Abstract
AIMS: This study aims to describe the exercise of clinical leadership by nurses within hospital care units, identify the factors influencing it and explore how nurses perceive its impact. DESIGN: Qualitative multiple case study. METHOD: The study involved 36 interviews, 120 h of observation and documentary analyses with nurses across various roles within three nursing teams to capture collective leadership. Thematic and cross-case analyses were also conducted. RESULTS: Nurses' clinical leadership was manifested in five distinct forms, irrespective of their role: (1) initiating actions involving reflective thinking and intervention, (2) influencing others through coaching, (3) actively participating in and mobilising efforts to enhance the quality of care, (4) fostering optimal synergy and team cohesion, and (5) leveraging personal and collaborative capacities. Factors influencing this leadership included clinical, human and material resources, time, a work environment that promotes autonomy and a positive work climate. Nurses perceived their leadership as having a positive impact on patients, themselves, the interdisciplinary team and the organisation. These findings were integrated into a modellisation of the exercise of nurses' clinical leadership based on Le Moigne's (La Théorie du Système Général. Théorie de la Modélisation. Paris: Presses Universitaires de France, 2006) philosophical approach. CONCLUSION: This study provides a perspective on nurses' collective clinical leadership in hospital care units, emphasising its leverage effect and the achievement of positive impacts. The proposed model serves as a valuable tool for nurse managers to better understand and support the exercise of clinical leadership. IMPLICATIONS FOR THE PROFESSION: The model can guide nurse managers in supporting clinical leadership within teams, assist individual nurses in associating clinical leadership with their practice and assist with mobilising their leadership skills. IMPACT: This study explores how nurses across various roles within a hospital care unit exercise clinical leadership. The findings reveal five active forms of nurses' clinical leadership, perceived by nurses to positively impact patients, the interdisciplinary team and the organisation. Nurses and managers can use these five forms to foster a collective approach to clinical leadership. PATIENT OR PUBLIC CONTRIBUTION: None. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER COMMUNITY?: This study introduces an innovative model for understanding and promoting nurses' clinical leadership. It provides insights into the positive impact of this leadership approach and the significance of promoting it. REPORTING METHOD: Standards for Reporting Qualitative Research [SRQR] (O'Brien et al. Academic Medicine, 89, 2014 and 1245). TRIAL AND PROTOCOL REGISTRATION: Not registered.