How Formal and Informal Nurse Leaders Enact Shared Implementation Leadership in a Hospital Setting

To describe how implementation leadership manifests among formal and informal point of care nurse leaders during a successful evidence-based practice implementation.

A collective case study.

A conceptual framework on shared implementation leadership guided the study. Two units known for strong implementation were selected as instrumental cases from a healthcare network. Data were collected from multiple sources (2022-2023), including document review, site visits, focus group and individual interviews with formal managerial and non-managerial nurse leaders, staff nurses, interdisciplinary clinical staff and departmental leaders. The Framework Method was used to thematically analyse within-case findings, followed by cross-case comparison.

Nurse leaders in formal and informal roles engaged in collaborative processes to collectively enact leadership behaviours throughout the implementation phases. Change-, relation- and task-oriented behaviours aimed to foster staff readiness, ensure supportive presence, structure implementation activities and reinforce the use of evidence-based practices on the units. Collaborative processes fostered leaders' engagement and kept one another informed to align and synchronise their collective actions.

This study extends our understanding of implementation leadership in nursing by highlighting a shared and relational approach among diverse point of care leaders. Strengthening team-level processes is essential to enhance leadership capacity for implementation in nursing.

Given the global push for innovative, high-quality healthcare, strong leadership is needed to create conditions for implementation and practice change. This study makes visible how multiple and diverse leaders collectively support implementation.

With much focus on nurse manager roles, there is a gap in the research showing how multiple point of care leaders facilitate implementation, which this study addresses. This study can serve as a template to assist nurse leaders in their implementation efforts and to advocate for developing diverse nurse leadership roles.

The report adheres to the COnsolidated criteria for REporting Quality research (COREQ) guidelines.

This study did not include patient or public involvement in the design, conduct or reporting.

International Registered Report Identifier (IRRID): DERRI-10.2196/54681.