Miriam Bender, Marjory Williams, Maricela F. Cruz, Claude Rubinson; Nursing Open 2021; First published 03 May 2021; DOI: 10.1002/nop2.910


Aims: Patients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. Registered Nurses are a recognized patient safety strategy. However, variability in research findings indicate the relationship is not as simple as “more nurses=better outcomes.” Hence, currently there exists no evidence-based frontline nursing care model. One emerging model is the Clinical Nurse Leader care model.

Design: This Hybrid Type II Implementation-Effectiveness study will evaluate the effect of the care model on standardized quality and safety outcomes and identify implementation characteristics that are sufficient and necessary to achieve outcomes. Methods: This study leverages a natural experiment in 66 clinical care units in nine hospitals across five states in the United States that have implemented the Clinical Nurse Leader care model.

Results: Findings will elucidate Registered Nurse’s mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.

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