Implementing Change

Innovativeness of nurse leaders

KAREN CLEMENT-O’BRIEN D N P , R N 1, DENISE F. POLIT P h D 2,3 and JOYCE J. FITZPATRICK P h D , R N , F A A N 4

1Director, Albany Medical Center, The Center of Learning & Development, Albany, NY, 2President, Humanalysis, Inc., Saratoga Springs, NY, USA, 3Adjunct Professor, School of Nursing, Griffith University, Gold Coast, Queensland, Australia and 4Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA

Introduction

The support of nurse leaders for the implementation

of practice innovations is crucial to establishing an

environmental culture that adopts and values evidence-

based practice standards. The ANCC Magnet Recog-

nition Program [American Nurses Credentialing Center

(ANCC) 2008] guides organizations to promote out-

comes and superior performance. The Magnet program

components were developed to evaluate how work

environments support excellence in nursing practice.

Demonstrations of innovations in nursing practice are

the outcome of transformational leadership, empower-

ing structures and processes and exemplary professional

practice in nursing. To achieve Magnet status, the chief

nursing officers (CNOs) of acute health care organiza-

Correspondence

Karen Clement-O�Brien Albany Medical Center

The Center of Learning &

Development

31 Nicklaus Drive

Gansevoort

New York

NY 12831

USA

E-mail: [email protected]

C L E M E N T - O ’ B R I E N K . , P O L I T D . F . & F I T Z P A T R I C K J . J . (2011) Journal of Nursing Management

19, 431–438

Innovativeness of nurse leaders

Aim The purpose of the present study was to describe the innovativeness and the rate of adoption of change among chief nursing officers (CNOs) of acute care

hospitals, and explore the difference in the innovativeness of CNOs of Magnet

hospitals vs. non-Magnet hospitals. Background There is little evidence to guide the description of innovativeness for

nurse leaders, crucial to the implementation of evidence-based practice standards.

Method CNOs of acute care hospitals of New York State participated in a mailed

survey which incorporated the Scale for the Measurement of Innovativeness. The

response rate was 41% (106/261).

Results The majority of the sample was prepared at the master�s level with 5– 10 years of experience in the CNO role. A significant relationship was found

between the innovativeness scale scores and the innovativeness diversity index. The

CNOs who completed more leadership courses had implemented significantly more

types of innovations and had higher innovativeness scale scores.

Conclusion Graduate level education, years of CNO experience and leadership course

completion were identified as significantly influencing innovativeness of CNOs.

Implications for nursing management The characteristics of innovativeness for

nurse leaders presented in the present study may assist organizations, CNOs and the

Magnet recognition programme to describe innovativeness that supports organi-

zations to continuously improve the quality of patient care.

Keywords: change, innovativeness, nurse leader, scale for the measurement of innovativeness

Accepted for publication: 22 September 2010

Journal of Nursing Management, 2011, 19, 431–438

DOI: 10.1111/j.1365-2834.2010.01199.x ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd 431

tions are evaluated on evidence of innovativeness.

However, there is little evidence to guide the description

of innovativeness for nurse leaders.

Purpose of the study

The purpose of the present study was to describe the

innovativeness and the rate of adoption of change

among CNOs of acute care hospitals. In addition, the

degree of innovativeness of CNOs of Magnet hospitals

and non-Magnet hospitals was compared. Examples of

innovativeness, according to the Magnet sources of

evidence criteria, were identified.

Conceptual framework

The Diffusion of Innovation Theory (Rogers 2003)

provided a framework for this study. The innovation-

decision making process describes how an individual

moves through the learning of a new idea, develops an

attitude and determines whether he or she will fully

implement and adopt an innovation or reject the new

practice.

Rogers (2003, pp. 245–252) categorized individuals

into groups according to their rate of adoption of an

innovation. These categories were defined statistically,

based on the number of standard deviations from the

mean adoption time. Individuals that fall within the

innovator classification are people who are considered

mavericks; they are more willing to travel and to take

risks to achieve personal interests or causes in which they

are heavily invested. Those in the early adopter category

are opinion leaders who are socially very well connected

and promote the local change. Early adopters are wat-

ched by others to see the dynamics and the impact of

innovation on their practice area. Members of the early

majority category learn more from other people than

from theory and science. They will listen to others and

will adopt an innovation if it readily helps them with an

immediate need. The late majority watches the early

majority, and the laggards bring up the rear; they are

traditionalists who make wise decisions for the good of

the organization at large (Berwick 2003).

The manner in which nursing practice has historically

been disseminated was frequently based on traditions

and experience (Sleep et al. 2002). The ability to

implement evidence-based practice is a challenge and

has been reported to take as long as 17 years in the

medical community (Liang 2007), with 10–20 years

before innovations are fully put to use (Ervin 2002).

Generating good practice ideas through research is not

the problem; getting good ideas to be used is the chal-

lenge, and the essence of the diffusion of innovation

(Berwick 2003).

Research questions

The research questions that guided this study were: (1)

What is the innovativeness of acute care hospital chief

nursing officers? (2) What is the rate of adoption of

change among acute care hospital chief nursing officers?

and (3) Is there a difference in the degree of innova-

tiveness of chief nursing officers of Magnet hospitals

compared with CNOs of non-Magnet hospitals?

Background

Characteristics of the leader

There is support in the literature for the view that the

characteristics of the leader influence change and the

motivation for adoption in an organization (Leonard-

Barton & Deschamps 1988, Longo 2007, Damanpour

& Schneider 2008). The main characteristics of the

leader that were found to influence change were their

motivation, leadership and commitment (Longo 2007).

Support from top management and championship

may have a significant effect on an adoption decision.

Leaders must first accept change before assisting others

with the change process (Rogers 2003). Innovation

takes time and there must be a perceived value for

adoption to occur. Gaining internal support for adop-

tion of an evidence-based practice change was one

challenge identified by Bradley et al. (2004) among 32

hospital administrators and leaders.

Innovativeness and change

The leader is key to preparing an organization for

change. If it is perceived that the leader does not value

the change or that the leadership team does not share

the same desire for the goal, staff are less likely to be

willing to accept the change (Litaker et al. 2008). Based

on their case studies, Kimball et al. (2007) and Morji-

kian et al. (2007) found that nurse leaders reported that

innovation depends on teamwork, building leadership

capacity and participation on all levels. This is a critical

strategy for generating new ideas, sustaining the change

momentum and being effective as a change agent. The

resources and support that nurse leaders provide made a

difference in the optimal utilization of evidence-based

nursing practice (n = 43; P < 0.05) (Wang & Ahmed

2004, Alfred & Byers 2005). Nurse leaders may have a

significant influence on the attitude of staff towards the

K. Clement-O�Brien et al.

432 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438

use of evidence-based practice and the implementation

of practice changes within their organization (Larrabee

et al. 2007). Lukas et al. (2007), in a longitudinal study

of descriptions of successful change, found that all ele-

ments (impetus to transform, leadership commitment to

quality and change, improvement initiatives, alignment

and integration) of the change matrix need to be part of

the organizational transformation and all are required

to interact collaboratively to maintain urgency for

change and forward movement of the organization.

Organizations are more likely to continue to use

implementation methods that they have used previously,

but these are not necessarily the best for the culture or

the outcomes to be achieved. Facilitation of practice by

clinical teams was shown to be the most effective strat-

egy 79% of the time and educational programmes least

effective at 42% (81% response rate) (Wallace et al.

2001). Collins et al. (2000) found the use of opinion

leaders superior to traditional methods, in enhancing

compliance with scientifically supported practice

guidelines. Cadden (2007) reported that multiple inter-

vention strategies, based on assessment of potential

barriers to change, are more likely to be effective than a

single intervention. Structured and systematic ap-

proaches were found to support organizational learning.

Higher levels of science-based and practice-based inno-

vativeness were associated with better clinical hospital

performance (Salge & Vera 2009).

Change leadership is described as continuously seek-

ing or encouraging others to seek opportunities for

innovative approaches to address organizational prob-

lems. Over a 3-year period, change management was

consistently identified as a learning and development

need of leaders (Wolf et al. 2005).

The literature review includes several qualitative

studies of populations such as health care staff at large,

government officials and a limited number of nurse

leader groups (Leonard-Barton & Deschamps 1988,

Wallace et al. 2001, Longo 2007, Litaker et al. 2008).

Measures of change have focused on attitudes, the

number of products implemented, characteristics of

nurse leaders and practice change implementations

(Grover 1993, Bradley et al. 2004, Alfred & Byers

2005, Larrabee et al. 2007, Damanpour & Schneider

2008). Rate of adoption to change among nurse leaders

and Magnet status comparisons were not found in the

literature. The present study was designed as a

beginning description of these variables among nurse

executives in acute care hospitals in New York State.

There is also no literature found comparing innova-

tiveness of nurse executives in Magnet-designated

hospitals and non-Magnet designated hospitals.

Methods

The study was approved by the Institutional Review

Board before data collection. The setting for the study

was acute care hospitals in the State of New York

(n = 261). The sample included the registered nurse

designated as the CNO at each facility. All CNOs,

regardless of length of service, were invited to partici-

pate in the study. Surveys were addressed and mailed

generically to the CNO at each facility.

Instrument

The operational definition for the rate of adoption was

the assignment of subjects to the categories of innova-

tiveness: innovators, early adopters, early majority, late

majority and laggards as described by Rogers (2003).

The instrument used to measure the innovativeness

variable was the Scale for the Measurement of Innova-

tiveness, which was designed to measure an individual�s willingness to change, not actual adoptive behaviour.

The scale allows assignment of respondents to categories

of innovativeness (Berwick 2003, Rogers 2003). The

total score on the scale is 70 with higher total scores

indicative of a greater degree of innovativeness and

greater willingness to change (Hurt et al. 1977). In

assessing the instrument�s reliability, Hurt et al. (1977) and Pallister and Foxall (1998) obtained Cronbach�s alphas at 0.83 and 0.80, respectively. In the present

sample the reliability of the instrument was tested by

calculation of the alpha coefficient (r = 0.72) which is

lower than the reliability scores obtained previously.

To further describe innovativeness of the sample, the

number and types of innovations implemented were

collected. These options were based on Magnet sources

of evidence for innovation (ANCC 2008): (1) the

structure and process by which nurses are involved with

the evaluation and allocation of technology and infor-

mation systems to support practice, (2) nurses� partici- pation in architecture and space design to support

practice, (3) an improvement in practice as a result of

nurse involvement in technology and information sys-

tem decision making, or (4) an improvement resulting

from nurses� participation in architecture and space design. The survey tool also included an open-ended

question for the purpose of collecting from CNOs their

perception of one of the �most innovative projects they have implemented�. The qualitative data were catego- rized according to the Magnet sources of evidence for

innovation (ANCC).

Other data collected were information about partici-

pation in leadership courses by type and number. The

Innovativeness of nurse leaders

ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438 433

categories of leadership courses were listed according to

the leadership curriculum of the University of Pennsyl-

vania, Wharton School of Business for Nurse Executives.

Demographic and background variables measured

included: age, gender, ethnicity, highest degree earned,

number of years at degree level and number of years in

the CNO role. Data regarding the organization included

Magnet status and number of years employed in a

Magnet organization if applicable.

Procedures

The subjects were asked to complete the survey tool and

return the survey via mail within a 3-week period. One

week after the tool was distributed a follow-up postcard

was sent as a reminder. One week later another follow-

up postcard was mailed to the administrative assistant

of the CNO. Each survey tool was coded with a number

for the purpose of tracking each tool sent and to do a

targeted second mailing to those who had not re-

sponded 6 weeks after the first survey mailing. Once the

sample was obtained the association of the coded tool

to the hospital from which it came was discarded. As an

incentive for CNOs to complete the survey, the cover

letter explained that a donation of one dollar would be

made to Nurses House, a national fund for nurses in

need, upon receipt of the completed tool.

Results

Characteristics of the sample

The target population for this study was CNOs of acute

care hospitals of New York State. The number of par-

ticipants returning the survey was 133 or 51%. Of the

133 subjects, 106 (79.7%) met the inclusion criteria for

the study, CNO of an acute care hospital of New York

State, for a response rate of 41% (106/261). Those

excluded from the study were not employed in an acute

care facility (n = 27, 20.3%). The participants included

99 females (93.4%) and seven males (6.6%). The age

range of participants was as follows: 31–39 (n = 5,

4.7%); 40–49 (n = 13, 12.3%); 50–59 (n = 67, 63.2%)

and 60–65 (n = 21, 19.8%) years. The level of educa-

tion of the participants was as follows: 12 participants

(11.3%) had bachelor�s degrees or less; 82 (77.4%) were at the master�s level; and 12 (11.3%) were at the doctoral level of preparation. The majority of the

participants were white females (n = 99, 93.4%), age

50–59 (n = 67, 63.2%) years, at the master�s level of education preparation (n = 82, 77.4%), with 5–

10 years� experience in the CNO role (n = 40, 37.7%).

Results related to the research questions

Research question 1: �What is the innovativeness of acute care hospital chief nursing officers who work in

New York State?� Overall, the mean score for the innovativeness scale for the sample was 59.81 [standard

deviation (SD) = 6.82; range 40–70]. Five participants

had perfect innovativeness scale scores of 70; two had

scores of 37. The innovativeness diversity index, the

number of types of innovations, ranged from 0 to 5. The

overall mean score was 2.93 (SD = 1.28).

�Do characteristics of CNOs predict their innova- tiveness scores?� The relationships among age, educa- tion and CNO years of experience, innovative scale

scores and the innovativeness diversity index were

analysed. The age groups (<50 for 31–39 and 40–

49 years) and education level ( £ BS for diploma, associate and baccalaureate) were collapsed because of

small numbers per cell. Higher levels of education cor-

related with higher scores on the innovativeness diver-

sity index (F = 4.47, P = 0.01). The number of years as

a CNO, when using collapsed three-group categories

(<5 years for <1 year, 1–3 years and 3–4 years), was

significantly related to the innovativeness diversity in-

dex (F = 4.37, P = 0.01) (see Table 1).

�Is the innovativeness scale score correlated with number of different types of innovation projects?� Using Pearson�s correlation, a significant relationship was found between innovativeness scale scores of the sample

and their innovativeness diversity index, r = 0.34,

P < 0.00.

Research question 2: �What is the rate of adoption of change among acute care hospital chief nursing officers

of New York State?� The rate of adoption of change and the willingness to change groupings were distributed

according to Rogers (2003) categories. The innova-

tiveness scale scores ranged from 37 to 70. The inno-

vator group was populated by participants with a

perfect score of 70, representing 4.7% of the sample.

The sample was significantly non-normal (Kolmogoriv–

Amirnov test of normality P = 0.01) and significantly

positively skewed (Shapiro–Wilk P = 0.00). The fre-

quency and percentage for the remaining groups were:

early adopters, 13 (12.3%); early majority, 35 (33.0%);

late majority, 37 (34.9%); and laggards, 16 (15.1%).

The education level, in the three-group categories, is

significantly related to the willingness to change classi-

fications (r = 15.93, P = 0.04) (see Table 2).

Research question 3: Is there a difference in the de-

gree of innovativeness of chief nursing officers of

Magnet hospitals compared with chief nursing officers

of non-Magnet hospitals?

K. Clement-O�Brien et al.

434 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438

There is considerable similarity in the two groups in

terms of demographics, the innovativeness scale scores,

the innovativeness diversity index and the willingness-

to-change categories. The average scores of the Magnet

group (mean = 59.5) and the non-Magnet group

(mean = 59. 88) on the innovativeness scale score (t =

0.21, P = 0.83) were similar. Using a chi-square test

(v2 = 3.13, P = 0.54), there was no difference in the distribution of willingness-to-change categories be-

tween groups. Those in Magnet hospitals were more

likely to be both laggards and innovators, but the

differences were not significant.

Additional analysis

Question number 12 asked participants to �Describe one of the most innovative projects you have implemented�. The more experience, the greater number of different

types of innovation projects reported. The overall theme

of �one of the most innovative projects� responses in- cluded: building or renovating emergency departments;

development and implementation of an electronic

medical record and other information technology to

support safe patient care; implementation of shared

governance structures; implementation of a nursing

model of care; design and development of new con-

struction; and development of an unique nurse role.

Discussion

In the acute care hospital setting, the influential role of

the chief nursing officer is instrumental in effecting

change in the clinical practice environment. The will-

ingness to change among CNOs influences the success

of the diffusion of an innovation. This study is unique

because of the focus on the descriptive characteristics of

innovativeness of the CNO, the Magnet status com-

parison and the statewide sampling of CNOs of acute

care hospitals. The recordings of examples of the

CNOs� most innovative projects are also unique. Most previous research on this topic is qualitative and does

not provide a descriptive analysis of the innovativeness

of nurse leaders.

Greater experience correlated with larger numbers

and different types of innovation projects. The man-

ager�s personal characteristics have a significant direct effect on the adoption of innovation (Greenhalgh et al.

2004, Damanpour & Schneider 2008). The present

study would suggest that the manager�s education level and professional experience influence their willingness

Table 1 Innovativeness scores by age, edu- cation, chief nursing officer (CNO) years of experience

Innovativeness scale score Mean (SD) F

Innovativeness diversity index Mean (SD) F

Age <50 60.22 (6.24) 0.04 3.11 (1.61) 0.26 50–59 59.69 (6.59) 2.87 (1.14) 60+ 59.86 (8.25) 2.95 (1.43)

Educational attainment £ BS 57.92 (7.18) 2.72 2.25 (1.49) 4.47**

MS 59.50 (6.8) 2.90 (1.23) Doctorate 63.83 (5.7) 3.75 (.97)

CNO years experience <5 years 58.06 (6.95) 2.11 2.58 (1.38) 4.37** 5–10 years 60.20 (7.3) 2.83 (1.32) >10 years 61.40 (5.67) 3.47 (.90)

Significance *P < 0.05, **P < 0.01; d.f. = 2.

Table 2 Willingness to change category by education and chief nursing officer (CNO) years of experience

£ BS N (%)

MS N (%)

Doctorate N (%)

<5 years N (%)

5–10 years N (%) 10 years N (%)

N (% of total) 12 (11.3) 82 (77.4) 12 (11.3) 36 (34.0) 40 (37.7) 30 (28.3) Laggards 1 (8.3) 14 (14.0) 1 (8.3) 6 (16.7) 6 (15.0) 4 (13.3) Late majority 7 (58.3) 26 (31.7) 4 (33.3) 18 (50.0) 12 (30.0) 7 (23.3) Early majority 4 (33.3) 30 (36.6) 1 (8.3) 10 (27.8) 12 (30.0) 13 (43.3) Early mdopters 0 (0.0) 9 (11.0) 4 (33.3) 1 (2.8) 8 (20.0) 4 (13.3) Innovators 0 (0.0) 3 (3.7) 2 (16.7) 1 (2.8) 2 (5.0) 2 (6.7)

r = 15.93, P = 0.04 r = 10.431, P = 0.24

Innovativeness of nurse leaders

ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438 435

to change and the number of innovative projects

implemented. The main drivers of change are the

characteristics of those driving the change: their moti-

vation, leadership and commitment (Longo 2007).

The CNOs recorded examples of their most innova-

tive projects and their level of involvement in the pro-

jects. Schroeder et al. (1986) observed that a hands-on

approach from top management was critical to the

technical, managerial and institutional support of an

innovation. The leader provides the context for change

(Greenhalgh et al. 2004). Key strategies for the CNO as

a change agent include building a business case and

communicating effectively about an innovation. The

current study suggests that CNOs of organizations

where more projects are implemented, with a higher

innovativeness diversity index, may create an environ-

ment that is positioned to accept change and have a

readiness to integrate change into the manner in which

daily work is accomplished. The leader builds a case

and is effective with the communication needed to bring

about change. The nurse leader needs to prepare

the environment, educate the staff, involve staff in the

change process and communicate the value of the

innovation. Without the support of leaders, who in

turn support staff with the use of evidence-based prac-

tice, moving clinical practice forward is very difficult

(Penz & Bassendowski 2006).

There was no difference in the innovativeness of

CNOs of acute care hospitals by Magnet status. The

results would suggest that hospital Magnet status does

not predict the innovativeness of the CNO. However,

the results do suggest that the innovativeness diver-

sity index of the CNO reflects their personal innova-

tiveness.

Limitations of the study

The selection of the statewide setting limits the gener-

alizability of the findings; however, it was the most

appropriate setting for the study of innovativeness of

CNOs and Magnet status. The series of mailings were

effective because of the consistency and repetitive nat-

ure; however, it was expensive. As there was no course

description for each leadership course listed or course

objectives, an assumption was made that there was

consistent interpretation of the meaning of each course

by title. The listings of the types of innovations imple-

mented were presented as they appear in the ANCC

Magnet Recognition Program criteria (2008). This was

done to minimize erroneous translation; however, the

phrases were long and complex, which may have

influenced the interpretation of statements. The open-

ended question asked for �one of the most innovative projects implemented�; however, it did not ask for the strategies utilized to implement the innovation, or how

the CNO involved staff in the innovation. The inno-

vative leader, with higher scores, may be more willing

to respond to the survey and share more experiences

than the low scorer. The willingness-to-change portion

of the survey recorded a reliability of 0.72 (alpha

coefficient), which is lower than Hurt et al.�s (1977) scores of 0.83 and 0.80. Respondents may have been

able to interpret which of the answers was the desirable

response. The CNO would want to be scored positively

toward innovativeness.

Implications for nursing management

As there is little evidence found in the current literature

to guide the description of innovativeness for nurse

leaders, the present study adds to this body of knowl-

edge. Graduate level education, years of CNO experi-

ence and leadership course completion were identified

as significantly influencing innovativeness of CNOs.

These characteristics of the CNO may support organi-

zations and health care at large to implement the evi-

dence-based practice needed to continuously improve

the quality of care delivered and patient outcomes. The

CNOs related many initiatives they had implemented to

meet the regulatory demands of the CMS, the Joint

Commission (TJC) and the Institute for Healthcare

Improvement (IHI). The present study identifies char-

acteristics of the CNO that can support the demands of

the health care industry. The open-ended comments

speak of the desires of nurse leaders to improve practice

and make practice safer, more effective and more sat-

isfying to the nurse. The present study strived to identify

the characteristics that support these initiatives. The

greater number of achievements, longer time of expe-

rience and advanced education support innovativeness.

Generating good practice ideas through research is not

the problem, but getting good ideas to be used is the

challenge, and the essence of the diffusion of innovation

(Berwick 2003). Leaders with the characteristics de-

scribed in the present study support the diffusion of

innovation dissemination.

Leadership is instrumental to practice standard sus-

tainability (Gustafson et al. 2003). The present study

supports the development of nurse leaders through

completion of leadership courses that may support

CNOs to achieve greater success in project implemen-

tation. CNOs, as hospital leaders, are often the indi-

viduals with accountability for implementation of

innovations. The endorsement and active support from

K. Clement-O�Brien et al.

436 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438

top management play a key role in project adoption

(Grover 1993).

Recommendations for future research

The leader provides the context for change (Greenhalgh

et al. 2004). The structure of the communication,

organizational process and strategies that are used

influence the spread of the innovation. Innovation de-

pends on teamwork; however, building leadership

capacity and participation on all levels becomes a crit-

ical strategy for generating new ideas and sustaining the

change momentum (Kimball et al. 2007). For the fu-

ture, study of the time it takes to implement projects,

the sustainability of projects and further work to iden-

tify successful strategies for implementing innovations

would enrich the body of nursing knowledge. The staff

is able to act on new opportunities when the leadership

team is strong and shares a common goal (Litaker et al.

2008). If internal support is not in place, adoption of an

evidence-based practice change remains a challenge

(Bradley et al. 2004). The nurse leader needs to be in-

volved in the change process.

Conclusion

Graduate level education, years of CNO experience and

leadership course completion were identified as signifi-

cantly influencing innovativeness of CNOs. The

opportunity to identify the willingness to change among

nurse leaders has helped identify characteristics that

support a more rapid diffusion of an innovation and the

delivery of quality patient care (IOM 2001). The main

drivers of change are the characteristics of those driving

the change: their motivation, leadership and commit-

ment (Longo 2007). Personal characteristics have a

significant direct effect on the innovation adoption

(Damanpour & Schneider 2008).

The ANCC Magnet criteria are focused on evidence

that promotes outcomes and superior performance. The

description of the innovativeness of leaders presented in

this research may assist organizations and their CNOs to

organize descriptions for Magnet recognition pro-

gramme evaluation, as well as add to the description of

sources of evidence for innovation provided by the

ANCC. The identification of the leader characteristics

that support a willingness to change among nurse leaders

will assist nurse leaders to: lead change, assist the work-

force to accept and adopt changes in a more efficient and

timely manner; assist organizations to achieve a more

rapid diffusion of an innovation; and assist staff to deliver

safe, effective, patient-centred, timely, efficient and

equitable patient care (IOM 2001). Staff are able to act on

new opportunities when the leadership team is strong and

shares common goals (Litaker et al. 2008). If internal

support is not in place, adoption of an evidence-based

practice change remains a challenge (Bradley et al. 2004).

The results provide evidence to support health care

organizations to meet public and regulatory demands.

The characteristics of innovativeness for nurse leaders

presented in the present study may assist organizations,

CNOs and the Magnet recognition programme to de-

scribe innovativeness that supports organizations to

continuously improve the quality of patient care.

Acknowledgements

The authors would like to thank Carol M. Musil, PhD, RN, FAAN, Professor of Nursing, Case Western Reserve Univer- sity, Cleveland, Ohio and Mary Jo LaPosta, MS, PhD, RN, Vice President/Chief Nursing Officer, Saratoga Hospital, Saratoga Springs, New York, for their guidance and support throughout the Doctor of Nursing Practice Thesis Defense.

References

Alfred K. & Byers J.F. (2005) FONE survey on nursing research

resources. Florida Nurse 53 (3), 20.

American Nurses Credentialing Center (2008) The Magnet Model

Components and Sources of Evidence-Magnet Recognition

Program. American Nurses Credentialing Center, Silver Spring,

MD.

Berwick D.M. (2003) Disseminating innovations in health care.

Journal of the American Medical Association 289 (15), 1969–

1975.

Bradley E.H., Schlesinger M., Webster T.R., Baker D. & Inouye

S.K. (2004) Translating research into clinical practice: making

change happen. Journal of the American Geriatrics Society 52

(11), 1875–1882.

Cadden S.M. (2007) Educating nurses about cardiac monitoring

in a stroke unit. Journal for Nurses in Staff Development 23

(1), 20–25.

Collins B.A., Hawks J.W. & Davis R. (2000) From theory to

practice: identifying authentic opinion leaders to improve care.

Managed Care 7, 56–62.

Damanpour F. & Schneider M. (2008) Characteristics of inno-

vation and innovation adoption in public organizations:

assessing the role of managers. Journal of Public Administra-

tion Research and Theory 10, 1–28.

Ervin N.E. (2002) Evidence-based nursing practice: are we there

yet? Journal of the New York State Nurses� Association 33 (2), 11–16.

Greenhalgh T., Robert G., Macfarlane F., Bate P. & Kyriakidou

O. (2004) Diffusion of innovations in service organizations:

systematic review and recommendations. The Milbank Quar-

terly 82, 581–586.

Grover V. (1993) An empirically derived model for the adoption

of customer-based interorganizatonal systems. Decisions Sci-

ences 24 (3), 603–640.

Innovativeness of nurse leaders

ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438 437

Gustafson D.H., Sainfort F., Eichler M., Adams L., Bisognano M.

& Steudel H. (2003) Developing and testing a model to predict

outcomes of organizational change. Health Services Research

38 (2), 751–776.

Hurt N.T., Joseph K. & Cook C.D. (1977) Scales for the mea-

surement of innovativeness. Human Communication Research

4 (1), 58–65.

Institute of Medicine. Committee on Quality Health Care in

America (2001) Crossing the Quality Chasm: A New Health

System for the 21st Century. National Academy Press, Wash-

ington, DC.

Kimball B., Joynt J., Cherner D. & O�Neil E. (2007) The quest for innovative care delivery models. Journal of Nursing Adminis-

tration 37 (9), 392–398.

Larrabee J.H., Sions J., Fanning M., Withrow M.L. & Ferretti A.

(2007) Evaluation of a program to increase evidence-based prac-

tice change. Journal of Nursing Administration 37 (6), 302–310.

Leonard-Barton D. & Deschamps I. (1988) Managerial influence

in the implementation of new technology. Managament Science

34 (10), 1252–1265.

Liang L. (2007) The gap between evidence and practice. Health

Affairs 26 (2), 119–121.

Litaker D., Ruhe M. & Flocke S. (2008) Making sense of primary

care practices� capacity for change. Journal of Laboratory and Clinical Medicine 152 (5), 245–253.

Longo F. (2007) Implementing managerial innovations in primary

care: can we rank change drivers in complex adaptive organi-

zations? Health Care Management Review 32 (3), 213–225.

Lukas C.V., Holmes S.K., Cohen A.B. et al. (2007) Transforma-

tional change in health care systems: an organizational model.

Health Care Management Review 32 (4), 309–320.

Morjikian R.L., Kimball B. & Joynt J. (2007) Leading change.

Journal of Nursing Administration 37 (9), 399–404.

Pallister J.G. & Foxall G.R. (1998) Psychometric properties of the

Hurt-Joseph-Cook scales for the measurement of innovative-

ness. Technovation 18 (11), 663–675.

Penz K.L. & Bassendowski S. (2006) Evidence-based nursing in

clinical practice: implications for nurse educators. Journal of

Continuing Education in Nursing 37 (6), 250–254.

Rogers E.M. (2003) Diffusion of Innovations, 5th edn. Free Press,

New York, NY.

Salge T.O. & Vera A. (2009) Hospital innovativeness and orga-

nizational performance: evidence from English public acute

care. Health Care Management Review 34 (1), 54–67.

Schroeder R., Van de Ven A., Scudder G. & Polley D. (1986)

Managing innovation and change processes: findings from the

Minnesota innovation research program. Agribusiness 2 (4),

501–523.

Sleep J., Page S. & Tamblin L. (2002) Achieving clinical excellence

through evidence-based practice: report of an educational

initiative. Journal of Nursing Management 10, 139–143.

Wallace L.M., Freeman T., Latham L., Walshe K. & Spurgeon P.

(2001) Organizational strategies for changing clinical practice:

how trusts are meeting the challenges of clinical governance.

Quality in Health Care 10 (2), 76–82.

Wang C.L. & Ahmed P.K. (2004) The development and valida-

tion of the organizational innovativeness construct using con-

firmatory factor analysis. European Journal of Innovation

Management 7 (4), 303–313.

Wolf G., Bradle J. & Nelson G. (2005) Bridging the strategic

leadership gap: a model program for transformational change.

Journal of Nursing Administration 35 (2), 54–60.

K. Clement-O�Brien et al.

438 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 431–438

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