Clinical Nurse Leader Integrated Care Delivery to Improve Care Quality: Factors Influencing Perceived Success

• Published in: Journal of nursing scholarship Vol. 48; no. 4; pp. 414 - 422
• Main Authors: Bender, Miriam, Williams, Marjory, Su, Wei, Hites, Lisle
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2016
• Subjects: Adult; Care delivery; Care delivery model; Case studies; Change agents; Clinical leadership; clinical nurse leader; Clinical nursing; Clinical outcomes; Critical care; Delivery of Health Care, Integrated - organization & administration; Education; effectiveness; Health care; Humans; implementation; Influence; Initiatives; Integrated care; Leadership; Middle Aged; Models, Nursing; Nurse Clinicians - psychology; Nurse Clinicians - statistics & numerical data; Nursing; Nursing administration; Nursing care; nursing care delivery; Nursing Evaluation Research; Ownership; Patient safety; Patients; Quality; Quality Improvement - organization & administration; Quality of care; Safety; Success; Young Adult; United States > US; California; effectiveness; clinical nurse leader; Care delivery model; implementation; nursing care delivery
• ISSN: 1527-6546; 1547-5069
• DOI: 10.1111/jnu.12217

Purpose Clinical nurse leaderTM (CNL)‐integrated care delivery is a new model for organizing master's‐level nursing clinical leadership at the microsystem level. While there is growing evidence of improved patient care quality and safety outcomes associated with CNL practice, organizational and implementation characteristics that influence CNL success are not well characterized. The purpose of this study was to identify organization and implementation factors associated with perceived success of CNL integration into microsystem care delivery models. Methods A survey was developed and administered to a nationwide sample of certified CNLs and managers, leaders, educators, clinicians, and change agents involved in planning or integrating CNLs into a health system's nursing care delivery model. Items addressed organizational and implementation characteristics and perceived level of CNL initiative success. Generalized linear modeling was used to analyze data. Results The final sample included 585 respondents. The final model accounted for 35% of variance in perceived CNL initiative success, and included five variables: phase of CNL initiative, CNL practice consistency, CNL instructor or preceptor involvement, CNL reporting structure, and CNL setting ownership status. Conclusions CNL initiative success is associated with modifiable organizational and implementation factors. Clinical Relevance Study findings can be used to inform the development of successful implementation strategies for CNL practice integration into care delivery models to improve care quality outcomes.