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Developing the Clinical Nurse Leader Survey Instrument

A Modified Delphi Study

Bender, Miriam, PhD, RN, CNL; Avolio, Alice, DNP, RN, NE-BC; Baker, Patricia, MSN, RN-BC, CNL; Harris, James L., PhD, MBA, CNL, APRN-BC, FAAN; Hilton, Nancy, MN, RN, NEA-BC; Hites, Lisle, PhD, MS, MEd; Roussel, Linda, PhD, RN, NEA-BC, CNL, FAAN; Shirley, Bobbi, MSN, RN, CNL, OCN; Thomas, Patricia L., PhD, RN, NEA-BC, CNL, ACNS-BC, FACHE; Williams, Marjory, PhD, RN, NEA-BC

doi: 10.1097/NCQ.0000000000000310

Clinical nurse leader (CNL)–integrated care delivery is an emerging nursing model, with growing adoption in diverse health systems. To generate a robust evidence base for this promising nursing model, it is necessary to measure CNL practice to explicitly link it to observed quality and safety outcome improvements. This study used a modified Delphi approach with an expert CNL panel to develop and test the face, content, and construct validity of the CNL Practice Survey instrument.

Sue & Bill Gross School of Nursing, University of California, Irvine (Dr Bender); VA Portland Health Care System, Portland, Oregon (Dr Avolio); UT Health School of Nursing, San Antonio, Texas (Ms Baker); University of South Alabama, Mobile (Dr Harris); St Lucie Medical Center, Port St Lucie, Florida (Ms Hilton); Evaluation and Assessment Unit, Department of Health Care Organization and Policy, The University of Alabama at Birmingham (Dr Hites); University of Alabama, Birmingham (Dr Roussel); Maine Medical Center, Portland (Ms Shirley); Kirkhoff College of Nursing, Cook-DeVos Center for Health Sciences, Grand Rapids, Michigan (Dr Thomas); and Central Texas Veterans Health Care System, Temple (Dr Williams).

Correspondence: Miriam Bender, PhD, RN, CNL, Sue & Bill Gross School of Nursing, University of California, Irvine, 252 Berk Hall, Irvine, CA 92697 (

This study was funded in part by the Commission on Nurse Certification. The authors acknowledge the Clinical Nurse Leader Research Collaborative members who contributed to this study through dialogue and feedback: Elizabeth Murphy, Bob LaPointe, LeeAnna Spiva, and Joan Stanley.

The authors declare no conflict of interest. This work was completed with support from the Central Texas Veterans Health Care System. The views of the authors do not necessarily represent the views of the Department of Veterans Affairs or the US Government.

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Accepted for publication: October 23, 2017

Published ahead of print: December 13, 2017

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