Nurse Leader Role Research Articles

Instantiating informatics in nursing practice for integrated patient centred holistic models of care: a discussion paper.

A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. Discussion paper. A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models.

Nurse leader competencies: A toolkit for success.

In Brief By introducing two new nurse leader roles, redefining key competencies, and implementinga 2-year training program, this organization is ensuring its future nursing leadership pipeline.

Implementing the Clinical Nurse Leader Role: A Care Model Centered on Innovation, Efficiency, and Excellence

Nurses must become full partners with other healthcare disciplines to become involved and take responsibility for identifying system problems. Nurses devise and implement improvement plans, track improvements over time, and make necessary adjustments as leaders who implement change and help improve the healthcare system. 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington, DC2011 Google Scholar We are facing the dilemma of fragmented healthcare that can only be improved through “new innovative care delivery models…that address patient needs and wants, span sites of care, result in more efficient use of resources, and demonstrate measurable improvement in patient satisfaction and quality outcomes over time.” 2 Kimball B Joynt J Cherner D O'Neil E The quest for new innovative care delivery models. J Nurs Adm. 2007; 37: 392-398 Crossref PubMed Scopus (37) Google Scholar With the implementation of the clinical nurse leader (CNL) role, the innovation unit as developed at Rush Oak Park Hospital (ROPH) addresses current healthcare system concerns, such as the creation of more effective interdisciplinary care, point-of-care coordination, and the implementation of evidence-based practice findings. 3 Buerhaus P Ulrich B Donelan K DesRoches C Registered nurses' perspectives on health care and the 2008 presidential election. Nurs Econ. 2008; 26: 227-235 PubMed Google Scholar Nurses must become full partners with other healthcare disciplines to become involved and take responsibility for identifying system problems. Nurses devise and implement improvement plans, track improvements over time, and make necessary adjustments as leaders who implement change and help improve the healthcare system. 1 Institute of Medicine The Future of Nursing: Leading Change, Advancing Health. National Academies Press, Washington, DC2011 Google Scholar We are facing the dilemma of fragmented healthcare that can only be improved through “new innovative care delivery models…that address patient needs and wants, span sites of care, result in more efficient use of resources, and demonstrate measurable improvement in patient satisfaction and quality outcomes over time.” 2 Kimball B Joynt J Cherner D O'Neil E The quest for new innovative care delivery models. J Nurs Adm. 2007; 37: 392-398 Crossref PubMed Scopus (37) Google Scholar With the implementation of the clinical nurse leader (CNL) role, the innovation unit as developed at Rush Oak Park Hospital (ROPH) addresses current healthcare system concerns, such as the creation of more effective interdisciplinary care, point-of-care coordination, and the implementation of evidence-based practice findings. 3 Buerhaus P Ulrich B Donelan K DesRoches C Registered nurses' perspectives on health care and the 2008 presidential election. Nurs Econ. 2008; 26: 227-235 PubMed Google Scholar

Postgraduate nurses’ insights into the nursing leadership role. Do they intuitively link the role to patient safety?

800x600 Nursing leaders are compelled to ensure a safety and quality agenda in the acute care environment as patient outcomes are linked to nursing care. Good nursing leadership where focus is directed to accountability and responsibility for clinical outcomes and patient safety, results in reduced adverse events and patient mortality. Integral to the future of high-quality effective clinical care with an absence of errors is the training of the next generation of nursing leaders. In this discussion paper, the extent to which future nurse leaders intuitively acknowledge patient safety as part of their leadership role was examined amongst a cohort of postgraduate nursing students. A content analysis to search for quality and safety terminology was conducted on 146 essay responses to a question about the nurse leader role in today’s healthcare environment. The results indicated minimal acknowledgement of patient safety as an intuitive consideration in the nursing leadership role. Recommendations are discussed for developing postgraduate nursing educational curricula with patient safety strategies as a central component to the practice of leadership. Normal 0 false false false EN-AU X-NONE X-NONE MicrosoftInternetExplorer4

Academic Leadership Development: A Case Study.

A dean at a private school of nursing implemented a leadership development program for early- to mid-career nursing faculty consisting of one 4-hour evening session per academic quarter for 7 quarters. Eight faculty members who had expressed interest in assuming a leadership role or been recommended by their supervisors as having strong leadership potential were invited to join. Program topics included leadership pathways, legal issues, budgeting and governance, diversity, the political arena, human resources, and student issues. Interviews with participants revealed 6 themes: the support a peer cohort provided, a desire for real-life application, a lack of previous exposure to related content or experiences, new perceptions of themselves as academic nurse leaders, the value of the program as preparation for academic nursing leadership roles, and broad program applicability.

Identifying barriers to evidence-based practice adoption: A focus group study

Objectives: The promotion of evidence-based practice (EBP) to ensure that the best scientific evidence, clinician expertise, and patient advocacy are used in health care delivery is an important leadership role of advanced practice nurses. While there has been much progress in advancing EBP, there are many hospital systems in the United States and other parts of the world that have yet to integrate an EBP framework. A focus group study was conducted to examine nurse’s views relative to the adoption of EBP in a specific community hospital setting. Methods: Design: A focus group design was used. Setting: A Midwestern United States rural community hospital. Sample: Four nurse practitioners, three nurse administrators/managers, and eleven inpatient direct care nurses. Three focus groups were conducted. Data were analyzed using qualitative methodology. Results: Themes identified included institutional and/or cultural barriers, lack of knowledge, lack of motivation, time management, physician and patient factors, and limited access to up-to-date user-friendly technology and computer systems. Conclusions: Engaging a participatory approach, findings provide strategy to consider when developing programs to expose nurses to EBP and for the translation of current standards into clinical practice. Building infrastructure to sustain and support EBP via leadership; time provision; access and support for continuing education; and collaborative integration of team members will guide the development of clinical environments that promote EBP.

Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN

Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level. Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director.

Factors that lead Generation Y nurses to consider or reject nurse leader roles

ObjectiveThis study examined factors that lead Generation Y nurses to consider or reject nursing leadership roles. BackgroundAlmost half of the current nurse leaders in the country are expected to retire by the end of the decade. Generation Y will soon comprise 50% of the nursing workforce and organizations look to them to assume leadership roles. Learning how to effectively recruit, motivate and retain Generation Y nurse leaders will be critical to the future of nursing. MethodsThis was a qualitative study that used a ConCensus™ process approach to collect the themes and factors of importance to participants related to nursing leadership roles. Three focus groups were conducted during 2013 and 2014 with 32 Generation Y Registered Nurses, not currently in leadership positions and born on or after January 1st, 1981. Key findingsFeedback from current nurse leaders about their roles is primarily negative. The strongest incentive for Generation Y nurses to seek leadership roles is the potential to create meaningful change in healthcare. Fear of failure in the role and lack of work-life balance are significant deterrents to accepting a leadership role. ConclusionsGeneration Y nurses do see the value and importance of nursing leadership in making a difference in patient care but have concerns about the level of support that will be available to them as they assume these roles. Attention must be directed toward providing resources and strategies to develop skilled Generation Y nurse leaders in order to promote effective succession planning.

Better documentation improves patient care.

This article is the sixth in a series of seven describing the journey within NHS Lanarkshire in partnership with the University of the West of Scotland to support nursing and midwifery leadership roles through Scotland's Leading Better Care programme. Preceding articles have provided an overview of the programme and discussed a range of staff development work programmes. This article describes work carried out on clinical documentation to promote delivery of the three quality ambitions of safe, effective and person-centred care.

Healthcare Reform—A New Role for Changing Times: Embracing the Clinical Nurse Leader Role—A Strategic Partnership to Drive Outcomes

Healthcare Reform—A New Role for Changing Times: Embracing the Clinical Nurse Leader Role—A Strategic Partnership to Drive Outcomes

Get out of the office and on to the ward.

The draft NMC code spells out what is expected of nurses in leadership roles, including ensuring concerns are listened to and putting patient care first. Managers must also ensure staff have the skills, knowledge and competence for safe practice.

The effect of a nurse team leader on communication and leadership in major trauma resuscitations

BackgroundEffective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. AimTo assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. MethodsThe study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. ResultsCommunication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1–12.5%) in ‘intimidating personality’ as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved (P = 0.025). ConclusionTrauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes.

The value of registered nurses in collaborative family practice: enhancing primary healthcare in Canada.

With the current focus on improving efficiencies and quality of care within the Canadian healthcare system, primary healthcare (PHC) is receiving renewed attention. The time is right for highlighting the value that registered nurses (RNs) can bring to collaborative practice in primary care settings. This paper discusses the untapped utilization of RNs in primary care in Canada, arguing for a strong leadership role for nurses and citing examples of RN services that could enhance care and improve population health and cost-effectiveness. Internationally, other countries with strong PHC strategies in place offer potential lessons regarding features that could be adapted in Canada.

Carol Bradley, MSN, RN, CENP

Carol Bradley, MSN, RN, CENP, is the Senior Vice President and Chief Nursing Officer, Legacy Health System in Portland, Oregon. Legacy Health, based in Portland, Oregon includes 6 hospitals and a regional network of primary care clinics. The system employs 3,500 nurses and approximately 200 advanced practice nurses. This is Carol's third experience as a health system nurse executive, and she considers this to be her "destination job." Legacy Health is on the cutting edge of what is happening in healthcare. Oregon is a very progressive state in promoting healthcare access and is actively involved in care transformation. Within Legacy, all of the primary care clinics have adopted the health home model, and the organization has a strong orientation toward performance excellence and patient engagement. Among Carol's many professional contributions is her service as American Organization of Nurse Executives (AONE) president in 1999.

Transforming care through leadership and research alignment

Transforming care through leadership and research alignment

Interdisciplinary preceptor teams to improve the clinical nurse leader student experience.

The Clinical Nurse Leader (CNL) role was introduced by the American Association of Colleges of Nursing (AACN) in 2003 (AACN, 2003). There are now over 2,500 certified CNLs in the United States. Still some areas of the country have no CNLs in practice; this was true of north central Texas until May 2010 when Texas Christian University (TCU) had its first graduating class. Lack of CNLs to serve as preceptors for the practicum courses in the CNL program was one concern, although AACN does offer options when CNLs are not available. TCU's CNL teaching team developed the interdisciplinary preceptor team (IPT) model to strengthen the practicum component of CNL education at TCU. One advantage of the IPT model is the match it provides with several CNL competencies: lateral integration of care via interdisciplinary teams, member and leader of health care teams, skillful communication within teams, and implementation of an interdisciplinary approach to safe, quality, patient care. Components of the IPT model are discussed with specific information about preceptor selection, team development, and examples of feedback from preceptors and students.

Does nurse manager education really matter?

Does nurse manager education really matter?

The Academic Story: Introducing the Clinical Nurse Leader Role in a Multifacility Health Care System

Introducing the clinical nurse leader (CNL) role in a multifacility health care system is an exciting but obstacle-filled journey. This story includes facilitating factors, opportunities, and successes plus suggestions for other academic-practice partners considering implementing the CNL role. A sample course sequence with course descriptions is provided.

Discharge phone calls: using person-centred communication to improve outcomes

This article describes the Clinical Nurse Leader role in implementing person-centred care bundles to improve patient outcomes through an innovative culture of caring. Demonstrating the financial value of introducing the Clinical Nurse Leader role into an organisation is essential for sustainability. Previous authors have established the Clinical Nurse Leaders' influence on patient satisfaction and have suggested that Clinical Nurse Leaders improve the continuity of care after discharge. Descriptive data are shared to illustrate the effectiveness of implementing the patient care bundles and a Clinical Nurse Leader-driven discharge phone call process. Clinical Nurse Leaders who practise from a caring lens are uniquely situated to lead initiatives that drive person-centred care with the goal of reducing readmission rates. Patients who receive person-centred care have an improved perception of the hospital experience and are more likely to return to the facility. Clinical Nurse Leaders establish relationships with patients that increase the likelihood of successful outcomes from the discharge phone call process. Further evaluation of the Clinical Nurse Leader's role and potential impact on patient outcomes is warranted. Clinical Nurse Leaders are uniquely prepared to lead transformational change within an organisation. Clinical Nurse Leader interventions that are developed at the microsystem level in response to problems may have system-wide implications.

To investigate the concerns and benefits of job sharing a community based Clinical Nurse Consultant role

Objective: The purpose of this study was to identify concerns and benefits of job sharing the Clinical Nurse Consultant (CNC) Youth Health team role and how these impact on job sharing a nursing leadership role. Design: qualitative descriptive method was used in this study. Setting: Primary care. Subjects: The sample comprised of key stakeholders of the Youth Health care team including members of the multidisciplinary team and health care referrers to the Clinical Nurse Consultants as well as the Clinical Nurse Consultants whom share the role. Main outcome measures: Identification of needs required to assist in developing recommendations for nursing leadership job share models for a changing workforce in healthcare. Results: The study identified several themes needed to ensure successful job sharing of a leadership role: effective communication, compatibility, support, teamwork, mentoring and flexibility in care provision. Implementing systems that support and encourage these are necessary. Conclusion: Results suggest that concerns do exist for organisations when staff job share a leadership role. However, several key points can aid in successful job sharing for organisations and nurses as well as improved patient outcomes. These results should help nurses to develop and facilitate increased success for job sharing of leadership roles and contribute to the current need to be flexible in workforce models of nursing.