Of the roughly three million licensed registered nurses (RNs) living in the United States (U.S.), about two-thirds are employed as staff nurses, which are defined as front-line RNs who spend the majority of their work day providing direct patient care in the clinical setting. The majority of staff nurses in the U.S. hold diploma, associate, or baccalaureate degrees in nursing (U.S. Department of Health and Human Services, 2013). Although some of these degree programs incorporate leadership education into their curricula, the majority of formal leadership training takes place in graduate and advanced nursing degree programs (American Association of Colleges of Nursing, 2015). Staff nurses cite this lack of formal training and education as the greatest barrier to pursuing leadership opportunities on their units, including charge nurse, team leader, and committee chair roles (Gerrish, Ashworth, Lacey, & Bailey, 2008; Wojciechowski, Ritze-Cullen, & Tyrrell, 2011; Dearmon, Riley, Mestas, & Buckner, 2015). Few resources for staff nurse leadership education exist. This is concerning because existing literature demonstrates that effective nursing leadership is instrumental in improving staff retention, safety, and patient outcomes (Wojciechowski et al., 2011; Mendes & Fradique, 2014; Dierckx de Casterle, Willemse, Verschueren, & Milis; Abraham, 2011).
Purpose
The purpose of this review was to explore the existing literature on staff nurse leadership and staff nurse leadership education to identify benefits, barriers, and knowledge gaps related to these topics, as well as to make evidence-based recommendations for a curriculum that is designed to prepare staff nurses to assume and maintain leadership roles.
Method
A broad literature search was conducted using the PubMed and CINAHL databases. Keyword searches used the terms nurse leadership, staff nurse leader, charge nurse role, staff nurse leader education, and nursing leadership education. Articles were excluded if they focused on high-level management positions in nursing and nursing leadership positions requiring advanced degrees, as this was not the focus of this review. A total of 18 articles were considered for the purpose of this review. The Quality and Safety Education for Nurses (QSEN) Institute has defined six core competencies to aid in curricular development for continuing education programs: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (Cronenwett et al., 2007). The findings from this literature review are related to these six core competencies.
Findings
Well prepared and competent staff nurse leaders can make positive transformations on the unit and improve patient outcomes. They report an increased sense of purpose, responsibility, empowerment, confidence, and job satisfaction. By contrast, poorly trained staff nurse leaders report decreased job satisfaction, lower self-confidence, increased stress, and a higher rate of burnout. Lack of time and lack of resources were cited as barriers to improved staff nurse leader education, and nurses identified lack of training and education as the most common barrier to pursuing a staff nurse leader role. Additionally, nurses reported increased workload and responsibility without appropriate financial compensation, authority, and autonomy were major barriers to pursuing a staff nurse leader role.
Communication is the greatest educational need for staff nurse leaders. This includes training on communicating effectively with patients, families, staff, administrators, physicians, and other members of the interdisciplinary team. Communication also includes conflict management, engaging and motivating team members, and creating a sense of community on the unit. Organizational skills were the second most-commonly identified educational needs for staff nurse leaders, including budgeting, multitasking, prioritizing, delegation, and goal-setting. Other educational needs included ethical and legal issues, work-life balance, stress management, self-reflection and self-awareness, and stress management.
Significance and Implications for Nursing
There is a need for improved leadership education targeted directly at staff nurses. Effective curricula for staff nurse leader education should include the topics of need identified in the literature, which dovetail with the six core competencies of the QSEN institute. Staff nurse leaders should prioritize educational pursuits based on their self-identified areas of weakness and unit needs. The most commonly preferred methods of education delivery among staff nurses are self-paced online educational modules and webinars; however, some nurses still prefer face-to-face classroom sessions (Abraham, 2011; George, 2002; Wojciechowski et al., 2011). Case studies and simulated scenarios with group discussion and debriefing were identified as effective methods of learning in the literature and should be incorporated into course delivery (Abraham, 2011; Krugman & Smith, 2003; Pollard & Wild, 2014). Continuing leadership education allows staff nurses to use their charge nurse or team leader role as a stepping stone to upper-level management and administration and can be the impetus for a staff nurse to embark on a career as a regional, national, and international nurse leader.