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ABSTRACT Aims Design Method Results Conclusion Implications for the Profession Impact Patient or Public Contribution What Does This Paper Contribute to the Wider Community? Reporting Method Trial and Protocol Registration This study aims to describe the exercise of clinical leadership by nurses within hospital care units, identify the factors influencing it and explore how nurses perceive its impact.Qualitative multiple case study.The study involved 36 interviews, 120 h of observation and documentary analyses with nurses across various roles within three nursing teams to capture collective leadership. Thematic and cross‐case analyses were also conducted.Nurses' clinical leadership was manifested in five distinct forms, irrespective of their role: (1) initiating actions involving reflective thinking and intervention, (2) influencing others through coaching, (3) actively participating in and mobilising efforts to enhance the quality of care, (4) fostering optimal synergy and team cohesion, and (5) leveraging personal and collaborative capacities. Factors influencing this leadership included clinical, human and material resources, time, a work environment that promotes autonomy and a positive work climate. Nurses perceived their leadership as having a positive impact on patients, themselves, the interdisciplinary team and the organisation. These findings were integrated into a modellisation of the exercise of nurses' clinical leadership based on Le Moigne's (La Théorie du Système Général. Théorie de la Modélisation. Paris: Presses Universitaires de France, 2006) philosophical approach.This study provides a perspective on nurses' collective clinical leadership in hospital care units, emphasising its leverage effect and the achievement of positive impacts. The proposed model serves as a valuable tool for nurse managers to better understand and support the exercise of clinical leadership.The model can guide nurse managers in supporting clinical leadership within teams, assist individual nurses in associating clinical leadership with their practice and assist with mobilising their leadership skills. This study explores how nurses across various roles within a hospital care unit exercise clinical leadership. The findings reveal five active forms of nurses' clinical leadership, perceived by nurses to positively impact patients, the interdisciplinary team and the organisation. Nurses and managers can use these five forms to foster a collective approach to clinical leadership. None. This study introduces an innovative model for understanding and promoting nurses' clinical leadership. It provides insights into the positive impact of this leadership approach and the significance of promoting it. Standards for Reporting Qualitative Research [SRQR] (O'Brien et al. Academic Medicine, 89, 2014 and 1245).Not registered [ABSTRACT FROM AUTHOR]

Aims: This study aimed to analyse nurses' perceptions of clinical leadership needs and compare their differences based on the sample's characteristics. Also, it aimed to compare nurses' perceptions of clinical leadership needs between nurses and nurse managers. Background: Various professional organisations have identified the need to develop clinical leaders. Clinical leadership is about having clinical expertise in specialised fields and having professionals involved in clinical care. However, worldwide, little emphasis is placed on the clinical leadership needs of nurses. Methods: Using STROBE (https://www.strobe‐statement.org/index.php?id=available‐checklists), a cross‐sectional study was conducted in 2020 using a purposive sample of 349 Jordanian nurses who were surveyed using the CLeeNA instrument. Different descriptive and inferential statistics were used to analyse the data. The response rate in the current study was 69.8%. Results: The 7‐point CleeNa scale was reduced into 3 categories 1 = "not important (1–3)," 2 = "Neutral (4)" and 3 = "highly important (5–7)." The total mean score of perceived CleeNa was 2.61(SD = 0.50) indicating "very important." The highest perceived mean score of the subscales was for "leadership and clinical practice." In contrast, the lowest perceived mean score of the subscales was "financial and service management." The total mean scores of perceived CleeNa were higher among married nurses, nurse managers, those who have a master degree or more, aged 35 years or more, had more than 4 years of nursing experience or/and more than 4 years of leadership experience, supervised more than 10 employees and were working in teaching hospitals. The total mean scores of perceived CleeNa scale and subscales of staff and team development, patient safety and risk management, and perceived standards of care were higher among nurse managers when compared with nurses. Conclusion and relevance to clinical practice: Results indicated that innovative clinical leaders are needed. A paucity of research identifies the extent to which clinical leadership is enacted in clinical nursing practice. Developing a clinical leadership programme is warranted to contribute positively to nurses' leadership roles and outcomes, patients' outcomes, and in turn, organisational outcomes. [ABSTRACT FROM AUTHOR]

Aim & Objective: Explore leadership self‐perception of clinical nurses at the bedside and their perception of leadership on patient care and outcomes. Background: According to Institute of Medicine Future of Nursing Report, nurses are called to exhibit leadership at every level. Published research on nursing leadership is primarily focused on formal leaders. Research examining leadership at the clinical nurse level has either tested application of a particular leadership model or studied nurses who have been identified as informal clinical leaders. We took an inductive approach without any prior knowledge if participating clinical nurses viewed themselves as leaders. Design: Descriptive qualitative method was used. Methods: Four focus groups were conducted with a total of 20 clinical nurses from 2 hospitals within an integrated health system using a convenience sampling method until saturation was reached. The Consolidated criteria for Reporting Qualitative research (COREQ) was used to report findings. Results: All participants identified qualities they admired in leaders. Fifty percent did not initially view themselves as leaders until they realised that they often demonstrated those same leadership qualities in providing nursing care to patients and families. Participants struggled to make a connection between their leadership at the bedside and patient outcomes. Conclusions: Clinical nurses assume a formal title is required to be a leader. Findings from this study imply that leadership attributes required at point of care are embedded in the nursing practice and look similar to servant leadership. Relevance to clinical practice: Leadership is in the nature of nursing practice, and more work is required to increase awareness that every nurse is a leader. Further efforts need to be pursued to help clinical nurses become self‐aware they are leaders in order to impact patient outcomes and transform health care from bottom‐up and inside‐out. [ABSTRACT FROM AUTHOR]

Aims and objectives: To increase knowledge about experienced nurses' understanding of a health‐promoting work environment, health‐promoting leadership and its role in retention of staff in the nursing workplace. Background: The quality of leadership is imperative in creating supportive and health‐promoting work environments to ensure workforce productivity and ethically sustainable caring cultures. More knowledge on how leaders can promote health and sustainable careers among nurses is needed. At a time of current and projected nursing shortage, it is important to understand the reasons why nurses intend to remain in their jobs. Design: Qualitative descriptive. Method: Twelve experienced registered nurses participated in an individual, digitally recorded, semi‐structured interview. Data were transcribed verbatim and subjected to qualitative content analysis of manifest and latent content. Results: A health‐promoting work environment should provide autonomy, participation in decision‐making, skills development and social support. Health‐promoting leaders should be attentive and take action. Conclusion: Health‐promoting work environments enable nurses to flourish. Having ample autonomy is therefore important to nurses so that when they face new challenges, they see them as a way of using and developing their competencies. Although most nurses claim their own leaders are not health promoting, they have a clear understanding of how a health‐promoting leader should act. The health‐promoting leader should not only be attentive and promote skills development, but also cater for nurses' meaningfulness. Relevance to clinical practice: Nurses in primary health care understand a health‐promoting work environment to be a workplace where they can develop, not only clinical skills, but also flourish as human beings. Further, nurses find it health promoting to have a meaningful job, using their competence to make a difference for patients and their families. Nurse Managers have an important role in facilitating meaningfulness in nurses' jobs to retain nurses as a valuable asset for the organisation. [ABSTRACT FROM AUTHOR]

Background: Clinical leaders drive healthcare performance in the provision of safe, high‐quality patient care by influencing others and augmenting change. Clinical leadership features strongly in nurse consultant roles and holds potential to strengthen the nurse consultant's place in healthcare teams, making their contribution as clinical leaders more recognisable. This study explores how clinical leadership is enacted through the nurse consultant role, providing understanding of the elements that influence their effectiveness as clinical leaders. Design: This study presents qualitative findings from a larger sequential mixed‐method study conducted in a large Local Health District in New South Wales, Australia. Methods: Focus groups were held with nurse consultants, managers and other stakeholders from a variety of context including acute, primary and community care settings across metropolitan and rural locations. An online discussion forum was provided for nurse consultants unable to attend focus groups. Transcript data were analysed using iterative theming techniques. Results: A total of 26 nurse consultants, 20 managers and 16 other stakeholders participated in focus groups and 22 nurse consultants contributed to the discussion forum. The role of the nurse consultant as clinical leader was a dominant feature, manifested through the following four themes: knowing and being known, being a collaborator, being a utility player and working across and within. Conclusions: Nurse consultants are cogent clinical leaders, recognised and valued for their contribution to interprofessional teams and service delivery. The nurse consultant role is seen as having a broad sphere of influence and is able to action change through clinical leadership. Relevance to clinical practice: Findings give organisational leaders and other healthcare professional's greater understanding of nurse consultants as clinical leaders. This informs how nurse consultants are appointed and positioned and how they can be supported in fulfilling their clinical leadership potential. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore what we know of the concept of clinical leadership and what the term means. Clues to the definition of clinical leadership, the attributes of effective and less effective clinical leaders, models of clinical leadership and the barriers that hinder clinical leadership development were explored. Background: While nursing leadership and healthcare leadership are terms that have been evident in nursing and health industry literature for many decades, clinical leadership is a relatively new term and is may still be misunderstood. Design: A search was undertaken of formal and informal literature using a library database and a range of search engines for the words “clinical leadership” and “clinical leadership in nursing.” In each case, the full search parameters were employed with searches between 1974–2016. Full‐text articles were requested, and English was the preferred language. Results: In total, 3,259 publications were located through seven database search tools, although these included a large number of duplications. Following further informal searches and removing irrelevant material, 27 research or literature review focused papers were retained that included 17 qualitative studies, one quantitative study, one mixed method study, one Delphi study and two that compared other research studies. As well, five literature reviews were retained in the synthesis. The data synthesis resulted five categories: definitions of clinical leadership, characteristics most likely or least associated with clinical leadership, models applied to clinical leadership and limits to clinical leadership development. Conclusion: Clinical leaders are recognised for having their values and beliefs parallel their actions and interventions. They are found across the spectrum of health organisations, often at the highest level for clinical interaction, but not commonly at the highest management level in a ward or unit team and they are seen in all clinical environments. Relevance to clinical practice: Clinical Leadership and an understanding on how clinical leaders contribute to the health service is central to the application of values‐based practice and how clinical leaders impact on innovation, change and making care better. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore how clinical leaders enact aesthetic leadership in clinical nursing workplaces. Background. Clinical leadership is heralded as vital for safe and effective nursing. Different leadership styles have been applied to the clinical nursing workplace over recent years. Many of these styles lack an explicit moral dimension, instead focusing on leader qualities and developing leader competence around team building, quality and safety. Aesthetic leadership, with its explicit moral dimension, could enhance clinical leadership effectiveness and improve nursing workplaces. How aesthetic leadership is enacted in clinical nursing settings requires exploration. Design. A qualitative design, employing conversation-style interviews with experienced registered nurses and written responses gathered from an online descriptive survey. Methods. Narrative data were gathered from interviews with 12 registered nurses and written accounts from 31 nurses who responded to an online survey. Together, transcribed interview data and the written accounts were subject to thematic analysis. Results. Three main themes emerged: Leading by example: 'be seen in the clinical area'; Leading with composure: 'a sense of calm in a hideous shift'; and Leading through nursing values: 'create an environment just by your being'. Conclusions. Aesthetic leadership was shown to enhance clinical leadership activities in the nursing workplace. The capacity for clinical leaders to be self-reflective can positively influence the nursing workplace. It was apparent that clinical leader effectiveness can be enhanced with nursing values underpinning leadership activities and by being a visible, composed role model in the clinical workplace. Relevance to clinical practice. Aesthetic leadership can enhance clinical nursing workplaces with its explicit moral purpose and strong link to nursing values. Clinical leaders who incorporate these attributes with being a visible, composed role model have the capacity to improve the working lives of nurses across a range of clinical settings. [ABSTRACT FROM AUTHOR]

Aims and objectives This paper reports the results of an online descriptive survey that sought to determine nurses' perceptions of aesthetic leadership among clinical leaders in nursing. Background Clinical leadership has been identified as an essential component to ensuring the delivery of safe, high-quality health care. Leadership has been increasingly linked in the literature to aesthetics. However, little consideration has been given to aesthetics in relation to clinical leadership in nursing. Design A mixed-method, online descriptive survey. Methods Participants were recruited via e-learning platforms and social media. A total of 66 surveys were completed, including 31 written accounts of aesthetic leadership in practice. Results Aesthetic leadership characteristics in clinical leaders most valued are support, communication and the approach taken to colleagues. Taking risks and challenging processes were least likely to be evident among effective clinical leaders. Conclusion Aesthetic leadership is multi-dimensional and a style of leadership to positively influence the clinical workplace. Support, effective communication and taking into consideration the feelings of colleagues are important dimensions of aesthetic leadership. Relevance to clinical practice Aesthetic leadership represents a way for clinical leaders to create and sustain a calm and positive clinical workplace. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore how aesthetic leadership is embodied by clinical leaders in the nursing workplace. Background A number of different leadership styles have been developed, theorised and applied to the nursing workforce over the years. Many of these styles lack an explicit moral dimension in their identified leader attributes, due to a shift in theorising of leadership to focus on the impact of leader traits on followers. It is timely to look at aesthetic leadership, with its explicit moral dimension, as a way of improving outcomes for nurses, patients and health care organisations. Design Qualitative design, using conversation-style interviews with experienced registered nurses in designated clinical leadership roles. Methods Twelve experienced registered nurses who worked in designated clinical leadership roles participated in an individual, digitally recorded, semi-structured conversation-style interview. Narrative data were transcribed and subject to thematic analysis. Findings Three main themes emerged: 'True to their beliefs': embodying principled practice; ' Not all policies fit every patient': ethical leadership in ambiguous situations; and ' Being open to people's concerns': providing fair and just solutions. A strong moral compass shaped and guided participants' day-to-day clinical leadership activities. Conclusions Participants provided a rich narrative on how aesthetic leadership is embodied in the clinical nursing setting. It was evident that their clinical leadership is shaped and guided by a strong moral compass. By incorporating into their practice an aesthetic world-view with its strong moral purpose, participants in this study have shown how aesthetic leadership can enhance the clinical nursing workplace. Relevance to clinical practice Nurses in the clinical setting value clinical leaders who embrace and operate with a strong moral compass. Aesthetic leadership, with its explicit strong moral purpose, offers a way of incorporating morality into clinical leadership in the nursing workplace. [ABSTRACT FROM AUTHOR]

Aims and objectives To determine whether a formal mentoring programme assists nurse practitioner candidates to develop competence in the clinical leadership competencies required in their advanced practice roles. Background Nurse practitioner candidates are required to show evidence of defined clinical leadership competencies when they apply for endorsement within the Australian health care system. Aiming to assist the candidates with the development or enhancement of these leadership skills, 18 nurse practitioner candidates participated in a mentoring programme that matched them with senior nurse mentors. Design A pre-postlongitudinal intervention study. Method Eighteen nurse practitioner candidates and 17 senior nurses participated in a voluntary mentoring programme that incorporated coaching and action learning over 18 months in 2012 and 2013. Participants completed a pen and paper questionnaire to document baseline measures of self-reported leadership practices prior to commencement of the programme and again at the end of the programme. Results The mentors and the nurse practitioner candidates qualitatively evaluated the programme as successful and quantitative data illustrated significant improvement in self-reported leadership practices among the nurse practitioner candidates. In particular, the nurse practitioner candidates reported greater competence in the transformational aspects of leadership, which is directly related to the nurse practitioner candidate clinical leadership standard. Conclusions A formal, structured mentoring programme based on principles of action learning was successful in assisting Australian advanced practice nurses enhance their clinical leadership skills in preparation for formal endorsement as a nurse practitioner and for success in their advanced practice role. Relevance to clinical practice Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in their transition to new roles. [ABSTRACT FROM AUTHOR]

Aims and objectives To evaluate mentoring, coaching and action learning interventions used to develop nurses' and midwives' clinical leadership competencies and to describe the programme participants' experiences of the interventions. Background Mentoring, coaching and action learning are effective interventions in clinical leadership development and were used in a new national clinical leadership development programme, introduced in Ireland in 2011. An evaluation of the programme focused on how participants experienced the interventions. Design A qualitative design, using multiple data sources and multiple data collection methods. Methods Methods used to generate data on participant experiences of individual interventions included focus groups, individual interviews and nonparticipant observation. Seventy participants, including 50 programme participants and those providing the interventions, contributed to the data collection. Results Mentoring, coaching and action learning were positively experienced by participants and contributed to the development of clinical leadership competencies, as attested to by the programme participants and intervention facilitators. Conclusions The use of interventions that are action-oriented and focused on service development, such as mentoring, coaching and action learning, should be supported in clinical leadership development programmes. Being quite different to short attendance courses, these interventions require longer-term commitment on the part of both individuals and their organisations. Relevance to clinical practice In using mentoring, coaching and action learning interventions, the focus should be on each participant's current role and everyday practice and on helping the participant to develop and demonstrate clinical leadership skills in these contexts. [ABSTRACT FROM AUTHOR]