EVIDENCE-
BASED CARE
SHEET
Authors
Hillary Mennella, DNP, ANCC-BC
Cinahl Information Systems, Glendale, CA
Zeena Engelke, RN, MS
Cinahl Information Systems, Glendale, CA
Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Sara Richards, MSN, RN
Cinahl Information Systems, Glendale, CA
Nursing Executive Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
November 23, 2018
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2018, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
Nursing Leadership Development
What We Know
› Nursing leadership is not synonymous with nursing management, although nurse
managers must demonstrate effective leadership skills to be successful in their role(12,13)
• Management refers to the planning and organization of services; leadership involves
identifying a goal and motivating others to work together to reach a goal(9)
› The Joint Commission (TJC) contends that nursing leadership development is an on-going
process; it is a structured educational plan that continuously cultivates the growth of
inexperienced staff into experts(14)
› Healthcare organizations must invest in adequate resources to promote leadership
development as a priority
› Leadership development refers to the process of cultivating competencies essential to the
particular nursing role and/or practice environment(13)
• Nursing leaders demonstrate clinical expertise; motivate others; communicate and
delegate effectively; demonstrate effective conflict resolution skills; cultivate talent in
and empower others; are committed, passionate, honest change agents and relationship
builders(5,13)
• Leadership development programs often involve mentoring, coaching, and classroom
and clinical instruction, and can involve the completion of evidence-based research or
other projects(6,7,10,18)
–Leadership development using structured long-term training programs in the workplace
allows for ongoing contact between participants and instructors, promotes application
of leadership principles, and provides time for participants to internalize leadership
behaviors(5,18)
- Structured programs can increase self-esteem,self-confidence, self-knowledge,
foundational thinking skills, human resource management, and shared decision
making(5,8,18)
- Structured programs can promote an engaged workforce and a culture of
accountability(14)
- Shared experience is an important component of leadership development and
promotes teamwork and communication(14)
- Various leadership development models are used within individual healthcare
organizations, and the investigator of a recent study found that Magnet hospitals (i.e.,
those hospitals recognized by the American Nurses Credentialing Center [ANCC] for
excellence in nursing leadership) incorporate evidence-based leadership development
practices into their programs to a higher extent than non-Magnethospitals(12)
–A co-active coaching intervention can be beneficial to clinical nursing leadership
development. This approach focuses on self, rather than behaviors, to provoke
reflection and ultimately results in more sustainable behavioral changes(4)
• Leadership education is incorporated into baccalaureate and graduate nursing education
and is the focus of workshops and fellowships offered by a variety of health care and
professional organizations(6,9,10)
› Nursing leadership is an important component of all nursing roles, from clinical leadership at the bedside to the
administrative leadership of nurse executives(1,2,6,7,8,9,18)
• Clinical leadership at the bedside refers to staff nurses providing evidence-based, cost-effective care in a collaborative
environment, with an emphasis on clinical expertise, expert decision making, patient safety, advocacy, and quality of
care(1,2)
–Clinical leadership at the bedside involves nurses who provide direct patient care, not those with management
responsibilities(1,2)
- Professional development and career advancement should focus on promoting and retaining expertise at the bedside(1)
- Requiring a baccalaureate degree as the entry-leveleducation for nursing would promote competency in clinical
leadership(2)
- According to researchers in Australia, the values and beliefs of clinical leaders parallel their actions and interventions(17)
–Nursing transition programs can promote leadership abilities in novice nurses(7)
- Topics to be covered include self-knowledge,communication skills, leadership, cultural competence, delegation,
technological competence, ethics, evidence-based practice, and health care economics(7)
–The Clinical Nurse Leader (CNL) is an advanced practice role developed by the American Association of Colleges of
Nursing (AACN) to promote expert nursing leadership at the bedside(2)
- Preparation for the CNL role requires a liberal arts foundation as part of a baccalaureate nursing degree and graduate
nursing education emphasizing leadership, clinical outcomes management, and care environment management. CNLs
should be prepared to practice across the continuum of care(2)
- Core competencies for the CNL role include critical thinking, advanced patient assessment, communication skills,
nursing technology, resource management, health promotion, risk reduction, disease management, information and
health care technologies management, ethics, global health care, health care systems, policy management, and care
coordination(2)
• Nursing leadership in a management role requires clinical expertise as well as the ability to create a high-performing
workplace, effective leadership of other professionals, and functionality in an administrative role(8)
–Core competencies for the nursing manager role include personal mastery, interpersonal effectiveness, human resource
management, financial management, systems thinking, and caring for staff, patients, and self(8)
–Empowering managers can motivate and encourage them to become leaders. The organization can benefit from including
managers in strategic planning; relying solely on authority is not inspiring, and it increases the risk that the organization
will not meet their objectives(11)
–Leadership development programs tailored for nursing management should address leadership styles, relationship
management, decision-making skills, workplace environment, cultural competence, emotional intelligence, financial
management, and staff recruitment and retention(8)
–Sigma Theta Tau International (STTI) and the American Organization of Nurse Executives (AONE) each offer courses
designed to increase nursing management competencies(10)
• Nursing leadership at the nursing executive (NE) level usually requires years of nursing administration/management
experience, as well as graduate education(9)
–Core competencies for the NE role include communication and relationship building management, knowledge of the
health care environment, leadership skills, professionalism, and business skills and principles(3)
–Leadership development programs tailored for NEs should address identifying personal values, formulating a vision,
building strong collaborative relationships, being an advocate for change and innovation, creating a positive workplace,
supporting the professional development of others, leading with passion, hiring the right people to advance the
organization, sharing decision making and power, and being accountable(15)
–Scandinavian researchers emphasize the need for caring in nursing leadership, particularly while moving between
“rooms” in the leader’s “house” of leadership. In a patient’s room, clinical presence can be used to avoid suffering.
A staff room is where the leader gains trust and respect and facilitates dialogue, while the superior’s room is where
relationships and competence are encouraged/neglected. A secret room is where a leader has the strength to persist and an
organizational room is to balance and prioritize resources(16)
 –Leadership development of the NE can be promoted through graduate education (e.g., joint MSN/MBA programs),
continuing education (e.g., the Harvard University Executive Development Program), or fellowships (e.g., the Robert
Wood Johnson Foundation [RWJF] Executive Nurse Fellows Program)(9)
• Nursing faculty begin the process of developing the nursing leaders of tomorrow by teaching and role modeling
leadership(6)
–STTI and the Elsevier Foundation offer the Nursing Faculty Leadership Academy designed to develop leadership
in nursing faculty early in their careers. The Academy promotes personal leadership development, faculty retention,
satisfaction, academic success, and supportive academic work environments(6)

What We Can Do
› Become knowledgeable about nursing leadership development; share this information with your colleagues
› Assess your leadership development needs based on your nursing role and level of expertise, and seek educational and
clinical experiences that will develop your leadership skills; consider graduate education, if appropriate
› Form strategic relationships with experienced nurses who exhibit leadership characteristics and can serve as mentors in your
professional development
› Consider participating in leadership development programs offered by professional nursing organizations, such as STTI and
AONE
› Collaborate with your organization to provide continuing education on leadership and the importance of leadership
development
 Coding Matrix
References are rated using the following codes, listed in order of strength:

M Published meta-analysis RV Published review of the literature PP Policies, procedures, protocols

SR Published systematic or integrative literature review
RCT Published research (randomized controlled trial)
R Published research (not randomized controlled trial)
C Case histories, case studies
G Published guidelines
RU Published research utilization report
QI Published quality improvement report
L Legislation
PGR Published government report
PFR Published funded report
X Practice exemplars, stories, opinions
GI General or background information/texts/reports
U Unpublished research, reviews, poster presentations or
other such materials
CP Conference proceedings, abstracts, presentation

References
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development. Nursing Administration Quarterly, 36(1), 41-51. (GI)
2. American Association of Colleges of Nursing. (2013). Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice. Retrieved November 12,
2018, from https://www.aacnnursing.org/Portals/42/AcademicNursing/CurriculumGuidelines/CNL-Competencies-October-2013.pdf (G)
3. American Organization of Nurse Executives. (2015). The AONE nurse executive competencies. Retrieved November 12, 2018, from http://www.aone.org/resources/nec.pdf (G)
4. Cable, S., & Graham, E. (2018). “Leading better care”: An evaluation of an accelerated coaching intervention for clinical nursing leadership development. Journal of Nursing
Management, 26(5), 605-612. doi:10.1111/jonm.12590 (R)
5. Chappell, K. K., & Willis, L. (2013). The Cockcroft difference: An analysis of the impact of a nursing leadership development programme. Journal of Nursing Management,
21(2), 396-402. doi:10.1111/j.1365-2834.2012.01425.x (R)
6. Cleeter, D. (2011). Faculty leadership development: Concept or reality? Journal of Pediatric Nursing, 26(4), 285-286. (GI)
7. Dyess, S., & Sherman, R. O. (2010). Developing a leadership mindset in new graduates. Nurse Leader, 8(1), 29-33. doi:10.1111/j.1365-2934.2006.00555.x (C)
8. Fennimore, L., & Wolf, G. (2011). Nurse manager leadership development: Leveraging the evidence and system-level support. Journal of Nursing Administration, 41(5),
204-210. doi:10.1097/NNA.0b013e3182171aff (R)
9. Frederickson, K., & Nickitas, D. (2011). Chief nursing officer executive development: A crisis or a challenge? Nursing Administration Quarterly, 35(4), 344-353. (GI)
10. Johnson, J., Billingsley, M., Crichlow, T., & Ferrell, E. (2011). Professional development for nurses: Mentoring along the U-shaped curve. Nursing Administration Quarterly,
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11. Leadership development: building the workforce of the future. (2015). Hospitals & Health Networks, 89(2), 39-49. (X)
12. Lyman, B. (2012). Leadership development: Pedagogical practices in magnet and non-magnet hospitals. Communicating Nursing Research, 45, 507. (R)
13. Marquis, B.L., & Huston, C.J. (2015). Career development: From new graduate to retirement. In B.L Marquis & C.J. Huston (Eds.), Leadership Roles and Management
Functions in Nursing, theory and Application (8th ed., pp. 243-245). Philadelphia, PA: Wullters Kluwer Health. (GI)
14. Pianezza, P. (2015). Leadership development. In Briefings on the Joint Commission (Vol. 26, p. 12). (GI)
15. Shirey, M. R. (2007). Competencies and tips for effective leadership: From novice to expert. Journal of Nursing Administration, 37(4), 167-170. (GI)
16. Solbakken, R., E, E., Rudolfsson, G., & Bondas, T. (2018). International nursing: Caring in nursing leadership – A meta-ethnography from the nurse leader’s perspective.
Nursing Administration Quarterly, 42(4), E1-E19. doi:10.1097/NAQ.0000000000000314 (R)
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18. Vogelsmeier, A. A., Farrah, S. J., Roam, A., & Ott, L. (2010). Evaluation of a leadership development academy for RNs in long-term care. Nursing Administration Quarterly,
34(2), 122-129. doi:10.1097/NAQ.0b013e3181d91778 (R)