The Survey On Clinical Leadership Of Nurses In Tertiary Hospitals In China

Background:Clinical leadership refers to the behavior of clinical medical personnel to provide guidance and support for patients and the medical team in the process of caring for patients.Nurses,as advocates of patient interests and best care providers directly,play a key clinical leadership role.They can identify and respond to threats patients with health problems in a timely manner,and coordinate other health care team members to settle the problems.In addition,nurses are also a key factor in ensuring effective communication between medical team members and continuity of patient-centered care.Research has shown that nurses have strong clinical leadership skills,which can help improving patient safety and the quality of care.At present,domestic researches are still more focused on the leadership related aspects of nursing managers,and there are fewer studies on nurses’clinical leadership.Therefore,it is necessary to fully grasp the current clinical leadership level of nurses in China,so as to provide a basis for training and developing nurses’ clinical leadership,to further improve the level of nursing service and quality of care,ensure patient safety,and ultimately improve patients’ outcome.Objective:To describe the current situation of clinical leadership of nurses in tertiary hospitals in China.Methods:This study is divided into two parts.Part 1:According to the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures,following the steps of literal translation,back translation,expert committee,pre-survey,the clinical leadership inventory prepared by Canadian scholar Patrick was translated to Chinese and was crosscultural adapted to form the Chinese version of the Clinical Leadership Inventory.Subsequently,196 nurses from tertiary hospitals were conveniently selected for reliability and validity test.Part 2:This research is a descriptive research.Using the Chinese version of the Clinical Leadership Inventory(Part I)and self-designed General Data Sheet as the survey tools,7,458 nurses from 28 tertiary hospitals in seven geographical administrative districts of China were surveyed in March 2021 using the convenience sampling method.Results:Part 1:The total content validity of the Chinese version of the Clinical Leadership Inventory was 0.944,and the content validity of each item were between 0.86～1.00.Confirmatory factor analysis confirmed that the 5-factor model fit well(χ2/df=2.855,RMSEA=0.073,SRMR=0.047,CFI=0.954,TFI=0.939).The total split-half reliability of the Chinese version of the clinical leadership inventory was 0.877,and the split-half reliability of each dimension were between 0.699～0.781.The total Cronbach’s αcoefficient was 0.945 and the Cronbach’s a coefficient of each dimension were 0.784～0.903.The retest reliability was 0.840.Part 2:7,458 valid questionnaires were collected through Wenjuanxing app,with a valid questionnaire rate of 95.09%.The average score of clinical leadership for 7,458 nurses was 4.06.The highest score among the five dimensions is encouraging the heart,with a score of 4.32±0.70.It was followed by enabling others to act,modeling the way and inspiring a shared vision.Challenging the process was the lowest score.Comparative results of clinical leadership under different characteristics showed:①The total score of clinical leadership of nurses aged over 35 years old was higher than that of nurses aged 35 and below,and there are statistical differences in the scores in the four dimensions of inspiring a shared vision,modeling the way,enabling others to act and encouraging the heart(P<0.05).②Women’s scores were higher than those of men in the two dimensions of enabling others to act and modeling the way(P<0.05).③The total score of clinical leadership of nurses with years working more than 15 years was higher than that of nurses with years of working less than 15 years(P<0.008).In the encouraging the heart dimension,nurses with more than 15 years of working experience had the highest scores,while nurses with less than 5 years of working experience had the lowest scores(P<0.008).④The clinical leadership of nurses with junior professional titles was lower than that of intermediate professional titles in total score,challenging the process,inspiring a shared vision,modeling the way,and encouraging the heart(P<0.008).In the dimension of enabling others to act,the scores of nurses those with junior professional titles were lower than that of nurses with senior professional titles,and there were statistical differences(P<0.008).⑤The clinical leadership scores of the clinical teacher were higher than those of ordinary nurses,and there were statistical differences in the total score and each dimension(P<0.05).⑥Different hospital regions had statistical differences in the total clinical leadership score and each dimension score(P<0.001).⑦The scores of nurses in non-emergency and critical care department were all higher than those in emergency and critical care department in the four dimensions of total score,inspiring a shared vision,enabling others to act,modeling the way,and encouraging the heart(P<0.05).⑧The total score and scores of all dimensions of staff nurses and nurses who have attended leadership-related training were higher than that of contract nurses and nurses who had not participated in leadershiprelated training,and the difference was statistically significant(P<0.05).Conclusions:The Chinese version of the Clinical Leadership Inventory has good reliability and validity,and provides a targeted evaluation tool for the future evaluation of nurses’clinical leadership.The clinical leadership of nurses in tertiary hospitals in China was at the upper-middle level,but it was at the medium level in the dimensions of challenging the process and inspiring a shared vision,and there is room for further improvement.And the results of this study suggest that nurses who are middle-aged,senior,Intermediate and Senior professional titles,clinical teacher,staff nurses,and have attend leadership related training show a better clinical leadership level.In the future,other factors affecting nurses’clinical leadership can be further explored to provide a basis for formulating targeted interventions to improve their clinical leadership,so as to improve patient outcomes,nursing quality and job satisfaction,etc.