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      An integrative review of leadership competencies and attributes in advanced nursing practice

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          To establish what leadership competencies are expected of master level‐educated nurses like the Advanced Practice Nurses and the Clinical Nurse Leaders as described in the international literature.


          Developments in health care ask for well‐trained nurse leaders. Advanced Practice Nurses and Clinical Nurse Leaders are ideally positioned to lead healthcare reform in nursing. Nurses should be adequately equipped for this role based on internationally defined leadership competencies. Therefore, identifying leadership competencies and related attributes internationally is needed.


          Integrative review.


          Embase, Medline and CINAHL databases were searched (January 2005–December 2018). Also, websites of international professional nursing organizations were searched for frameworks on leadership competencies. Study and framework selection, identification of competencies, quality appraisal of included studies and analysis of data were independently conducted by two researchers.


          Fifteen studies and seven competency frameworks were included. Synthesis of 150 identified competencies led to a set of 30 core competencies in the clinical, professional, health systems. and health policy leadership domains. Most competencies fitted in one single domain the health policy domain contained the least competencies.


          This synthesis of 30 core competencies within four leadership domains can be used for further development of evidence‐based curricula on leadership. Next steps include further refining of competencies, addressing gaps, and the linking of knowledge, skills, and attributes.


          These findings contribute to leadership development for Advanced Practice Nurses and Clinical Nurse Leaders while aiming at improved health service delivery and guiding of health policies and reforms.

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          Most cited references 44

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          How should we define health?

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            The relationship between nursing leadership and patient outcomes: a systematic review update.

            Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes. © 2013 John Wiley & Sons Ltd.
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              Cochrane Qualitative and Implementation Methods Group guidance series—paper 6: reporting guidelines for qualitative, implementation, and process evaluation evidence syntheses

              To outline contemporary and novel developments for the presentation and reporting of syntheses of qualitative, implementation, and process evaluation evidence and provide recommendations for the use of reporting guidelines.

                Author and article information

                Role: Senior ,
                Role: Senior researcher
                Role: Coördinator Master Advanced Nursing Practice
                Role: Professor of Nursing Science
                Role: Senior researcher
                J Adv Nurs
                J Adv Nurs
                Journal of Advanced Nursing
                John Wiley and Sons Inc. (Hoboken )
                21 July 2019
                November 2019
                : 75
                : 11 ( doiID: 10.1111/jan.v75.11 )
                : 2378-2392
                [ 1 ] Radboud University Medical Center, Radboud Institute for Health Sciences Scientific Institute for Quality of Healthcare Nijmegen The Netherlands
                [ 2 ] Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy Haarlem The Netherlands
                [ 3 ] Erasmus School of Health Policy & Management Erasmus University Rotterdam Rotterdam The Netherlands
                [ 4 ] Hogeschool van Arnhem en Nijmegen HAN University of Applied Sciences Nijmegen The Netherlands
                [ 5 ] HAN University of Applied Sciences Nijmegen The Netherlands
                Author notes
                [* ] Correspondence

                Maud Heinen, Radboud university medical center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.

                Email: Maud.Heinen@

                © 2019 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 3, Pages: 15, Words: 10275
                Review Paper
                Evidence Synthesis
                Review Papers
                Custom metadata
                November 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:05.12.2019


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