A cognitive learning model of clinical nursing leadership ☆ Jacinthe Pepin a, ⁎, Sylvie Dubois a , Francine Girard a , Jacques Tardif b , Laurence Ha a a Center for innovation in nursing education (CIFI), Faculty of Nursing, University of Montreal, Quebec, Canada b Faculty of Education, University of Sherbrooke, Quebec, Canada summary article info Article history: Accepted 4 November 2010 Keywords: Cognitive learning model Clinical nursing leadership Competency-based education Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a “complex know–act” that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education. © 2010 Elsevier Ltd. All rights reserved. Introduction There is a strong call from around the world for the development of nursing leadership in practice (Shaw, 2007), research (American Association of Colleges of Nursing, 2006), education (Allan, 2010), administration (American Organization of Nurse Executives [AONE], 2005), and political advocacy (Sorenson et al., 2008), to benefit the health of patients and families, communities and the population as a whole. If leadership has long been attributed to specific positions in the health care system (i.e. managers, head nurses), clinical nursing leadership is being recognized as a central professional competency to be developed by nurses to ensure quality care and patient safety (Bartels & Bednash, 2005; Task Force on the Essential Patient Safety Competencies for Professional Nursing Care, 2006). Nursing education has been challenged to improve the teaching of leadership to prepare future nurses as safe and effective clinicians (Benner et al., 2010), who are flexible, visionary, and ready to take risks to lead changing healthcare environments (Taylor et al., 2010). However, the literature on clinical nursing leadership, and specifically on the process of developing clinical nursing leadership, is sparse, as observed successively by Cook (2001), Stanley (2006) and Hyrkäs and Dende (2008). The National Research Council (NRC) (2001) suggests that educational programs and assessment designs start with a cognitive learning model that describes how people develop a specific competency. This paper reports on a research study whose purpose was to develop a cognitive learning model (CLM) of the clinical nursing leadership competency, from the beginning of a nursing program (students) to expertise (nurses). Literature review Often associated with positions of power, nursing leadership is now expected to be demonstrated by all nurses, from the clinician to the executive, especially in a context of interprofessional collabora- tion and of shared clinical governance. The interest for clinical leadership in the nursing profession lies in the improvement of health and care (Canadian Health Services Research Foundation [CHSRF], 2006; Cook & Leathard, 2004; National Steering Committee on Patient Safety, 2002; Shaw, 2007), as well as on nurses' work satisfaction (Cummings et al., 2008). Huber (2006) defined clinical leadership as the process of influencing others in order to attain the highest standard of care for patients and families. Previous research focused on defining the characteristics of effective leaders by using small samples, and on educational strategies for the development of leadership attributes. In 1999, Cook defined a clinical leader as “an expert clinician, involved in providing direct Nurse Education Today 31 (2011) 268–273 ☆ This research is part of a funded program by the Canadian Health Services Research Foundation (CHSRF): Goudreau, Leclerc, Pepin et al. 2008–2012. ⁎ Corresponding author. Faculty of Nursing, University of Montreal, P.O. Box 6128, Downtown Montreal, Quebec, H3C 3J7, Canada. Tel.: +1 514 343 7619; fax: +1 514 343 2306. E-mail address: jacinthe.pepin@umontreal.ca (J. Pepin). 0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2010.11.009 Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/nedt