Advancing the clinical nurse leader model through academic-practice-policy partnership

Bender, Miriam; Baker, Patricia Sawyer; Harris, James L.; Hites, Lisle; LaPointe, Robert J.; Murphy, Elizabeth A.; Roussel, Linda; Spiva, LeeAnna; Stanley, Joan; Thomas, Patricia L.; Williams, Marjory

doi:10.1016/j.outlook.2019.02.007

Cited by 9 publications

(7 citation statements)

References 45 publications

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“…In terms of organization, it is a multisite study that builds on strong partnerships between the PI and the healthcare nursing community, meaning the study has been co‐developed collaboratively with health system leaders (whose health systems are sites for this study) to answer questions that are pertinent to both them and policy makers (Bender et al 2019 ). In terms of methods, we have explicitly chosen a research design and methods with the capacity to reflect and capture the dynamic interdependency of contextual factors in nursing practice.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Aims: Patients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. Registered Nurses are a recognized patient safety strategy. However, variability in research findings indicate the relationship is not as simple as "more nurses=better outcomes." Hence, currently there exists no evidence-based frontline nursing care model. One emerging model is the Clinical Nurse Leader care model. Design: This Hybrid Type II Implementation-Effectiveness study will evaluate the effect of the care model on standardized quality and safety outcomes and identify implementation characteristics that are sufficient and necessary to achieve outcomes. Methods: This study leverages a natural experiment in 66 clinical care units in nine hospitals across five states in the United States that have implemented the Clinical Nurse Leader care model. Results: Findings will elucidate Registered Nurse's mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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%

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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“…The literature has demonstrated the capacity of the CNL to improve health care quality in a variety of settings, from hospitals to clinics 3–8. In practice, CNLs have found themselves performing a variety of quality improvement, leadership, and care integration functions such as facilitating communication between interprofessional health care team members who would otherwise not communicate with each other, promoting utilization of human resources that would otherwise go unused, and working on solutions when the health care team recognizes a problem 9–11.…”

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confidence: 99%

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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Advancing the clinical nurse leader model through academic-practice-policy partnership

Cited by 9 publications

References 45 publications

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

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

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

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

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