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Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory

A Participatory Research Approach

Bender, Miriam PhD, RN; Spiva, LeeAnna PhD, RN; Patrick, Sara MSN, RN-BC; Meffert, Sarah MSN, RN, CNL; Moton, Lonnie MSN, APRN-BC; Clarke, Sharee MSN, CNL, FNP-C; Mathis, Kendra DNP, RN, CNL; Leclerc, Lucy PhD, RN-BC; Knotts, Kimberly MSN, RN, NEA-BC; Mount, April MSN, RNC

doi: 10.1097/NCQ.0000000000000386

Background: Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States.

Problem: However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks.

Approach: Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system.

Outcomes: Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development.

Conclusions: A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.

Sue & Bill Gross School of Nursing, University of California, Irvine (Dr Bender); WellStar Health System, Atlanta, Georgia (Drs Spiva and Leclerc and Ms Patrick); WellStar Windy Hill Hospital, Marietta, Georgia (Ms Meffert); WellStar Medical Group, Atlanta, Georgia (Mss Moton and Clarke); WellStar Paulding Hospital, Hiram, Georgia (Dr Mathis and Ms Knotts); and WellStar Atlanta Medical Center, Georgia (Ms Mount).

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

This study was funded in part by the Commission on Nurse Certification and the University of California, Irvine, Institute for Clinical and Translational Science.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Accepted for publication: January 1, 2019

Published ahead of print: March 4, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved