Digital Leadership Scale for Clinical Nurses: Development and Validation of an Instrument

Clinical Snapshot

Key Findings

• P Value: p<0.001 for both convergent validity correlations

• Effect Size: Four factors explained 56.9% of total variance; convergent validity correlations: r=0.82 with Nursing Informatics Competency Scale; r=0.83 with Self-Leadership Scale

• Primary Outcome: Development and validation of a 29-item, four-factor Digital Leadership Scale for Clinical Nurses (DLS-CN) with domains: (1) ability to use digital technology, (2) digital safety management, (3) digital collaboration mindset, and (4) organisational influence

• Nnt Or Sensitivity: Cronbach's alpha=0.95 (overall internal consistency); individual domain alphas not reported in abstract; CFA fit indices not reported in abstract

• Confidence Interval: Not reported

Clinical Application

The 29-item scale is of practical length for clinical administration and requires no specialised equipment. It can be administered as a paper-based or electronic survey. Scoring and interpretation would require access to the full published instrument and normative data. Feasibility in non-Korean settings requires cross-cultural adaptation. Australia's National Digital Health Strategy 2023–2028, led by the Australian Digital Health Agency (ADHA), explicitly identifies digital health workforce capability as a priority. The Australian College of Nursing and ANMF have identified digital literacy as an emerging competency domain. The DLS-CN could theoretically inform nursing workforce digital capability assessments aligned with these frameworks. However, direct application requires cross-cultural adaptation and re-validation in the Australian context, given differences in healthcare system structure, digital infrastructure (e.g., My Health Record), and nursing scope of practice. The TGA and PBS are not directly relevant to this instrument development study. RACGP digital health guidelines focus on general practice rather than hospital nursing, but the broader principle of digital leadership competency assessment is transferable. Clinical nurses in hospital and healthcare institution settings, particularly those involved in digital health implementation, nursing informatics, or leadership development programmes

Abstract

BACKGROUND: The rapid advancement of digital technologies, combined with the evolving complexity of health care environments, has introduced a new paradigm in nursing practice. Clinical nurses are now required not only to deliver safe and effective patient care but also to demonstrate competencies in digital literacy and innovation. Among these emerging competencies, digital leadership has become a critical attribute-enabling nurses to lead digital transformation, ensure patient safety, enhance care quality, and support system-level change within health care organizations. Despite its increasing relevance, there is a notable absence of validated measurement tools tailored to assess digital leadership in clinical practice. OBJECTIVE: This study aimed to develop and psychometrically validate a Digital Leadership Scale for Clinical Nurses (DLS-CN) to systematically evaluate the digital leadership capabilities of nurses working in clinical settings. METHODS: The scale development process followed a rigorous multistep procedure. Initial items were derived from previous qualitative research involving a literature review and in-depth interviews, complemented by an additional literature review conducted in this study. The content validity of 38 preliminary items was evaluated by 9 experts over 2 rounds. A pilot test was conducted with 30 nurses, followed by cognitive interviews with 5 nurses to refine item clarity and relevance. The final set of items was administered to 446 clinical nurses across various health care institutions. Data were randomly split for exploratory factor analysis and confirmatory factor analysis. Additional analyses were conducted to evaluate item discrimination, convergent validity, and internal consistency using IBM SPSS 25.0 and AMOS 23.0. RESULTS: The finalized DLS-CN consists of 29 items grouped under four domains: (1) ability to use digital technology, (2) digital safety management, (3) digital collaboration mindset, and (4) organizational influence. These 4 factors explained 56.9% of the total variance. The scale showed strong internal consistency (Cronbach α=0.95). Convergent validity was demonstrated through strong positive correlations with the Nursing Informatics Competency Scale (Pearson correlation coefficient r=0.82; P<.001) and the Self-Leadership Scale (Pearson correlation coefficient r=0.83; P<.001). CONCLUSIONS: The DLS-CN is a valid and reliable instrument for measuring digital leadership among clinical nurses. It offers a practical tool for educators, administrators, and researchers to assess and enhance digital leadership capabilities-ultimately supporting the digital transformation of health care systems.

References

1. 1.Lee, J.-H., & Jung, S.-Y. (2026). Digital Leadership Scale for Clinical Nurses: Development and Validation of an Instrument. JMIR Nursing. https://doi.org/10.1111/jnu.12587