Emergence of informal clinical leadership among bedside nurses in the acute care clinical setting: A mixed methods study

Abstract

Quality and safety initiatives direct all nurses to lead practice change. Existing nurse leadership research predominantly focuses on formal nursing leaders and overlooks a critical resource pool: informal leaders at the point of care. This study explored influences on the emergence of informal clinical leadership among bedside nurses in the acute care hospital setting. Nurse personal attributes (demographic characteristics, professional experience, and psychological capital) and situational context in the acute care workplace setting were examined as predictors of clinical leadership behavior. The study used a convergent parallel mixed methods design with an exploratory correlational quantitative strand and a descriptive qualitative strand.

A convenience sample of 134 nurses (mean age = 35.62 years, 94% female, 81% white, 85% BSN-prepared) were recruited from eight acute care hospitals in three different geographic areas in the United States. The data collection instrument included a researcher-developed personal attributes questionnaire, the Clinical Leadership Behaviors Questionnaire (CLB-Q), the Psychological Capital Questionnaire 12-Item (PCQ-12), and three open-ended questions. Data collection occurred through an online survey.

The findings supported nurses are interconnected in practice, and informal clinical leaders can emerge from this network. Nurses described preferring to seek clinical guidance from peers with a positive attitude about providing help or work in general or from experienced peers. Psychological capital was the only significant predictor in the regression model accounting for 42% of the variance in clinical leadership behavior scores. Whereas, the professional experience variables were not supported statistically as predictors of clinical leadership behavior. Additional research is needed to further explore the complexities of the interpersonal relationships among nurses and the resulting influences on informal leadership at the point of care. However, given the strength of the association between psychological capital and informal clinical leadership and the other positive nursing practice outcomes associated with psychological capital, nurse professional development in the clinical setting, in academia, or informally among nurse peers should afford opportunities for nurses to increase their psychological capital. Given the emphasis on positive attitude, nurses with specialized knowledge and skills should be afforded opportunities to develop interpersonal skills to promote their emergence as informal clinical leaders.