The hospital setting is a complicated, challenging, and complex environment in which
to deliver high-quality, lower-cost care. It is particularly vulnerable to what is often termed
―care fragmentation.‖ The Clinical Nurse Leader (CNL), the first new nursing role advanced
nationally in decades, is an innovative strategy uniquely positioned to address teamwork and
strengthen leadership at the bedside to improve patient outcomes for a reduced cost at the
microsystem level. The CNL is less than 5 years old and limited research has been
conducted, particularly around the development, implementation, and perceived
transformational leadership aspects of the role. Consequently, to address the research gap,
this study investigated the above aspects on 5 inpatient units. Qualitative findings regarding
the role reveal the perception and alignment of a complex role for complex times, and the
―pull of polarity‖ on multiple levels (organization, unit, staff and each other). Quantitative
results suggest licensed personnel and those with higher educational preparation as group
perceive the transformational leadership practices of the CNL to be higher than those
unlicensed personnel and those with less education. Furthermore, it generally appears the
longer the CNL has been practicing on the unit, the higher the perceptions of their