title: Clinical Nurse Leader Integrated Care Delivery to Improve Care Quality: Factors Influencing Perceived Success.
abstract: Clinical nurse leader(TM) (CNL)-integrated care delivery is a new model for organizing master's-level nursing clinical leadership at the microsystem level. While there is growing evidence of improved patient care quality and safety outcomes associated with CNL practice, organizational and implementation characteristics that influence CNL success are not well characterized. The purpose of this study was to identify organization and implementation factors associated with perceived success of CNL integration into microsystem care delivery models.
  
  
  
  A survey was developed and administered to a nationwide sample of certified CNLs and managers, leaders, educators, clinicians, and change agents involved in planning or integrating CNLs into a health system's nursing care delivery model. Items addressed organizational and implementation characteristics and perceived level of CNL initiative success. Generalized linear modeling was used to analyze data.
  
  
  
  The final sample included 585 respondents. The final model accounted for 35% of variance in perceived CNL initiative success, and included five variables: phase of CNL initiative, CNL practice consistency, CNL instructor or preceptor involvement, CNL reporting structure, and CNL setting ownership status.
  
  
  
  CNL initiative success is associated with modifiable organizational and implementation factors.
  
  
  
  Study findings can be used to inform the development of successful implementation strategies for CNL practice integration into care delivery models to improve care quality outcomes.
authors.affiliation: Assistant Professor, Program in Nursing Science, University of California, Irvine, Irvine, CA, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Bender
authors.affiliation: Associate Chief Nursing Research, Central Texas Veterans Health Care System, Temple, TX, USA.
authors.forename: Marjory
authors.initials: M
authors.lastname: Williams
authors.affiliation: Program Manager, Evaluation and Assessment Unit, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Su
authors.affiliation: Associate Professor, Director of Evaluation and Assessment Unit, Center for the Study of Community Health, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Lisle
authors.initials: L
authors.lastname: Hites
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D007857:Leadership; D008875:Middle Aged; D016294:Models, Nursing; D009720:Nurse Clinicians / Q000523:psychology* / Q000706:statistics & numerical data; D015403:Nursing Evaluation Research; D058996:Quality Improvement / Q000458:organization & administration*; D055815:Young Adult
keywords: Care delivery model; clinical nurse leader; effectiveness; implementation; nursing care delivery