Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: A Collective Case Study (Preprint)

Abstract

Nursing leadership teams at the point of care consisting of both formal and informal leaders are regularly called upon to support the implementation of evidence-based practices in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership, representing an important knowledge gap.

This study will explore shared implementation leadership among formal and informal nursing leaders on inpatient hospital units. The central research question is: How is implementation leadership shared among members of point of care nursing leadership teams on inpatient hospital units? The sub questions are: 1) What implementation leadership behaviors are enacted and shared by formal and informal leaders? 2) What social processes enable shared implementation leadership by formal and informal leaders? 3) What factors influence shared implementation leadership in nursing leadership teams?

We will use a collective case study approach to describe and generate an in-depth understanding of shared implementation leadership in nursing. We will select nursing leadership teams on two inpatient hospital units that have successfully implemented an evidence-based practice as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff and senior nurse leaders), review of organizational documents and researcher-generated fieldnotes. We have developed a conceptual framework of shared implementation leadership to guide data analysis, which describes effective implementation leadership behaviors, formal and informal nursing leaders’ roles at the point of care, social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared implementation leadership following a cross-case analysis.

The study protocol received research ethics approval on February 24, 2022 (Protocol number 2022-8408). Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 24 participants to date. We anticipate data collection to be completed by December 2023 and findings to be published in a peer-reviewed journal by late 2024.

The success of real-word implementation is inconsistent. Effective nursing leadership for implementation care create conducive contexts for change. The anticipated results will shed light on how multiple and diverse members of the point of care nursing leadership team enact and share implementation leadership. This study will advance knowledge of how to promote high quality healthcare delivery, by further developing the concept of shared implementation leadership in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the point of care to inform future intervention studies.