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Background: Nurse champions are front-line practitioners who implement innovation and reconstruct policy. Purpose: To understand through a network theory lens the factors that facilitate nurse champions' engagement with radical projects, representing their actions as street-level bureaucrats (SLBs). Materials and methods: A personal-network survey was employed. Ninety-one nurse champions from three tertiary medical centers in Israel participated. Findings: Given high network density, high levels of advice play a bigger role in achieving high radicalness compared with lower levels advice. High network density is also related to higher radicalness when networks have high role diversity. Discussion: Using an SLB framework, the findings suggest that nurse champions best promote adoption of innovation and offer radical changes in their organizations through professional advice given by colleagues in their field network. Healthcare organizations should establish the structure and promote the development of dense and heterogeneous professional networks to realize organizations' goals and nurses' responsibility to their professional employees, patients, and society.

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AIMS: To develop and test the relationship between nurse champions' personal social networks and innovation success in terms of spread. DESIGN: A cross sectional. METHOD(S): Data were collected on 94 nurse champions at three medium-large tertiary medical centres from 2015-2016. Data from champions on their personal network were assessed via a standardized and acceptable three-step network survey. Success in terms of innovation spread was assessed via perceived extent of spread. Network structural and relational characteristics were depicted by level of spread. Multivariate linear regression was used to assess the relationship between network characteristics and innovation spread. FINDINGS: Above and beyond various project and network control variables, network density was significantly and positively related to project spread, tie-strength diversity was significantly and negatively related to project spread and difference in ethnic origin between champions and alters was significantly and positively related to project spread. Maximum age of network members was marginally significantly related to project spread. CONCLUSION(S): Our findings show that high-density personal social networks; networks where tie strength among network members is similar, thus, creating liking and trust among members; having at least one older network member who might have close access to professional and organizational resources acquired throughout their career; and having ties with network members from different ethnic groups to prevent knowledge stickiness, all promote innovation spread. Champions should be carefully nominated based on their ability to engage network members and to build ties with various network members inside and outside the nursing unit; once selected, champions should be aware of their social networks. IMPACT: The current study explored champions' personal-network structure, composition and variance measures and their implications for innovation project spread. The findings demonstrated that nursing champions' personal social networks matter for innovation spread. This finding has implications for the nominating and the coaching of champions.

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BACKGROUND: Frontline nurse champions are key innovation-implementation agents. Despite the growing interest in nurse champions' innovation, whether project novelty is a product of championship behavior (e.g., expressing confidence in the innovation's success and network building), the project's contextual characteristics (project type and initiation level), or their joint effects, remains unsolved. PURPOSE: To develop and test an interactionist model of project novelty in nursing. METHODS: A cross-sectional design with a multisource approach to data collection. FINDINGS: Results demonstrated a direct effect of project type, a two-way interaction effect of level of initiation and project type, a two-way interaction effect of championship and project type, and a three-way interaction effect of project type, initiation level, and championship on project's novelty. DISCUSSION: Bottom-up service and administrative projects require champions' championship behaviors to foster novelty, whereas for bottom-up quality-improvement projects, such behaviors can harm project novelty. For human-resource projects and for top-down projects, championship behaviors do not matter.

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AIMS: To identify the sociodemographic attributes, project characteristics and champion strategies that differentiate formal from informal nursing champions, and to test their success in terms of project spread and novelty. BACKGROUND: Champions spread innovation in healthcare organizations. Empirical research has not explored the differences between formal and informal champions in terms of their antecedents and success. DESIGN: A quantitative cross-sectional design. METHOD: Data were collected on 93 nursing champions in three hospitals from 2015 - 2016. Champions were identified according to a validated approach; data on their sociodemographic attributes, project characteristics and strategies were assembled through interviews and validated questionnaires. Their success in terms of novelty and spread was assessed via expert ratings and validated questionnaire. FINDINGS: Informal champions had longer tenure and were involved mainly in bottom-up projects aimed mostly at improving human resources and services; formal champions were mostly involved in top-down projects aimed at quality control. Informal champions expressed more enthusiasm and confidence about the innovation; formal champions tended to use more online resources and peer-monitoring strategies. Projects of informal champions were more novel than those of formal champions. Project spread did not differ between the two groups. CONCLUSION: Formal and informal champions differ in their characteristics and implementation strategies. To encourage project's innovation, the organizational climate should encourage the emergence of informal champions; formal and informal champions should be chosen wisely, assuring that they possess enough organizational resources; and coaching programmes for junior champions should be planned to equip them with championing behaviours.

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