Behaviors and strategies in clinical leadership in nursing: scoping review
DOI:
https://doi.org/10.29352/mill0226.37839Keywords:
behavior; leadership; nursing; professional practice; peer research reviewAbstract
Introduction: Clinical leadership in nursing refers to the demonstration of informal leadership skills and behaviors by nurses in clinical practice. It contributes to the construction of innovative and structured healthcare models, which result in the continuous improvement of the quality of care and the satisfaction of health needs.
Objective: Mapping the scientific evidence on the behaviors of clinical nurse leaders and the strategies that promote clinical nursing leadership in healthcare organizations.
Methods: Scoping review according to the guidelines of the Joanna Briggs Institute. The search was completed in MEDLINE Complete, CINAHL Complete, Scopus, Web of Science, ProQuest and Repositório Científico de Acesso Aberto de Portugal. Primary studies published in Portuguese, English or Spanish were included.
Results: A total of 2407 records were identified, of which 24 were included in the review. 47 clinical leadership behaviors in nursing and 18 strategies to promote these behaviors were identified (strategies related to the nurse (n=3), the multi-professional team (n=5), the healthcare organization (n=8) and entities external to the healthcare organization (n=2)). Most of the behaviors are task-oriented (n=25), with behaviors related to clinical practice prevailing (n=18).
Conclusion: Leadership behaviors are associated with effective communication skills, decision making, clinical experience, support, mentoring, education and team building. Strategies should be defined to facilitate the development and enhancement of leadership behaviors in clinical practice.
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AL-Dossary, R. N., Kitsantas, P., & Maddox, P. J. (2016). Residency Programs and Clinical Leadership Skills Among New Saudi Graduate Nurses. Journal of Professional Nursing, 32(2), 152–158. https://doi.org/10.1016/j.profnurs.2015.10.004
Alilyyani, B., Althobaiti, E., Al-Talhi, M., Almalki, T., Alharthy, T., Alnefaie, M., Talbi, H., & Abuzaid, A. (2024). Nursing experience and leadership skills among staff nurses and intern nursing students in Saudi Arabia: a mixed methods study. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01750-1
Amestoy, S. C., Cestari, M. E., Buss Thofehrn, M., & Milbrath, V. M. (2009). Características que interferem na construção do enfermeiro-líder. Acta Paul Enferm, 22(5), 673–678. https://www.scielo.br/j/ape/a/qwBRmB7pVwZMKsDLHXHs6Zh/abstract/?lang=pt
Ashour, H., Banakhar, M., & Elseesy, N. (2022). Clinical leadership behaviors among critical care nurses in private and governmental hospital: A cross-sectional survey. International Journal of Nursing Sciences, 9(3), 357–363. https://doi.org/10.1016/j.ijnss.2022.06.017
Behrendt, P., Matz, S., & Göritz, A. S. (2017). An integrative model of leadership behavior. Leadership Quarterly, 28(1), 229–244. https://doi.org/10.1016/j.leaqua.2016.08.002
Bender, M., Spiva, L. A., Patrick, S., Meffert, S., Moton, L., Clarke, S., Mathis, K., Leclerc, L., Knotts, K., & Mount, A. (2019). Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory: A Participatory Research Approach. Journal of Nursing Care Quality, 34(4), 301–306. https://doi.org/10.1097/NCQ.0000000000000386
Burns, D. (2009). Clinical leadership for general practice nurses, part 1 - Perceived needs. Practice Nursing, 20(9), 466–460. https://research.manchester.ac.uk/en/publications/clinical-leadership-for-general-practice-nurses-part-1-perceived-
Cardiff, S., Gershuni, O., & Giesbergen‐Brekelmans, A. (2023). How local, first‐line nurse leaders can positively influence nurse intent to stay and retention: A realist review. Journal of Clinical Nursing, 32(19–20), 6934–6950. https://doi.org/10.1111/jocn.16813
Carney, M. (2009). Public health nurses perception of clinical leadership in Ireland: Narrative descriptions. Journal of Nursing Management, 17(4), 435–445. https://doi.org/10.1111/j.1365-2834.2009.01015.x
Carvalho, M., Gaspar, F., Potra, T., & Lucas, P. (2022). Translation, Adaptation, and Validation of the Self-Efficacy Scale for Clinical Nurse Leaders for the Portuguese Culture. International Journal of Environmental Research and Public Health, 19(14). https://doi.org/10.3390/ijerph19148590
Chávez, E. C., & Yoder, L. H. (2015). Staff Nurse Clinical Leadership: A Concept Analysis. Nursing Forum, 50(2), 90–100. https://doi.org/10.1111/nuf.12100
Connelly, L. M., Yoder, U. H., & Miner-Williams. (2003). A qualitative study of charge nurse competencies. MEDSURG Nursing, 12(5), 298–307. https://abrir.link/PDUaM
Cook, M. J., & Leathard, H. L. (2004). Learning for clinical leadership. Journal of Nursing Management, 12(6), 436–444. https://doi.org/10.1111/j.1365-2834.2004.00420.x
Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P. M., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115, 113. https://doi.org/10.1016/j.ijnurstu.2020.103842
De Kok, E., Janssen-Beentjes, K., Lalleman, P., Schoonhoven, L., & Weggelaar, A. M. (2023). Nurse leadership development: A qualitative study of the Dutch Excellent Care Program. Journal of Nursing Management, 2023, 1–11. https://doi.org/10.1155/2023/2368500
Duprez, V., Dhont, L., van der Cingel, M., Hafsteinsdóttir, T. B., & Malfait, S. (2023). Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15902
Elliott, N., Higgins, A., Begley, C., Lalor, J., Sheerin, F., Coyne, I., & Murphy, K. (2013). The identification of clinical and professional leadership activities of advanced practitioners: Findings from the Specialist Clinical and Advanced Practitioner Evaluation study in Ireland. Journal of Advanced Nursing, 69(5), 1037–1050. https://doi.org/10.1111/j.1365-2648.2012.06090.x
Grindel, C. G. (2016). Clinical Leadership: A Call to Action. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 25(1), 9–16. https://pubmed.ncbi.nlm.nih.gov/27044123/
Guibert‐Lacasa, C., & Vázquez‐Calatayud, M. (2022). Nurses’ clinical leadership in the hospital setting: A systematic review. Journal of Nursing Management, 30(4), 913–925. https://doi.org/10.1111/jonm.13570
Hart, P. L., Spiva, L., Baio, P., Huff, B., Whitfield, D., Law, T., Wells, T., & Mendoza, I. G. (2014). Medical-surgical nurses’ perceived self-confidence and leadership abilities as first responders in acute patient deterioration events. Journal of Clinical Nursing, 23, 2769–2778. https://doi.org/10.1111/jocn.12523
Higgins, A., Begley, C., Lalor, J., Coyne, I., Murphy, K., & Elliott, N. (2014). Factors influencing advanced practitioners’ ability to enact leadership: A case study within Irish healthcare. Journal of Nursing Management, 22(7), 894–905. https://doi.org/10.1111/jonm.12057
Holmgren, C., Jussèn, S., Hagiwara, M. A., & Rådestad, M. (2022). Charge nurses’ perceived experience in managing daily work and major incidents in emergency departments: A qualitative study. Australasian Emergency Care, 25(4), 296–301. https://doi.org/10.1016/j.auec.2022.02.003
Husebø, S. E., & Olsen, Ø. E. (2019). Actual clinical leadership: A shadowing study of charge nurses and doctors on-call in the emergency department. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1). https://doi.org/10.1186/s13049-018-0581-3
International Council of Nurses. (2017). Nurses´ role in achieving the sustainable development goals. https://icn.ch/sites/default/files/2023-05/IND_2017_Report_ENG.pdf
International Council of Nurses. (2019). Strategic Plan 2019-2023. www.icn.ch
Iraizoz-Iraizoz, A., García-García, R., Navarrete-Muro, A., Blasco-Zafra, A., Rodríguez-Beperet, A., & Vázquez-Calatayud, M. (2023). Nurses’ clinical leadership in the intensive care unit: A scoping review. In Intensive and Critical Care Nursing (Vol. 75). Churchill Livingstone. https://doi.org/10.1016/j.iccn.2022.103368
Isler, C., Maddigan, J., Small, S., Jarvis, K., & Swab, M. (2021). Strategies and interventions that foster clinical leadership among registered nurses: A scoping review protocol. JBI Evidence Synthesis, 19(10), 2839–2846. https://doi.org/10.11124/JBIES-20-00342
Jones, T. L. (2020). Self-Reported Leadership Practices among Frontline Medical-Surgical Nurses: An Exploratory Descriptive Study of Prevalence, Patterns, and Associated Factors. MEDSURG Nursing, 29(3), 159–169. https://www.proquest.com/docview/2410492113?sourcetype=Scholarly%20Journals
Lamb, A., Martin-Misener, R., Bryant-Lukosius, D., & Latimer, M. (2018). Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nursing Open, 5(3), 400–413. https://doi.org/10.1002/nop2.150
Mianda, S., & Voce, A. (2018). Developing and evaluating clinical leadership interventions for frontline healthcare providers: a review of the literature. BMC Health Services Research, 18(1), 747. https://doi.org/10.1186/s12913-018-3561-4
Mrayyan, M. T., Algunmeeyn, A., Abunab, H. Y., Kutah, O. A., Alfayoumi, I., & Khait, A. A. (2023). Attributes, skills and actions of clinical leadership in nursing as reported by hospital nurses: a cross-sectional study. BMJ Leader, 0, 1–9. https://doi.org/10.1136/leader-2022-000672
Mtsoeni, L., Matlala, S., & Downing, C. (2023). Newly qualified intensive care nurses’ lived experiences of being a shift leader in a private healthcare institution in Gauteng, South Africa. International Journal of Nursing Sciences, 10(3), 351–358. https://doi.org/10.1016/j.ijnss.2023.06.007
National Academies of Sciences, E. and Medicine. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. (M. K. Wakefield, D. R. Williams, S. Le Menestrel, & J. L. Flaubert, Eds.). National Academies Press. https://doi.org/10.17226/25982
Nursing and Midwifery Council. (2018). Future nurse: Standards of proficiency for registered nurses. www.nmc.org.uk
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71
Patrick, A., Laschinger, H., Wong, C., & Finegan, J. (2011). Developing and testing a new measure of staff nurse clinical leadership: The clinical leadership survey. Journal of Nursing Management, 19(4), 449–460. https://doi.org/10.1111/j.1365-2834.2011.01238.x
Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2024). Scoping reviews (2020). In E. Aromataris, C. Lockwood, K. Porritt, B. Pilla, & Z. Jordan (Eds.), JBI Manual for Evidence Synthesis. JBI. https://doi.org/https://doi.org/10.46658/JBIMES-24-09
Razavi, N. S., Gandomkar, R., Jafarian, A., & Jalili, M. (2022). Team Leadership Behaviors from the Viewpoints of Healthcare Team Members: A Qualitative Study. International Journal of Organizational Leadership, 11, 189–205. https://ijol.cikd.ca/article_60632_1b5fd5fa1b645b6fecf68fb7c116931e.pdf
Sherman, R. O., Schwarzkopf, R., & Kiger, A. J. (2011). Charge Nurse Perspectives on Frontline Leadership in Acute Care Environments. ISRN Nursing, 2011, 1–8. https://doi.org/10.5402/2011/164052
Simmons, S., Jacobs, S., & McKillop, A. (2020). Developing clinical leadership in New Zealand hospice staff nurses. International Journal of Palliative Nursing, 26(5), 200–205. https://pubmed.ncbi.nlm.nih.gov/32584689/
Singhal, S., Hosking, I., Ward, J., & Boyle, A. A. (2021). A Qualitative Study: What Do Nurses in Charge in Emergency Departments Do? Cureus. https://doi.org/10.7759/cureus.17912
Specchia, M. L., Cozzolino, M. R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership styles and nurses’ job satisfaction. Results of a systematic review. International Journal of Environmental Research and Public Health, 18(4), 1–15. https://doi.org/10.3390/ijerph18041552
Stanley, D. (2006a). In command of care: Clinical nurse leadership explored. Journal of Research in Nursing, 11(1), 20–39. https://doi.org/10.1177/1744987106059458
Stanley, D. (2006b). Recognizing and defining clinical nurse leaders. British Journal of Nursing, 15(2), 108–111. https://pubmed.ncbi.nlm.nih.gov/16493288/
Stanley, D., & Stanley, K. (2018). Clinical leadership and nursing explored: A literature search. Journal of Clinical Nursing, 27(9–10), 1730–1743. https://doi.org/10.1111/jocn.14145
Supamanee, T., Krairiksh, M., Singhakhumfu, L., & Turale, S. (2011). Preliminary clinical nursing leadership competency model: A qualitative study from Thailand. Nursing and Health Sciences, 13(4), 433–439. https://doi.org/10.1111/j.1442-2018.2011.00649.x
Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., … Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/10.7326/M18-0850
van Dongen, L. J. C., & Hafsteinsdóttir, T. B. (2022). Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study. Journal of Clinical Nursing, 31, 3414–3427. https://doi.org/10.1111/jocn.16168
van Kraaij, J., van Oostveen, C., Vermeulen, H., Heinen, M., Huis, A., Adriaansen, M., & Peters, J. (2020). Nurse practitioners’ perceptions of their ability to enact leadership in hospital care. Journal of Clinical Nursing, 29, 447–458. https://doi.org/10.1111/jocn.15105
Watson, S. M., Ferrillo, H., Goncalves, S. A., & Clark-Burg, K. (2021). Understanding clinical leadership behaviors in practice to inform baccalaureate nursing curriculum: A comparative study between the United States and Australia novice nurses. International Journal of Nursing Education Scholarship, 18(1). https://doi.org/10.1515/ijnes-2021-0021
Wei, H., King, A., Jiang, Y., Sewell, K. A., & Lake, D. M. (2020). The Impact of Nurse Leadership Styles on Nurse Burnout: Nurse Leader, 18(5), 439–450. https://doi.org/10.1016/j.mnl.2020.04.002
World Health Organization. (2021). Global strategic directions for nursing and midwifery. World Health Organization.
Xu, X., Zhang, Y., Zhou, P., & Zhou, X. (2022). Developing a leadership and management competency framework for nurse champion: A qualitative study from Shanghai, China. Journal of Nursing Management, 30(4), 962–972. https://doi.org/10.1111/jonm.13580
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