Emergent Leadership: A Novel Perspective of Frontline Clinical Leadership

Purpose: Approximately, 44,000 - 98,000 preventable deaths and over 1 million patient injuries occur yearly due to medical errors in health care delivery in hospitals in the United States (U.S.). Despite changes to health care policies and systems, improvement of the quality and safety of patient care have not met expectations because rates of preventable deaths and harm remain high in the U.S. More recently, the promotion of leadership at the point-of-care has been proposed as a strategy for improving the quality and safety of patient care. In the landmark report The future of nursing: Leading change, advancing health, the Institute of Medicine and the Robert Wood Johnson Foundation called for leadership at all levels and throughout all practice settings of the nursing profession. In addition, this report recognized that frontline staff nurses’ frequent and extended contact with patients and families places them in a unique position to directly influence the quality, safety, and efficiency of health care delivery. Therefore, staff nurse clinical leadership is crucial for service improvement in health care. However, frontline staff nurses have not traditionally been viewed to be in positions of leadership and established leadership models are based on individuals that are in hierarchical positions of authority within the organization. Moreover, current models of leadership do not fully describe staff nurse clinical leadership from the perspective of a frontline clinician that does not have formal authority yet demonstrates leadership within the interdisciplinary health care team. Therefore, the purpose of this presentation is: 1) to define the concept of staff nurse clinical leadership and differentiate this concept from other forms of frontline clinical leadership in the acute-care hospital setting, 2) to present the notion of emergent leadership as a novel perspective of staff nurse clinical leadership in interdisciplinary health care teams.

Methods: A review of the literature and a concept analysis using the Walker and Avant methods were used to examine, define, and differentiate staff nurse clinical leadership from other similar concepts related to frontline clinical leadership in nursing. The review of the literature was conducted to assess the current state-of-the science of this phenomenon. In addition, a review of the literature for the concept emergent leadership also was conducted to evaluate the theoretical underpinnings of this phenomenon.

Results: The concept analysis and review of the literature of staff nurse clinical leadership indicated there was a lack of consensus about its meaning.  Therefore, staff nurse clinical leadership was defined as a process that involves a staff nurse who, although has no formal authority, exerts influence over other individuals in the interdisciplinary health care team. In addition, there was a lack of literature that described staff nurse clinical leadership from the perspective of a frontline clinician that emerges as a leader within an interdisciplinary health care team. The theoretical underpinnings of emergent leadership, however, were consistent with the type of frontline clinical leadership that takes place in staff nurse clinical leadership.  In addition, the findings of the emergent leadership literature review supported the emergence of leadership within the context of interdisciplinary teams or groups of individuals that assume responsibility for the completion of tasks, team functions, and team problem-solving in work environments.

Conclusion: A clear delineation of the concept staff nurse clinical leadership distinguished this concept from other concepts and catchphrases frequently encountered in the frontline clinical leadership literature. A description of staff nurse clinical leadership from the perspective of emergent leadership provided a new approach and preliminary framework for advancing staff nurse clinical leadership practice, education, theory development, and research. Staff nurses may apply the gained clarity of the concept of staff nurse clinical leadership to their practices and roles as emergent leaders within their professional setting. Nurse educators may use the concept and framework to inform their strategies to effectively educate staff nurses about frontline clinical leadership. The science of staff nurse clinical leadership is emerging and more work is still needed. These findings provide a foundation for further theory development and research of effective models and global trends of staff nurse clinical leadership.