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Learning Objective 1: describe leadership qualities of front line leaders
Learning Objective 2: identify how consistent foundational knowledge of leadership, delegation, and communication strategies can enhance charge nurse performance.
Background: There is a general recognition that confident leadership is key to successful organizations. This appreciation exists at both the senior and unit levels of organizations yet the literature is sparse regarding the development of charge nurses, a critical frontline leader. It is no longer sufficient for charge nurses to be strong clinicians. As organizational structures have flattened, the responsibilities of the charge nurse have expanded and evolved (Connelly, 2003, Sherman, 2005). Additionally, the complexity of healthcare delivery and the demands placed on the charge nurse have increased. To be effective, charge nurses must also be effective leaders, navigating increasing patient complexity and acuities while maintaining interdisciplinary team relationships and unit morale (Porter O’Grady, 2006). Review of the literature revealed agreement regarding the development of leadership skills and abilities in the clinical arena resulting in improved patient safety and staff satisfaction yet little attention has been paid to the organizational requirements of effective charge nurses. The purpose of this study was to examine the perceptions of staff nurses that assumed the charge nurse role to determine if interactive, didactic education would improve confidence resulting in less frustration and greater satisfaction for staff assuming the charge nurse role.
Intervention: Nurses assuming the charge nurse role expressed frustration, dissatisfaction, vague understanding of what was expected when identified as the charge nurse, and recognition that past experiences did not necessarily prepare them to confidently execute charge nurse responsibilities. This led a group of nursing leaders, managers, educators, and staff nurses into the process of developing a relevant and Charge Nurse Role educational series. After examination of staff satisfaction survey results, listening to concerns expressed by staff nurses, and identifying the day to day frustrations within this group, the leadership team identified a void in the development of the charge nurse role. Nurse Managers established that the criterion used to identify a charge nurse for a given shift was typically tenure in the organization rather than leadership abilities, knowledge, and strong interpersonal skills. In reviewing the position descriptions for charge nurses and brainstorming the role expectations within the organization, it became apparent that there was a gap between the knowledge, skills, and execution of the desired behaviors for charge nurses throughout the organization.
Sixty five nurses attended a series of 3 educational workshops for charge nurse development. Self evaluation of leadership abilities and behaviors were completed during the first session of the educational program. The topical outline included examination of leadership and management, delegation, RN scope of practice and legal responsibility, conflict management, nursing image and socialization, team building, and decision making. The third workshop was constructed around scenarios developed by the unit managers with facilitated dialogue, role playing, and group evaluation to assimilate common experiences of the charge nurse on varied units. Application of information covered in the first two workshops was highlighted to demonstrate the nurse managers understanding of the difficulties charge nurses face and to offer visual and verbal support to the charge nurses as they made thoughtful but often difficult decisions when placed in the charge nurse role. Findings:
Evaluations for each of the educational sessions were collected and 90% of the attendees identified the educational offerings as excellent or very good. Comments identified that the attendees appreciated the time to examine there own thoughts and feelings (82%) with comments revealing they felt they had been given words and language to discuss, describe, and explain their experiences. 96% of the attendees identified that they had not had any formal training in delegation, in fact they learned by observing others without an appreciation for the deliberate steps in the delegation process that would lead to effectiveness. Summary/Recommendations:
Staff nurses selected for the charge nurse workshop series have been enthusiastic about the value of these educational sessions. Nurse Managers have observed increase confidence in decision making and assertive communication between the charge nurses when executing the charge nurse role. Staff nurses overwhelmingly identified the desire for ongoing education and readily identified topics for future sessions to include role playing, conflict management, group dynamics, and assertive communication strategies. Additionally, the charge nurse evaluations identified a new appreciation for existing leadership abilities and the power of different perspectives related to old problems. Many nurses described a renewed sense of pride in the profession and an appreciation for the organizations willingness to invest in their professional development. Connelly, L., Yoder, L., and Miner-Williams, D. (2003). A Qualitative Study of Charge Nurse Competencies, MedSurg Nursing, 12(5), 298-305.
Connelly, L., Nabarrete, S., and Smith, K. (2003). A Charge Nurse Workshop based on Research, Journal for Nurses in Staff Development, 19(4), 203–208.
Porter O’Grady, and Malloch, K. (2006). Quantum Leadership: A Resource for Healthcare Innovation (2nd Edition). Jones and Bartlett Inc.
Sherman, R. (2005). Don’t Forget Our Charge Nurses, Nursing Economics, 23(3), 125-130 & 143.