Developing a Clinical Nurse Leader Practice Model: An Interpretive Synthesis
Objective: The Institute of Medicine's Future of Nursing report identifies the Clinical Nurse Leader (CNL) as an innovative and necessary new role for meeting higher healthcare quality standards. The American Association of Colleges of Nursing CNL White Paper defines core competencies necessary for practice. The literature documents preliminary evidence of improved outcomes associated with CNL integration into clinical microsystems. However, the CNL role is not yet clearly defined in terms of fundamental activities and responsibilities necessary to produce outcomes. Lack of practice clarity limits the ability to articulate, implement, and measure CNL-specific practice and outcomes. The purpose of this study was to clarify CNL practice components contributing to improved quality care standards. Methods: An interpretive synthesis was conducted to integrate the extant CNL literature into a coherent understanding of CNL practice. A literature search was conducted in CINAHL, Pubmed, Dissertations and Theses, and Google. Results were reviewed and included if they described aspects of CNL practice in action. Thirty implementation reports, eight qualitative/mixed methods studies, three quantitative studies, and 254 conference abstracts were included. Grounded theory methodology was utilized to reanalyze primary CNL evidence and identify domains and components of CNL practice. Results: CNL practice encompasses five domains: Preparation for CNL Practice; the Structure of CNL Practice; the Core Phenomenon of CNL Practice - Continuous Leadership at the Point-of-Practice; Outcomes of CNL Practice; and Acceptance. These domains interact to produce the structure, function, and outcomes of CNL practice. The core phenomenon of CNL practice involves developing relationships across professions to promote and manage information exchange, shared decision-making, and effective care processes. The model highlights the importance of a systematic approach to CNL development and implementation: the extent to which each domain is adequately addressed influences the degree of CNL success. Conclusions: This study advances understanding of the CNL by synthesizing an empirically derived CNL Practice Model that clarifies practice components and differentiates them from existing nursing roles and practices. The model provides a guideline to organizations wanting to implement the CNL. It also provides a basis for future research identifying quantifiable measures of CNL practice and CNL-specific influence on outcomes.
Clinical Nurse Leader, information exchange, interpretive synthesis, nursing, practice model, shared decision-making
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