Developing Clinical Leadership in Orthopedic Nursing: A Qualitative Study to Identify the Components of a Complex Intervention

Background/Objective: Clinical leadership is essential for improving care quality and patient safety in complex orthopedic emergency settings. This study examined perceptions of clinical leadership among Orthopedic and Trauma Clinical Nurse Specialists (OTCNSs) at a major regional trauma center in Romania. The objective was to apply and contextually adapt a previously developed methodological approach to identify candidate components for a clinical leadership development intervention tailored to the specific clinical demands of orthopedic trauma care and the Romanian legislative environment. Methods: A qualitative approach was utilized, systematically applying and contextually adapting the two-phase methodological architecture developed by Palermo et al. Semi-structured interviews were conducted with seven OTCNSs and analyzed using hybrid deductive–inductive thematic analysis. Following this, a consensus meeting was convened with nine OTCNSs, one Head Nurse, and one Clinical Researcher to co-construct a locally tailored intervention prototype. Results: Five overarching themes emerged from the interviews: individual attributes and professional capabilities, interprofessional collaboration and relational dynamics, team frameworks and organizational culture, role-based leadership and functional autonomy, and patient-centered trajectories. Based on these findings and stakeholder consensus, a four-component intervention prototype was co-constructed: (1) clinical orientation pathway and strategic onboarding, (2) core competency curriculum for advanced orthopedic nursing, (3) point-of-care mentorship and reflective clinical support, and (4) collaborative peer circles and case-based reflection. Conclusions: This study identified perceived leadership-development needs among OTCNSs and generated a preliminary, contextually tailored intervention prototype. The findings suggest that clinical leadership is shaped by a dynamic interplay of personal, relational, institutional, and patient-centered variables. The candidate intervention components require feasibility testing, refinement, and evaluation before they can be recommended for wider implementation.