Identification of the Components of a Complex Intervention to Develop Clinical Leadership in Specialist Clinical Nurses: A Qualitative Study with Interviews and Stakeholders’ Consensus

Purpose: Healthcare systems have undergone changes due to ageing populations and responding to new care needs, with developments in nursing in terms of organization, skills and new roles. The introduction of specialist clinical nurses (SCN) in all departments was considered crucial to expand the professional development possibilities for nurses. The purpose of this study was to examine SCNs perceptions of their role and clinical leadership, and to identify the components of a complex intervention aimed to improve clinical leadership. Methods: Qualitative research was performed in a multisite Hospital, via semi-structured interviews with SCNs, involved with a purposive sample, to investigate perceptions of their role and barriers/facilitators to clinical leadership and its development. A review of relevant literature informed the interview guide and a thematic analysis of data was performed. The results and literature relating to clinical leadership were synthesised for the first phase, of the Medical Research Council framework (development of the intervention) to develop a complex intervention focusing on clinical leadership. A consensus meeting was performed with SCNs and nurse managers to define the intervention. Results: Seven interviews were conducted with SCNs. Five macro themes were identified contributing to clinical leadership as a SCN: personal characteristics and competencies, collaboration and relationships, organization and culture of teams, leadership in the role and patient. During the consensus meeting the results were discussed and participants highlighted existing resources for leadership and those requiring development. A complex intervention to improve clinical leadership was defined, consisting of an introductory pathway, basic training package, coaching/support in practice and group work. Conclusion: The study has identified a variety of factors that could influence clinical leadership and how they could be applied within this clinical role. Elements to further develop clinical leadership for SCNs have been outlined taking into account the local context and the need to introduce additional interventions based on the needs of the individual and the team. Keywords: shared governance, leadership, specialist nurse, complex intervention, MRC framework, qualitative research