This survey study assesses the views of clinical leaders of the 13 designated Regional Emerging Special Pathogen Treatment Centers in the US regarding whether they would allow clinicians to abstain from caring for infected patients.

Primary care (PC) represents a widely accessed health care service for youths and families in the United States. In recent years, there has been an increase in youth presenting to PC with suicidal thoughts and behaviors. This study aims to better understand current suicide prevention practices and provider perspectives regarding suicide prevention practices in PC with pediatric populations. Two studies (one using focus groups, the other using individual interviews) were conducted with 40 PC staff (including physicians and physician assistants, integrated behavioral health staff, nurses and nurse practitioners, and clinic leaders) from pediatric PC clinics in Washington State. Focus groups/interviews elicited feedback on current suicide care practices, staff and clinic needs, barriers, facilitators, and suggestions for improvement. Focus groups/interviews were recorded, transcribed, and analyzed using thematic analysis. Results were similar across clinics and highlight challenges and needs for pediatric PC including time limitations, lack of resources for parents, need for additional provider training in suicide prevention, need for team-based approaches, need for standardized and streamlined pathways for patients at different risk levels, and need for integrating screening and intervention components into existing workflows. Overall, results suggest that suicide care is difficult to implement within PC contexts. Understanding PC staff needs, barriers, and facilitators is imperative to adapt feasible suicide care pathways for PC. Results highlight important needs and key components for implementation strategies to target. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The COVID-19 pandemic and associated policies discouraging routine-care visits dramatically affected cancer screening in the United States. Yet little is known about the perspectives of providers and staff at federally qualified health centers (FQHCs) on colorectal cancer (CRC) screening during this period. We administered hour-long telephone interviews with clinic leadership and frontline staff at a Los Angeles-based FQHC. Questions explored barriers and facilitators to CRC screening, and adaptations implemented to address challenges posed during three phases of the COVID-19 pandemic: early (March-July 2020), middle (August – December 2020), and later (January – December 2021). All interviews were recorded, transcribed, and content-analyzed by trained and experienced qualitative methodologists. Participants’ (n = 20) ages ranged from 26–56; most were female (85%), and in leadership positions (65%). Early in the pandemic CRC screening efforts were severely hampered as the health center was inundated with upper respiratory infections, lacked infrastructure to rapidly scale telehealth, and had minimal guidance from prior disaster plans geared for short-term challenges (e.g., flu). Limited availability of stool test kits and reduced gastroenterology capacity also thwarted CRC screening delivery. Throughout the pandemic, the FQHC faced challenges hiring and retaining staff for cancer screening outreach. In the later phase of the pandemic, the FQHC responded by expanding CRC screening options, deploying health record tools enabling automated outreach, and retraining staff on CRC screening workflows. Interviewees identified strategies to strengthen pandemic preparedness and sustain CRC screening, including improved monitoring of infectious disease through incoming patient call data to guide staffing decisions, diversifying vendor relationships and specialty care partnerships to ensure access, particularly in gastroenterology, and increasing home-based testing options. Our findings, while limited to the experience of one large FQHC, may help inform efforts to develop guidance that community health centers can apply in responding to future pandemics or other natural disasters to minimize impacts on CRC screening.

Oncology advanced practitioners (OAPs) play an important role in cancer care delivery. However, leadership in clinical research remains low among OAPs. Although OAPs often participate in patient care for early-phase clinical trials, they rarely have the opportunity to lead as a principal investigator (PI), despite being capable and effective PIs when provided education and mentoring. As cancer care needs continue to increase, there is a critical need for well-trained PIs and sub-investigators (sub-Is) to evaluate novel therapeutics. To address this need, an intensive 3.5-day educational course at HonorHealth Research Institute (HRI) was developed to provide education and guidance to OAPs who desire to learn and evolve into the role of a PI in clinical trials. The course involved lectures, roundtable discussions with physicians, and protocol synopsis workshops. Participants included 21 OAPs. Participants were given questionnaires to evaluate the impact of the course and assess knowledge retention. In lectures, 65% of questions answered demonstrated improvement. In course evaluations, 100% of participants agreed that the learning objectives were met. In follow-up surveys, 63% reported they had reviewed their drafted protocol synopsis with their mentor, while the majority felt at least somewhat confident that they would be able to move forward with their protocol synopsis. Overall, participants responded favorably to the course, which successfully provided foundational knowledge for OAPs to transition into clinical research leadership positions.

Objective: To understand shared-use mobile device deployment, management and usage challenges in healthcare delivery organizations (HDOs), including capabilities and unmet needs in Australia, Canada, the United Kingdom and the United States. Methods: Online survey of 400 HDO clinical and health information technology leaders with institutional responsibilities for the management of shared-use mobile devices. How the challenges identified in the survey can be overcome is explored by examining the deployment of a mobile device management platform. Results: Across nations 92% of respondents agreed that mobile devices are essential tools, yet only 56% had fully implemented shared-use device policies and procedures. Respondents stated improvement is needed in auditing facility device usage: 16% have no consistent policy/process for assigning devices at shift start; 46% use verbal or informal processes. Perceived mobile device benefits include: facilitates delivery of high-quality (94%) and accelerated care (51%) enabling reduced length of stay (86%); increased clinician satisfaction (94%) and reduced burnout (90%); enhanced care team coordination/communication (67%); and improved clinical application access (54%). Challenges in ease of use were endemic, including: securing sensitive information (44%); sharing of access credentials (79%); devices left logged in (74%); and ensuring rapid, frictionless access. Clinicians experience access issues, with frequent helpdesk contact (87%) for lockouts. Clinician frustration occurs when devices are unavailable (87%) or broken, uncharged, or missing applications (86%), delaying care delivery. Management issues included lack of visibility into mobile device usage (40%), assignment (48%), and applications accessed (55%); no centralized system for managing devices (39%); and time-consuming device setup (35%), with little variability by nation. When devices are unavailable or access difficult, 81% stated personal devices are used, an unsafe workaround. Substantial minorities across nations reported still relying on manual paper or digital log of device sign-out. A high mean annual rate of mobile device loss (23% across nations) ensures the negative impact of missing/unavailable devices is substantial, increasing risk of information security breach, delays in care communications and delivery, reduced productivity, shift change disruption, and increased staff frustration. Differences in responses by facility size (bed count) were few and modest. HDOs reported meaningful savings of $1.1 million per year on average by deploying shared-use mobile devices, with 92% indicating improved return on investment and reduced manual management workload. Conclusions: HDOs reported significant perceived challenges in effectively managing shared-use devices, but recognize they facilitate efficient clinical-operational workflows and increased clinician satisfaction. Need exists to overcome substantial capability gaps to systematically manage device fleets while ensuring a friction free, secure and efficient user experience.

Medication adherence is essential for improving heart failure outcomes yet remains suboptimal. Organisational models in general practice-such as group practices and Community Health Centres-have long been promoted as a means to strengthen primary care and are currently undergoing national reform. However, their impact on adherence remains unclear. This study investigated whether general practice organisational arrangements were associated with adherence to therapies recommended by clinical guidelines for heart failure. We conducted a retrospective cohort study using linked administrative data from the Romagna Local Health Authority (Northern Italy), encompassing all adults discharged with an incident diagnosis of heart failure between January 2020 and March 2023. The primary outcome was adherence to angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or β-blockers over one year, based on pharmacy claims. The exposure was the general practice organisational model: group practice within a Community Health Centre, group practice outside a Community Health Centre, or solo/networked practice. We used multilevel logistic regression to estimate adjusted associations, accounting for patient- and context-level confounders, with additional stratified analyses by health district. No systematic association emerged between general practice organisational models and adherence in the overall cohort of 3304 patients with heart failure. However, in one district (Rubicone), group practices were associated with higher adherence (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers: odds ratio = 3.00, 95% confidence interval 1.48-6.09, P = .002; β-blockers: odds ratio = 1.81, 95% confidence interval 0.98-3.37, P = .06). Residual variation between general practitioners was modest but not negligible. Organisational arrangements alone may be insufficient to improve adherence in heart failure care. Their effectiveness likely depends on how they are implemented and supported at the local level, through clinical leadership, specialist involvement, and integration across care settings. As new national reforms promote broader structural change, our findings underscore the importance of local facilitators and context-sensitive implementation. These insights are particularly relevant for understanding the operational strengths and weaknesses of legacy models that are now being phased out.

Exploring how organizational support shapes nurses' clinical leadership: evidence from Tunisia.

PurposeThis study aims to explore the perceptions of clinical management unit leaders regarding their role in healthcare accreditation processes within a European public hospital. It aims to identify the predisposing, enabling and reinforcing factors that shape leadership practices and influence the development of a quality-oriented organisational culture.Design/methodology/approachA qualitative hermeneutic approach was employed, combining individual and group semi-structured interviews and participant observation. Six healthcare professionals responsible for accreditation projects under the Andalusian Agency for Health Quality participated. Data were analysed using Ricoeur’s interpretative framework, guided by the PRECEDE model.FindingsThree themes emerged in this study: (1) conceptual tensions between accreditation and quality culture, (2) leadership as a collective and emotionally demanding endeavour and (3) accreditation as a process that generates both tangible improvements and emotional reinforcement. The study highlights the need to clarify the internal lead’s role and align accreditation language with clinical and managerial realities.Research limitations/implicationsFuture research could examine how gender dynamics influence leadership in accreditation processes.Practical implicationsFindings support the need for leadership development, institutional investment and the redesign of accreditation standards to better reflect clinical practice and managerial responsibilities.Social implicationsThe study underscores the emotional and cultural impact of organisational change, highlighting the importance of supportive environments that foster shared responsibility, team engagement and sustainable quality improvement.Originality/valueThis is the first study to apply the PRECEDE model to explore leadership in accreditation. It offers a novel framework for understanding how internal leads navigate quality improvement within complex healthcare organisations and provides actionable insights for institutional development.

Digital health technologies (DHTs) expand healthcare access, improve care coordination, and reduce costs. However, integrating these tools into care faces complex barriers. Understanding the perspectives of health system leaders is essential for developing sustainable DHTs. The objective of this project is to explore the experiences and priorities of health system stakeholders regarding the implementation of DHTs. The study team conducted semi-structured interviews with 12 stakeholders from diverse U.S. health systems, including clinical, operational, and executive leadership. Interviewees were selected using purposeful and snowball sampling. Interviews were transcribed and analyzed thematically using the Consolidated Framework for Implementation Research (CFIR). A constant comparative coding process was used to identify and organize key themes. Participants viewed DHTs as a way to enhance healthcare access and efficiency and improve public health operations, especially in rural or underserved settings. However, several major adoption challenges emerged: (1) integrating DHTs into existing workflows and electronic health records is operationally burdensome; (2) digital care can introduce risks to quality, continuity, and equity; and (3) external factors (reimbursement policy, regulatory constraints, infrastructure investment) are critical to long-term adoption. Digital health is seen as essential to the future of healthcare delivery, but meaningful integration requires alignment across clinical, operational, and policy domains. Coordinated investment, regulatory reform, and robust data infrastructure are needed to ensure DHTs are scalable and sustainable.

Digital health technologies (DHTs) expand healthcare access, improve care coordination, and reduce costs. However, integrating these tools into care faces complex barriers. Understanding the perspectives of health system leaders is essential for developing sustainable DHTs. The objective of this project is to explore the experiences and priorities of health system stakeholders regarding the implementation of DHTs. The study team conducted semi-structured interviews with 12 stakeholders from diverse U.S. health systems, including clinical, operational, and executive leadership. Interviewees were selected using purposeful and snowball sampling. Interviews were transcribed and analyzed thematically using the Consolidated Framework for Implementation Research (CFIR). A constant comparative coding process was used to identify and organize key themes. Participants viewed DHTs as a way to enhance healthcare access and efficiency and improve public health operations, especially in rural or underserved settings. However, several major adoption challenges emerged: (1) integrating DHTs into existing workflows and electronic health records is operationally burdensome; (2) digital care can introduce risks to quality, continuity, and equity; and (3) external factors (reimbursement policy, regulatory constraints, infrastructure investment) are critical to long-term adoption. Digital health is seen as essential to the future of healthcare delivery, but meaningful integration requires alignment across clinical, operational, and policy domains. Coordinated investment, regulatory reform, and robust data infrastructure are needed to ensure DHTs are scalable and sustainable.

IntroductionResearch shows steady growth in clinical leadership (CL); however, CL is still misunderstood in all clinical environments. Few studies have been conducted on the CL needs of nursing staff. No studies have linked CL needs (CLeeNs) in nursing to safety climate (SC) in clinical settings. Therefore, this study analyzed the differences in the perceived nurses’ CL needs and SC between nurses and nurse managers.MethodsA cross-sectional research design was implemented employing an online survey. A convenience sample of 252 registered nurses (RNs) and 139 nurse managers was employed using the Clinical Leadership Needs Analysis (CLeeNA) instrument and the Safety Climate Survey (SCS).ResultsThe chi-square test showed that nurse managers differed from nurses in most of the sample demographics, except in their time commitment, area of work, and the reported decision-making style in their area of work. The mean score of the overall scale of CLeeNs was “very important” (M = 6.05, SE = 0.072). The highest mean of the subscales was for “standards of care.” In contrast, the lowest mean of the subscales was “financial and service management.” The T-test revealed that the total mean score of CLeeNs was higher among nurse managers as compared to that of nurses (6.52 ± 1.01 vs. 5.79 ± 1.55, p = .001), which held the same trend for all subscales and the individual mean scores of CLeeNs for the privilege of nurse managers. The mean score of the perceived SCS of the total sample was 3.41 (SE = 0.032), indicating negative perceptions of the SC. Although there were no statistically significant differences in the total and individual mean scores of SC (p = .252), nurse managers reported slightly higher scores (3.46 ± 0.64) than nurses (3.38 ± 0.62). This result indicates that there were no significant differences found between RNs and nurse managers in SC scores, and a weak negative correlation was observed between CLeeNs and SC.ConclusionsCL and CLeeNs are essential for a safe climate; however, little is known about how nurses and nurse managers differ in their perceived CL and SC in practice. CL should be sustained in all hospital settings. The low perceived SC is worrying and mandates immediate intervention at all organizational levels. Notably, a negative correlation was observed between CLeeNs and SC, suggesting that stronger perceptions of CL do not necessarily translate into more favorable SC perceptions.

A Framework for Expectations of Physician Commitment in Long-Term Care Homes: A Consensus Statement.

Specialized education in psychiatric nursing is one of the key pillars for improving the quality of mental health services in different societies. This study aimed to review and compare the Master’s programs in psychiatric nursing in Iran and at King’s College London. The findings revealed that Iran’s psychiatric nursing program is relatively new and still in its developmental stage, focusing mainly on clinical care and the management of psychiatric patients. In contrast, King’s College London offers a program with a longer history and a more advanced structure, emphasizing research skills, clinical leadership, interprofessional education, and innovative teaching approaches such as evidence-based and collaborative learning. Significant differences were found in admission criteria, program duration, the balance between theory and practice, and evaluation tools. Drawing on successful international experiences could help enhance psychiatric nursing education in Iran, highlighting the need to adopt innovative teaching approaches, strengthen research and leadership, and ensure a balanced integration of theory and practice. The use of educational technologies and the creation of research opportunities for students are also crucial. Ultimately, the study underscores the importance of continuous revision and adaptation of educational programs to align with international standards while considering local contexts. Such reforms are essential for empowering psychiatric nurses and advancing mental health services. The results can serve as a guide for policymakers and nursing educators to improve the quality and effectiveness of graduate psychiatric nursing programs.

Enhancing the perceived clinical leadership competence of nursing undergraduates through service-learning unit led by students: A quasi-experimental study.

<p><strong><em>Background:</em></strong><em> Clinical leadership among nurse managers plays a vital role in ensuring the quality and effectiveness of hospital services. Nurse managers are responsible for integrating professional competence, managerial skills, and interpersonal collaboration to enhance patient outcomes and team performance. However, in Indonesia, there remains a lack of standardized and contextually relevant instruments to measure clinical leadership competencies.</em></p><p><strong><em>Objectives:</em></strong><em> This study aimed to develop and validate a clinical leadership competency assessment instrument specifically tailored to the Indonesian hospital context and to evaluate its feasibility for practical application in nursing management.</em></p><p><strong><em>Methods:</em></strong><em> The study employed a research and development design conducted in Tasikmalaya City. The sample consisted of 38 nurse managers selected through accidental sampling. The research process consisted of several stages: instrument design, expert validation, revision, and limited testing. Content validity was examined using the Content Validity Index to ensure conceptual and contextual relevance, while item validity and reliability were analyzed through appropriate statistical methods to ensure measurement accuracy and internal consistency. </em></p><p><strong><em>Results:</em></strong><em> The developed instrument included 49 items across five core dimensions: communication, collaboration, decision-making, team empowerment, and change management. Validation results showed a CVI of 0.86 (>0.80), and high reliability (Cronbach’s Alpha 0.950). Non-valid items were removed, resulting in a final instrument that is valid, reliable, and contextually appropriate for use by nurse managers.</em></p><strong><em>Conclusions:</em></strong><em> The instrument is valid, reliable, and feasible for assessing nurse managers’ clinical leadership competencies. Beyond its psychometric soundness, it provides a strategic framework to strengthen leadership accountability, improve team coordination, and enhance hospital service quality. The instrument can also serve as a valuable tool in hospital management and nursing education to guide professional development and promote evidence-based leadership practices</em>

Physician assistants/associates (PAs) were introduced into NHS secondary care facilities to help address workforce shortages in the UK. However, recent controversy and the government-commissioned Leng Review in England highlighted concerns around role clarity, supervision, and professional boundaries relating to PAs, largely due to inconsistent implementation and local variations. We examined how PA roles are developed and integrated in hospital teams across high-income countries, generating insights relevant to ongoing workforce reforms in the UK, including those recently recommended in England by the Leng Review. We conducted a realist review to explain how, why, and under what contexts PA roles are developed and integrated in secondary care. We systematically searched peer-reviewed studies from high-income settings and UK-specific grey literature (Jan 2000-March 2025). We extracted and synthesised data to develop context-mechanism-outcome configurations (CMOCs). We mapped history, regulation, and scope of practice in included countries to support contextual interpretation. We iteratively refined CMOCs to produce a final programme theory. We developed 56 CMOCs from 122 sources across nine high-income settings, which were synthesised into five inter-related themes: (1) organisational drivers, such as service design, workforce shortages, and policy reforms, created opportunities for new workforce models like introducing PA roles; (2) PAs' role and identity formation were shaped through time, supervision, and opportunities for meaningful, appropriately challenging work; (3) negotiation of professional boundaries revealed unclear or overlapping roles creating tensions, whereas well-defined, complementary roles reducing resistance; (4) role perceptions and acceptance from team members and patients depended on perceived value and relative advantages, also shaped by psychologically safe team cultures; and (5) evidence and impact were difficult to measure using standard metrics, which often overlooked PAs' contributions to teamwork and continuity, and role variations and methodological limitations constrained generalisability. Our findings offer a transferrable framework for understanding workforce innovations and new roles in complex health systems. We provide practical insights for hospital managers and clinical leaders in the NHS, including those in England who are implementing the reforms recommended by the Leng Review. Realist evaluations are needed to refine our programme theory and inform effective workforce changes.

Aims/Background Despite national frameworks outlining the four pillars of advanced practice (clinical practice, leadership and management, education, and research), engagement of Advanced Clinical Practitioners (ACPs) in the UK remains inconsistent, and significant challenges persist. This scoping review aimed to explore ACPs' engagement with each pillar and to identify both successful and challenging factors. Methods A scoping review was conducted following Arksey and O'Malley's framework in 2005 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken across five databases (CINAHL, MEDLINE, Scopus, PsycInfo, and Cochrane Library) and grey literature sources. The search covered studies published from 2017 to 2025, in line with the introduction of the Multi-professional Framework. A three-stage screening process was used to identify eligible studies, and data were extracted using a standardised form. Thematic analysis was employed to synthesise the findings. Results Thirty-three studies met the inclusion criteria. The review identified strong ACP engagement in clinical practice, including contributions to direct patient care, improved patient satisfaction, and reduced waiting times. However, engagement with the leadership, education, and research pillars was inconsistent and often limited by excessive workload, lack of protected time, and ambiguity in role definitions. Structural variation across National Health Service (NHS) trusts further contributed to disparities in advanced clinical practice role development and utilisation. Conclusion Advanced clinical practice roles are firmly embedded in clinical care but remain underutilised in leadership, research, and education. Addressing these disparities requires clearer career pathways, organisational investment, and structured policy support to enable ACPs to contribute fully across all four pillars of practice.

The Crucial Role of Loan Accessibility in Advancing HIV Care.

Psychiatry seems beleaguered: from underfunding of education, training, research and services to marginalisation within the healthcare world and even doubts about its relevance. Medical training, with advanced relational and formulation skills and a strong foundation of research, equips psychiatrists to exercise clinical leadership across the healthcare landscape. This expertise can and must be used to benefit patient care.

ABSTRACTAimTo understand Lead Tissue Viability Nurses' agency, autonomy and authority to perform their role.BackgroundLead Tissue Viability Nurses need both clinical autonomy and organisational authority to improve wound care, patient safety, and cost‐effectiveness. Their role goes beyond bedside care to include strategic decisions shaping policy, resources, and quality initiatives. Despite this, the role is often misunderstood and under‐recognised. This study, based on the four pillars of advanced nursing practice—clinical practice, education, research, and leadership—examines the challenges they face.DesignA qualitative study.MethodsInterviews with six Lead Tissue Viability Nurses working in large tertiary care organisations. A thematic analysis was undertaken.ResultsThe results aligned with the four pillars of advanced nursing practice. Six sub‐themes emerged, reflecting the skills, knowledge, and influences involved, and critically, the challenges faced in meeting role expectations: Clinical Practice—working with clinical specialties (a); Education—supporting generalist nurses (b); Leadership—collaborating with dressing companies (c) and national bodies (d); Research—partnering with clinicians (e) to implement national guidance (f).ConclusionOur study highlights the restricted agency that constrains their capacity to meet the complex demands of the role. Their specialised knowledge frequently remains unacknowledged and underutilised, while their contributions are often marginalised within organisational discourse. To attain the level of recognition commensurate with this senior nursing position, their distinct professional and organisational identity should be clearly articulated.Implications for the Profession and/or Patient CareLead Tissue Viability Nurses should be acknowledged for their advanced practice role, reflecting the specialist expertise and leadership they bring to patient care. Additionally, they must be granted the agency, autonomy and authority necessary to implement best practice.ImpactEnsuring that Lead Tissue Viability Nurses can execute their duties effectively and achieve high‐quality outcomes will directly influence patient care.Patient or Public ContributionNo patient or public contribution at this stage, as this study was about exploring the nurses' organisational role from their perspective.