A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader Care Model in improving quality and safety outcomes

Bender, Miriam; Williams, Marjory; Cruz, Maricela; Rubinson, Claude

doi:10.1002/nop2.910

Cited by 4 publications

(6 citation statements)

References 44 publications

(54 reference statements)

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“…However, the findings do reflect and expand on findings in other CNL studies, suggesting its continued relevance. To address this limitation, our current research involves a Hybrid Type II Implementation-Effectiveness study that leverages a natural experiment in 66 CNL-integrated clinical units in 9 hospitals across the country and will evaluate the effect of the CNL care model on standardized quality and safety outcomes and implementation characteristics that are sufficient and necessary to achieve outcomes 13…”

Section: Discussionmentioning

confidence: 99%

“…12 This known CNL implementation variation has not been explicitly addressed in research to establish the conditional links between CNL care model structures, processes, and outcomes. 13 The validated CNL Practice Model identifies 5 major domains of CNL practice: (a) Readiness for CNL-integrated care delivery (Readiness); (b) Structuring CNL-integrated care delivery (Structuring); (c) CNL practice: continuous clinical leadership (Practice); (d) Outcomes of CNLintegrated care delivery (Outcomes); and (e) Value of CNL practice (Value). [14][15][16] Each domain has distinct components, meanings, and potential positive and negative effects on CNL practice.…”

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confidence: 99%

“…However, other research has demonstrated variability in CNL implementation (eg, who CNLs report to) that influenced the consistency of CNL practice and outcomes 12. This known CNL implementation variation has not been explicitly addressed in research to establish the conditional links between CNL care model structures, processes, and outcomes 13…”

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confidence: 99%

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Factors Influencing Implementation Success of the Clinical Nurse Leader Care Delivery Model

Bender

Williams

Chandler

2023

Journal of Nursing Care Quality

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Background:The clinical nurse leader (CNL) care model has existed since 2007. However, there is limited understanding how the model can best be implemented. Purpose: A validated CNL Practice Survey measuring domains theorized to influence CNL implementation was used to examine the link between CNL domains and CNL implementation success. Methods: Mixed methods were used to analyze data from a nationwide 2015 survey administered to clinicians and administrators involved in CNL initiatives. Results: Of total respondents (n = 920), 543 (59%) provided success scores, with 349 (38%) providing comments. Respondents with negative comments gave significantly lower average CNL success scores. The majority of negative comments mapped onto Readiness and Structuring domains, providing details of barriers to CNL implementation success. Conclusions: Findings provide information about structural domains that can be strategically targeted to better prepare settings for CNL implementation and success.

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Section: Discussionmentioning

confidence: 99%

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Factors Influencing Implementation Success of the Clinical Nurse Leader Care Delivery Model

Bender

Williams

Chandler

2023

Journal of Nursing Care Quality

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“…To help overcome these gaps in knowledge, a national level (United States) program of research on CNL practice was launched with the goal of producing a robust evidence base for CNL-integrated care delivery (Bender et al, 2018(Bender et al, , 2021Bender, Baker, et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…To date, little has been published on organizational factors associated with, or necessary for, successful CNL practice integration (Williams & Bender, 2015). To help overcome these gaps in knowledge, a national level (United States) program of research on CNL practice was launched with the goal of producing a robust evidence base for CNL‐integrated care delivery (Bender et al, 2018, 2021; Bender, Baker, et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Clinical Nurse Leader implementation success across a national sample of settings: A Bayesian multilevel modeling analysis

Williams,

Coppin,

Bender

2023

J of Nursing Scholarship

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IntroductionThe Clinical Nurse Leader (CNL) care model is a different way of organizing frontline nursing care delivery in contrast to the traditional “staff nurse” model and is increasingly being adopted by health systems across the United States and abroad. However, variability in implementation and outcomes has been noted across health settings.AimA recently validated CNL Practice Model provides an explanatory pathway for CNL model integration into practice. The purpose of this study was to identify and compare patterns of empirical correspondence to the CNL Practice Model and predict their influence on implementation success.MethodsWe conducted a secondary analysis of a 2015 national‐level study with clinicians and administrators involved with CNL initiatives in their health system. A psychometrically validated CNL Practice Survey was used to collect data measuring the presence (0%–100%) of the five domains of the CNL Practice Model (organizational readiness, CNL structuring, CNL practices, outcomes, and value) and one measure of CNL implementation success. We modeled the complex hierarchical structure of the data using a Bayesian multilevel regression mixed modeling approach. A zero–one‐inflated beta distribution, a mixture of Bernoulli distributions for the minimum and maximum responses and a beta distribution for the responses between the minimum and maximum, was used to fit success ratings in the model.ResultsA total of 920 participants responded, 540 (59%) provided success scores. The model captured ratings skewed toward upper bound, while also adequately modeling data between the minimum and maximum values. The Bayesian model converged and gave estimates for all hierarchical parameters, which would likely have failed to converge in a pure maximum likelihood framework. The variability around success score across CNL Practice Model element ratings was greatest at the component level, 0.29 (0.18–0.48), compared to either the domain level, 0.16 (0.01–0.54), or the item level, 0.09 (0.01–0.17). The components most predictive of implementation success were (a) consensus CNL model can close gaps, (b) organization level implementation strategy, and (c) alignment of empirical CNL microsystem level structuring to the model's conceptualization.ConclusionsFindings provide further empirical evidence to support the explanatory pathway proposed by the CNL Practice Model and identified specific organizational readiness and CNL workflow structures that are critical antecedents predictive of CNL practice manifestation and production of expected outcomes. Findings indicate actionable implementation evidence that can be successfully adopted across real‐world healthcare settings to achieve safer and higher quality patient care.Clinical RelevanceCNL integrated care delivery is a frontline nursing care model that is being increasingly adopted by health systems across the United States and abroad. However, variability in CNL implementation and outcomes has been noted across health settings, limiting its evidence base. Findings of this study contribute a better understanding about the variability of CNL practice and outcomes found in the literature and contribute empirical and conceptual clarity about the relationships between modes of CNL implementation and successful adoption in healthcare settings.

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Describing a programme of implementation‐effectiveness research on the organization and implementation of frontline nursing care delivery into diverse health systems

Bender,

Williams

2024

Journal of Advanced Nursing

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AimsThe longitudinal programme of research described in this paper seeks to generate knowledge about factors influencing the implementation of a system‐level intervention, the clinical nurse leader care model, involving nurses as leaders at the frontlines of care and the outcomes achievable with successful implementation. The research programme has the following aims, (a) to clarify clinical nurse leader practice, (b) develop and empirically validate a translational model of frontline care delivery that includes clinical nurse leader practice and (c) delineate the patterns of and critical outcomes of successful implementation of the clinical nurse leader care model.DesignThis programme of research follows a knowledge‐building trajectory involving multiple study designs in both qualitative (grounded theory, case study) and quantitative (descriptive, correlational and quasi‐experimental) traditions.MethodsMultiple mixed methods within a system‐based participatory framework were used to conduct this programme of implementation–effectiveness research.ResultsFindings are demonstrating how the clinical nurse leader care model, as a complex system‐level intervention, can be implemented in diverse healthcare contexts to make a difference to patient care quality and safety. Findings also contribute to implementation science, helping to better understand the dynamic interdependencies between implementation, the interventions implemented and the contexts in which they are implemented.ConclusionFindings translate into sets of evidence‐informed implementation ‘recipes’ that health systems can match to their specific contexts and needs. This allows health systems to take on strategies that both maximize resource impact within their existing structures and support achieving intended outcomes.ImplicationThis programme of research is producing actionable implementation and outcome evidence about ways to organize nursing knowledge and practice into care models that can be successfully adopted within real‐world healthcare settings to achieve safer and higher quality patient care.

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A study protocol to evaluate the implementation and effectiveness of the Clinical Nurse Leader Care Model in improving quality and safety outcomes

Cited by 4 publications

References 44 publications

Factors Influencing Implementation Success of the Clinical Nurse Leader Care Delivery Model

Factors Influencing Implementation Success of the Clinical Nurse Leader Care Delivery Model

Predictors of Clinical Nurse Leader implementation success across a national sample of settings: A Bayesian multilevel modeling analysis

Describing a programme of implementation‐effectiveness research on the organization and implementation of frontline nursing care delivery into diverse health systems

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