' perceptions about the program and to collect general feedback. MethodsA descriptive qualitative study of MPP participants who completed the program between 2017 and 2019 was conducted. Semi-structured interviews and focus groups were used to collect general programmatic feedback and examples of skill implementation. All encounters were conducted and recorded online via Zoom. Three investigators independently analyzed transcripts for codes related to key programmatic areas using conventional content analysis. ResultsTen of 14 past MPP participants participated. Themes included confidence and skills gained in clinical teaching, self-reflection and network opportunities supporting professional and leadership development, and a need for structured expectations and deliverables. Participants noted several benefits of the MPP on clinical teaching, such as improving confidence and adopting teaching techniques, structural and organizational skills, and a learner-centered approach. Participants also mentioned programmatic offerings that improved leadership and professional development, such as networking opportunities in the MPP and at conferences. Participants did not mention IPE in their responses. ConclusionsAll participants recognized the MPP as an effective training program to enhance clinical precepting skills, leadership, and professional development. Program structure and intentional incorporation of IPE skills are areas of improvement for future cohorts.

Healthcare leadership development during a pandemic: do not stop, adapt.

Research carried out in 2016 by two of the authors of this article investigated the role that leadership 'theory' plays within an individual's leadership development and identified other components of clinical leadership programmes that are key to enabling the development of future leaders. While early career doctors identified leadership theories and concepts as important within their development as clinical leaders, these must be closely tied to real-life practices and coupled with activities that aim to develop an increased self-awareness, understanding of others, clinical exposure and leadership tools that they can use in practice. During a healthcare crisis, such as a global pandemic, maintaining a focus on leadership development (particularly for more junior clinicians) might not be seen as important, but leadership is needed to help people and organisations 'get through' a crisis as well as help develop leadership capacity for the longer term. This article, drawing from contemporary literature, the authors' own research and reflections, discusses how leadership development needs to continually adapt to meet new demands and sets out tips for those involved with clinical leadership development.

Organizational Commitment, Organizational Citizenship Behavior and Turnover Intention: The Moderating Role of Leadership Behavior

Organizational Commitment, Organizational Citizenship Behavior and Turnover Intention: The Moderating Role of Leadership Behavior

Medicines Optimisation for Respiratory Patients: The Establishment of a New Consultant Respiratory Pharmacist Role in Northern Ireland.

Medicines optimisation for those with respiratory conditions can have a significant impact on clinical outcomes and substantial efficiency gains for health care. Consultant pharmacists are experts working at the top of their specialism in four main pillars of practice, namely clinical care, leadership, education and training, and research and development. A consultant respiratory pharmacist has recently been appointed at a large Health and Social Care Trust in Northern Ireland to provide expert care and clinical leadership for the medicines optimisation agenda with regards to respiratory care in Northern Ireland. Alongside clinical practice, leadership, and service development, emphasis will be placed on monitoring and evaluating the work of the consultant respiratory pharmacist with a view to gathering the necessary evidence to support the case for further investment in such consultant pharmacist posts in the region. This short communication article outlines some of the clinical and economic factors associated with the decisions to invest in the consultant pharmacist model of care in Northern Ireland

Exploring clinical leadership in long-term care: An integrative literature review.

The aim of this study is to understand the concept of clinical leadership and clinical leadership development for nurses working with older adults in long-term care health care facilities. In Canada, clinical care within long-term care is undertaken by registered nurses and licenced practical nurses working with health care aides. Effective clinical leadership is essential for providing quality nursing care. An integrative literature review using the framework of Whittemore and Knafl (2005). All selected articles were quality appraised using the Critical Appraisal Skills Program and the accuracy, authority, coverage, objectivity, date and significance checklist. The analysis resulted in four themes: ambiguous definitions, practice-based and value-driven care, the impact of clinical leadership and clinical leadership development for Canadian nurses. The findings suggest that ambiguity surrounds the concept of clinical leadership, with the term denoting both 'management' as a formal administrative role and 'leadership' in general. More recently, the clinical leadership focus has been on informal leadership by nurses at the bedside, where personal and professional values align with clinical action. Effective clinical leadership can have a positive impact on quality care and employee job satisfaction.

Strategies and interventions that foster clinical leadership among registered nurses: a scoping review protocol.

The objective of this scoping review is to identify and describe strategies and interventions aimed at fostering registered nurses' clinical leadership in any clinical setting, identify the theories and/or frameworks that guide registered nurses' clinical leadership development, and describe the types of research conducted on this topic. Registered nurse clinical leaders may be defined as staff nurses in clinical settings who influence and coordinate patients, families, and health care team members for the purpose of integrating care for positive patient outcomes. They have been described as expert clinicians, effective decision-makers, and relationship-focused professionals who build trust among patients, families, and health care colleagues to ensure the best possible patient care. Clinical nursing is the cornerstone of the nursing profession. Registered nurses' clinical leadership is considered critical to the health of patients and to the advancement of nursing practice. Hence, it is important to understand strategies and interventions for fostering this leadership. This scoping review will include any quantitative, qualitative, or mixed methods studies that have registered nurse participants practicing in any clinical setting globally and that examined strategies and interventions to foster registered nurses' clinical leadership. Besides primary research studies, we will also include reviews. This scoping review will be conducted using JBI methodology. Academic databases and sources of gray literature will be searched for published and unpublished studies. Screening and full-text review of accessed records will be conducted to determine alignment with the inclusion criteria. For records that meet the inclusion criteria, data will be extracted, mapped, and presented in a table. A narrative summary will describe how the tabulated results addressed the review questions. Open Science Framework Registration: https://osf.io/hjfkd.

Clinical leadership development in Australian healthcare: a systematic review.

Despite clear priority and high costs of leadership capability programmes in healthcare, and significant investments into improving clinical leadership, there remains a prominent gap around evidence of effectiveness or impact on patient outcomes in Australia. We aimed to conduct a systematic review on postgraduate clinical leadership programmes to gather learnings on the processes, theoretical underpinnings, and impact of such programmes for medical and other health professionals. Our search included empirical, peer-reviewed evaluations of Australian clinical leadership development programmes published between November 2008 and March 2019 and yielded 3284 records. Four studies met criteria. Findings revealed that currently, little value is placed on formal evaluations and peer-reviewed publication including assessment of individual, organisational or system level impacts of clinical leadership development programmes, with limited evidence available on effective approaches to clinical leadership development in the Australian healthcare system.

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.

Clinical leadership development workshop for licenced practical nurses in supportive living in Alberta: An exploratory qualitative study

Objective: Since 2013, the scope of practice of LPNs in Alberta, Canada has expanded to include leadership in SL that requires that the development of new CL skills be prioritized. To date, few SL work-based educational programs have been devoted to developing CL skills for LPNs. The objective of this study is the assessment of the impact of a brief patient group education intervention (Conversation MapsTM) in people with type 2 Diabetes Mellitus.Methods: An exploratory qualitative design was used, incorporating multiple data collection methods, including individual and focus group interviews, and a demographic questionnaire. Interview data were analyzed using thematic description.Results and conclusions: Findings suggest that the CLD workshop was effective and feasible in SL practice settings. Data showed that improvement in LPN autonomy and control over decision-making resulted from gaining confidence and feeling empowered, which led to positive change in participants’ CL attitudes. Including other team members, health care aides (HCAs), and management in the CLD workshops also improved team relationships for all.

Professional learning, organisational change and clinical leadership development outcomes.

The aim of this study is to develop a conceptually sound outcome model for clinical leadership (CL) development in healthcare, linking individual professional learning and organisational change. Frontline doctors' CL is often offered as a solution to healthcare challenges worldwide. However, there is a paucity of rigorous evidence of effectiveness of CL development, or theories supporting it. Importantly, the literature currently lacks robust outcome models for CL development, impeding robust impact evaluations. This multi-source, sequential integrated mixed-methods study draws on systematic content analysis of NHS policy documents and empirical data from a CL programme evaluation study: exploratory factor analysis (EFA) of 142 participants' survey responses and thematic qualitative analysis of 30 in-depth participant interviews across six cohorts. Through integrating findings from the three analyses we examine: (a) the expected organisational outcomes of CL, (b) individual learning outcomes of CL development, and (c) the mechanisms linking the two. The policy analysis identified three desired solutions to key healthcare problems which CL is expected to offer: Speeding up good practice, Inter-professional collaboration and dialogue, and Change and transformation. Triangulating the EFA results with the qualitative analysis produced five individual outcome constructs: Self-efficacy, Engaging stakeholders, Agency, Boundary-crossing expertise, and Willingness to take risks and to learn from risks and failures. Further qualitative analysis uncovered key mechanisms linking the individual outcomes with the desired organisational changes. Despite significant investments into CL development in the UK and worldwide, the absence of conceptually robust and operationally specific outcome models linking individual and organisational impact impedes rigorous evaluations of programme effectiveness. Our study developed a novel individual and organisational outcome model including a theory of change for clinical leadership. Our findings further contribute to professional learning theory in medical settings by conceptualising and operationalising the mechanisms operating between individual and organisational learning outcomes.

From staff nurse to nurse consultant: Survival Guide part 11: Surviving self-doubt.

In this article author talks about the staff nurse who are facing problem because of coronavirus Topics include the survival as a nurse centres on inner belief in the clinical skills, the belief in the clinical relationship skills with patients, the COVID-19 pandemic, both personally and as a nurse, and the exception and many of the feel unable to put ourselves forward for promotion or clinical leadership or professional development

Has the clinical governance development agenda stalled? Perceptions of New Zealand medical professionals in 2012 and 2017

Clinical governance is a key policy and organisational foundation for health care quality improvement. This study sought to measure progress with clinical governance development from the perspective of practicing medical professionals in the New Zealand public health system. A short fixed-response survey, with questions derived from a government policy statement, was sent in 2012 and 2017 to all registered medical professionals in ongoing employment in New Zealand’s public health system. Respondents, therefore, worked across New Zealand’s 20 District Health Boards (DHBs), which own and manage public hospital and health care services. The survey sought to gauge medical professionals’ perspectives around performance on, and implementation of, key clinical governance components. The overall performance in clinical governance development declined or stalled between the two survey periods across eight out of 10 key survey questions. There were improvements on two questions relating to respondent familiarity with clinical governance concepts, and to management support for clinical leadership development, but no change in areas such as having a structure to support clinical governance, or working in partnership with management. Limited government and DHB policy attention to clinical governance may well have contributed to stalled development across the New Zealand health system. If so, this finding has lessons for other countries and health systems in which there has been varying government support for the clinical governance agenda with ramifications around expectations for clinical leadership on, and involvement in, quality improvement.

Enriching Medical Student Learning Experiences.

Objective:Medical students should develop skills in assessing their own learning needs and developing strategies to meet those needs. Medical curricula should be designed to provide active and enriching ways to explore medicine beyond the classroom. The program should enrich the elements of motivation, discovery, innovation, social services, cultural exploration, and personal development. The University of Kansas School of Medicine instituted a new curriculum in 2017 called ACE (Active, Competency-based, and Excellence-driven). Eight 1-week courses of enrichment experiences are embedded within the first 2 years of the curriculum.Methods:After each of 8 medical content blocks, students are required to participate in a 1-week, nongraded enrichment experience according to their own learning needs and interests. Students choose the type of enrichment activities including clinical experiences, professional development, leadership development, research and scholarly activity, and community engagement. Students select their top enrichment choices and a computer lottery makes the assignments from their designations. Students engaged in research and scholarly activity are guided to appropriate research mentors.Results:A total of 196 enrichment activities at 3 campuses were developed for 211 students during the first 2 years of medical school. Most students selected clinical experiences with enrichments available in most medical specialties and subspecialties. Students also use enrichment weeks to conduct research/scholarly activity, particularly those students pursuing the Honors Track. A total of 2071 enrichment experiences were completed in the first 2 years.Conclusions:Most enrichments involved clinical experiences, although research/scholarly activity and professional development enrichments also were popular. Evaluations from students and antidotal data suggested enrichments are popular among students and a good change of pace from the usual rigorous activities of the curriculum. Because of the large number of experiences required to conduct the enrichment weeks, a continuous process of evaluation is required to maintain the program. Therefore, flexibility is required to administer the program.

Reflection on creating a coaching approach to student nurse clinical leadership development.

Coaching is an intervention that facilitates another person's learning, development and performance. Applied to student nurse practice placement learning, coaching has the potential to boost leadership learning that is student led, less focused on following the directions of a mentor and more focused on students taking responsibility for identifying their learning goals and objectives. This article gives personal perspectives about how a collaboration between four Greater Manchester (GM) universities and their partner practice organisations developed, implemented and evaluated a coaching approach to student nurse clinical leadership development and peer learning, while increasing practice placement capacity-the GM Synergy model. Perspectives are given on setting up a project team, testing the model before implementation and developing a robust evaluation framework. Coaching as a model for student support and clinical leadership development is in line with the Nursing and Midwifery Council's Future Nurse: Standards of Proficiency for Registered Nurses document, with the practice supervisor role complementing the role of the coach in clinical practice.

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.