Charge Nurse Education: Intersecting Reflective Practice with Role Expectations

Thomas, Patricia

 

Background: As the complexity of healthcare delivery increases, demands placed on charge nurse to effectively and efficiently manage the unit are increasing exponentially (Connelly, Nabarrete, & Smith, 2003; Hughes & Kring, 2005). Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders. No longer a role suited for ‘on the job training’ or learning solely through observation, this charge nurse educational series was developed to address the gap between staff nurse confidence in executing charge nurse role expectations and the perceptions of the Nurse Managers that the staff did not understand the importance or implications of the charge nurse role.

Sixty five staff nurses were selected by their unit manager to participate in a three part, 12 hour series of educational sessions to highlight the role expectations described in the Charge Nurse Position description. Feedback from staff satisfaction surveys identified the need for Nurse Managers to more clearly articulate the performance expectations of the Charge Nurse and to offer a venue where interactive learning and application of skills could be demonstrated. Staff perceived deficits in their ability to manage conflict and delegate appropriately but believed the lack of clarity and consistency in the execution of the charge nurse role from one shift to another and one unit to another added further frustrations that were not being addressed.

Nurse Managers brainstormed content areas for inclusion in the educational series. Six 6 core content areas were identified.

1.      Daily charge nurse role expectations

2.      Conflict resolution and negotiation

3.      Team building and communication

4.      Delegation and Scope of Practice

5.      Critical thinking and Problem Solving

6.      Legal implications of professional practice

The first four hour session focused on charge nurse expectations, conflict resolution and delegation. The second four hour session focused on critical thinking/problem solving, team building and communication. The third session was devoted to Nurse Manager led application of the principles previously covered to include role playing, interactive scenarios, and practical application of identified practice situations. During this session, an emphasis was placed on mentoring, support, and avenues to communicate concerns.

Level of Educational Program: Hospital staff nurses that assumed the charge nurse role.

Targeted Learning Outcomes:

1.      Establish clarity for charge nurse role expectations

2.      Practice self assessment and reflection to evaluate strengths and growth areas when assuming the charge nurse role

Teaching/Learning Activities: Didactic materials for each content area; Role playing, scenarios, case studies, self assessments, and pre-test/post test

Evaluation: Program evaluation consisted of: 1) an overall program evaluation tool; 2) pre-test/post test for each content area; and 3) a ‘one minute paper’. The one minute paper included 5 questions to summarize the most helpful, least helpful and most beneficial information followed by what new things were learned and what the participant would like to learn more about. The time between each session attended was 6-8 weeks, giving the nurses time to test new knowledge and skills before returning to the classroom.

 

Overall, the educational series received high marks, with greater than 90% of the participants rating the meeting of objectives for each session as excellent. The scores on the pre-test/post tests identified that greater attention could be focused on aspects of delegation and legal implications of the charge nurse role with nearly 1/3 of the nurses feeling additional time in these content areas were desired. The themes from the one minute papers highlighted personal awareness for how the nurses’ practice had changed based on exposure to content during the educational series with two thirds of the participants reporting greater confidence in executing the charge nurse role. Nurse Manager observation of charge nurse interactions and decision making during the shift verified a change in attitude, confidence, and actions for the staff that attended.

References

Connelly, L., Nabarrete, S. & Smith, K. (2003). A Charge Nurse Workshop Based on Research. Journal for Nurses in Staff Development, 19(4), 203-208.

Krugman, M. & Smith, V. (2003). Charge Nurse Leadership Development and Evaluation. Journal of Nursing Administration. Research in Nursing Administration. 33(5):284-292.

Hughes, C. & Kring, D. (2005). Consistent charge nurses improve teamwork. Nursing Management. 36(10), p.16.