title: Nurses' and midwives' clinical leadership development needs: a mixed methods study.
abstract: OBJECTIVE
  This paper is a report of a descriptive study of nurses' and midwives' clinical leadership development needs.
  
  
  BACKGROUND
  Nurses and midwives are expected to fulfil a leadership role at all levels, yet efforts to strategically support them are often unfocused. An analysis of clinical leadership development needs can provide the foundation for leadership initiatives to support staff.
  
  
  METHODS
  A mixed methods design was used. A questionnaire was sent to 911 nurses and midwives and 22 focus groups comprising 184 participants were conducted. Data were collected between March and June 2009 across all promotional grades of nurses and midwives in Ireland. Repeated measures anova with Greenhouse-Geisser adjustment was used for post hoc pair wise comparisons of the subscale dimensions of clinical leadership. anova with Tukey's post hoc method was used for comparison between grades on each individual subscale. Thematic analysis was undertaken on the focus group data.
  
  
  RESULTS
  Results reveal that needs related to development of the profession were the highest for all grades. The staff grade expressed a higher need in relation to 'managing clinical area', 'managing the patient care' and 'skills for clinical leadership' than managers. Qualitative analysis yielded five themes; (1) clinical leadership and leaders from a nursing and midwifery perspective; (2) quality service from a nursing and midwifery perspective; (3) clinical leaders' roles and functions; (4) capital and (5) competences for clinical leaders and leadership and the context of clinical leadership.
  
  
  CONCLUSIONS
  Clinical leadership concerns quality, safety and effectiveness. Nurses and midwives are ideally placed to offer the clinical leadership that is required to ensure these patient care outcomes. Development initiatives must address the leader and leadership competencies to support staff.
authors.affiliation: UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Ireland. mary.casey@ucd.ie
authors.forename: Mary
authors.initials: M
authors.lastname: Casey
authors.forename: Martin
authors.initials: M
authors.lastname: McNamara
authors.forename: Gerard
authors.initials: G
authors.lastname: Fealy
authors.forename: Ruth
authors.initials: R
authors.lastname: Geraghty
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003659:Decision Making, Organizational; D004812:Epidemiologic Methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D007494:Ireland; D007857:Leadership; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D020380:Needs Assessment; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration*; D010344:Patient Advocacy; D011787:Quality of Health Care; D013192:Staff Development / Q000458:organization & administration*; D055815:Young Adult