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J Adv Nurs. 2018 Oct 30. doi: 10.1111/jan.13895. [Epub ahead of print]

Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction.

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Faculty of Nursing, University of Windsor, Windsor, Ontario, Canada.



To analyse the critical attributes of clinical leadership and test a model linking clinical leadership behaviours of staff nurses to patient care quality and job satisfaction.


Research has historically proclaimed the beneficial effects of clinical leadership for optimizing care and improving patient outcomes. Few studies, however, have assessed the influence of clinical leadership at the staff nurse level and empirically tested the concept.


A predictive cross-sectional design was used in this study.


Data were collected during January 2016 using a survey questionnaire. A random sample of Registered nurses working in direct care positions in acute care hospitals was surveyed. The hypothesized model was tested using structural equation modeling in the analysis of a moment structures software.


Nurses reported higher levels of clinical leadership skills in their practice. Staff nurses' use of clinical leadership behaviours directly and positively influenced the quality of care they given to patients and their satisfaction in the workplace.


The findings indicate that informal leadership at the clinical level may be an underused asset in health care and if identified and developed, staff nurse clinical leaders have potential to improve the delivery of patient care and may offer a tangible solution to the patient safety conundrum.


clinical leadership; informal leaders; job satisfaction; leadership; nursing; patient safety; quality of care; staff nurse clinical leadership


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