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Background: The complexities of the 21st century health care environment necessitate engaging leadership at all levels, both formal and informal, for positive, adaptive change in the clinical setting. Prevalent studies about leadership in health care focus on formal leadership, where leadership is associated with a position of authority such as an administrative or managerial role. Numerous instruments have been identified and applied to measuring formal leadership in those roles. However, if staff nurses are expected to lead change in patient care settings, similar instruments should be available to measure informal clinical leadership.
Aim: This purpose of this analysis was to review the literature for instruments specifically measuring informal clinical leadership among staff nurses and to compare the application and psychometric properties of the instruments identified.
Methods: A search was executed in the PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL) and IngentaConnect™ databases on the terms clinical leadership and nurse with the filters peer-reviewed journals, published in the English language, and publication dates between 2004 and 2014. The abstracts in the result sets were reviewed to identify quantitative studies in which the instruments were tested with staff nurses, and psychometric properties were reported. Results: The concatenated, deduplicated result set yielded 34 articles addressing informal clinical leadership among staff nurses but included only one quantitative study meeting the inclusion criteria. A second study meeting the criteria was selected from the reference list of one of the excluded studies. The concept of clinical leadership was slightly different between the two instruments largely due to the level of abstraction. One instrument measured clinical leadership at a higher conceptual level while the other tested for very specific leadership behaviors. There was a logical overlap between both conceptualizations of clinical leadership. Both instruments were tested among acute care staff nurses; however, the sample size was larger in one of the studies. Internal consistency reliability was reported as acceptable with Cronbach’s alpha values generally exceeding .70 for the subscales on both instruments. Both instruments were reported to have content validity verified by panels of local experts.
Conclusion: Informal clinical leadership among staff nurses is a concept of increasing interest among researchers. However, the lack of a consistent definition and extensively tested instruments for the measurement of informal clinical leadership indicates the need for further research and development in this area. The significance of this research would be using this increased nursing practice knowledge to design and test nursing education and nursing staff development interventions to promote informal clinical leadership behaviors among staff nurses. This would help empower nurses to lead change at the point of care in response to the rapidly evolving and highly complex demands of the 21st century health care environment.
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