Many nurses are reluctant to assume a Charge Nurse role, since they are often asked to do this without any education or training. Yet charge nurses play a critical role in helping their Nurse Manager or leader achieve desired financial and clinical outcomes. Examples include: staffing, scheduling, assignments, patient placement and throughput.
One key competency that Charge Nurses struggle with is learning how to delegate. Many find it is difficult to delegate tasks to peers, since they rely on peers for assistance with patient care later when not in the Charge Nurse role. Staffing in some organizations require the Charge Nurses to take a patient assignment, while in other hospitals they do not. But delegation is still a key competency Charge Nurses need to exhibit to assure that units run efficiently.
Following a delegation framework will help assure that the right task(s) will be assigned to the right staff member, under the best circumstance, and begin to answer issues of communication, supervision, and evaluation needed. Delegation remains an underdeveloped skill among nurses, and one that is difficult to measure - but it can be planned for! The following outlines components of the Rights of Delegation Model:
Assessment and Plan: As a Charge Nurse, am I giving the right tasks to the right nurse/staff member?
Communication: Is the Charge Nurse providing communication that puts the unit on the right path?
Supervision and Surveillance: Find the right amount of supervision for the unit
Observation and Feedback: Assess effectiveness of Charge Nurse Delegation
-OIJN/ANA . "Delegation Dilemmas: Standards and Skills for Practice" Pamela Cipriano, PhD, RN, NEA-BC, FAAN
-Emerging RN Leader. "How to Delegate Care" Rose Sherman, EdD, RN, FAAN
Winning Strategies for Charge Nurses
When transitioning from a staff nurse to a charge nurse position, it is important for new charge nurses to build trust and respect within the unit. With increased responsibilities as well as co-workers to manage, it helps to have a plan and an understanding of key nurse leader skills. Here are three winning strategies to help ensure success:
These skills and other behaviors can be emphasized through charge nurse leadership training. Learning programs that use real examples and scenarios will help charge nurses recognize where and how they can have a positive impact.
Many healthcare organizations invest in the development of new nurse leaders to increase engagement and retention, and ultimately improve patient care.
NCharge, created by Catalyst Learning Company, offers an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills and business knowledge they need to more effectively manage, inspire and lead. Please contact Catalyst Learning for information on charge nurse leadership training and how to strengthen nurse leader skills within your healthcare organization.
While strong performance often secure promotions in healthcare and nursing management, first-time supervisors may be navigating uncharted territory when it comes to leadership skills. In other words, the best employees don't always make the best leaders.
Gallup reports that the #1 reason people quit their jobs is a bad boss or immediate supervisor.
Poor leadership skills can have a ripple effect across a department or nursing unit. It's no secret that turnover can cost healthcare organizations thousands of dollars per employee.
Healthcare organizations can be proactive on this front and position first-time supervisors for success. Below are five of the common pitfalls you can help your first time supervisors and charge nurses to avoid.
Anxious to excel in their new position, frontline supervisors and charge nurses may have a tendency to micro-manage their teams. This negatively impacts productivity and team development and can leave managers feeling overwhelmed.
Some new supervisors fail to provide adequate direction because they don't want to appear bossy among colleagues who, until recently, were their peers. This can negatively impact employee engagement and lead to increased turnover as well.
Supervisors and charge nurses are in management positions because of their experience and knowledge, and sometimes they find it difficult to delegate tasks to those who are less experienced.
New managers can be so consumed with their new role and the increased responsibility that they forget to check-in with the team. Listening to the concerns of staff members is key to a supervisor's success.
When the University of Texas Medical Branch (UTMB) assessed its training needs in late 2015, nursing leadership recognized a gap in charge nurse development. With no formal tools in place and a somewhat inconsistent structure to the Charge Nurse position, UTMB decided to take action. Catalyst Learning's NCharge® courses were chosen to bring more commonality and consistency to this vital hospital role for both current and aspiring Charge Nurses. To date, 60 participants in three cohorts have completed all five NCharge courses: Charge Nurse Fundamentals; Critical Thinking; Leading Change in a Dynamic Climate; Supervisory Skills for Positive Outcomes; and Employee Engagement & The Patient Experience. Patient Care Facilitators (PCF), who have similar responsibilities to Certified Clinical Nurse Leaders, have also been included in this comprehensive professional development program. Because Charge Nurses often look to PCFs as experts on the patient care experience, UTMB determined that leadership training could equally benefit the PCF role, said Barbara Bonificio, Director of Nursing Excellence. Bonificio added that the NCharge program could become an important asset in a comprehensive health system initiative to increase employee engagement and patient satisfaction. In fact, UTMB leaders believed the program was valuable enough to include some of its relevant results at the unit level in UTMB's recent reapplication for Magnet status.
By putting in place formal training, UTMB hopes to make significant improvements not only in patient satisfaction, but also RN-to-RN communication, nurse sensitive indicators and workflow on the units. Comparisons of participant surveys conducted before classes began and after completion indicate positive movement in critical skills development across several of these areas.
Most notably, when asked if they were cognizant of the key drivers of positive patient experience, only about 65% of respondents strongly agreed when surveyed before taking classes. After completion of the program, more than 85% strongly agreed with that statement. When asked if they understood the linkage between employee engagement and the patient experience, nearly 90% strongly agreed after the course, up from less than 70% before entering the program. Also, only about 60% of respondents strongly agreed they were cognizant of key drivers of an engaged team prior to NCharge. That number jumped to close to 90% after completion.
A Timely Decision
When UTMB launched NCharge in December 2015, hospital staff was preparing to relocate to a new facility and would be faced with a new set of workflows. The program's Leading Change module proved to be timely, as all participants in the class were involved in this major move. One especially valuable component of the Leading Change module educated students about the change curve, demonstrating that workers at different levels in an organization also are at different stages of the curve, said Sharon Hensley, Nursing Program Manager. Those in leadership roles may have already processed a change, while frontline workers may have just been introduced to it. "That was very impactful for them," she said. Prior to taking the Leading Change class, only 55% of survey respondents strongly agreed they were cognizant of their role to assist the team with change management. After completion, nearly 90% strongly agreed. In terms of leadership, 100% of respondents reported strong agreement that they were cognizant of their influence on the attitude and tone of the unit, up from only 60% prior to the class.
Beyond these targeted outcomes, NCharge has been successful in helping to dispel some misconceptions and illuminate different perspectives. For example, before the courses, many participants believed value-based purchasing simply meant that if system departments bought in volume, UTMB got a discount. "The financial impact of value-based purchasing was a real eye-opener for everyone," said Bonificio. "I don't think they realized the significant dollar amounts attached to not being reimbursed, as well as the penalties for not reaching certain targets."
Because each cohort comprised a mix of experienced Charge Nurses and those hoping to land the role, NCharge was beneficial to both groups because they were exposed to each other's perspectives. In addition, the module on types of communication is already being put to use on the floor. "Participants learned the best way to talk to people whose communication styles are different than their own," said Bonificio. Now, graduates are "excited to share the skills they have learned with their units."
Looking to the Future
Reception to the NCharge program has been overwhelmingly positive overall, Hensley said. "There were significant dollars connected to the people being selected, and I think that was impressive to them - that we are investing in them." UTMB nurse leaders are happy with the program response and results so far, and plan to continue offering it to PCFs and Charge Nurses. In fact, they envision further advantages across other nursing roles. "It would be beneficial if all nurses could understand challenges their charge nurse colleagues face," according to Bonificio. "If everyone understood these challenges, it would make the units run much more smoothly."
When a unit is under the direction of a charge nurse, service recovery is an important part of their role. Whether they are coaching other RNs or answering directly to the patient or family, charge nurses can directly impact the patient experience.
The charge nurse's ability to communicate and lead can have a significant impact on management, patients and staff. With strong clinical skills they raise the bar on patient care, but charge nurses aren't always comfortable with the leadership side of their role.
A focus on charge nurse development can improve employee engagement and patient care. Healthcare organizations that empower charge nurses to lead will achieve better results.
Research has shown that frontline leaders like charge nurses play an important role in keeping team members engaged. They also serve as the first line of defense when there is an upset patient or visitor. These skills can be learned and strengthened through dedicated training.
First, help charge nurses assess their leadership skills by exploring questions such as:
Key Skills that Benefit Patients and Staff
With greater self-awareness, charge nurses will have a better understanding of the key skills they can put to use right away to benefit patients and staff. Training outcomes for charge nurses should include the ability to:
Saint Anthony Hospital staff worked hard to improve its Leapfrog Hospital Safety Grade from a D in 2014 to an A in October 2016. The nonprofit, community teaching hospital in Chicago found one key to success came in providing front-line nurse leadership with increased confidence and management tools that would help improve hospital standards and quality of care.
Finding the Right Curriculum
Saint Anthony’s development team was searching for a structured, in-depth learning program that would empower their nurses to take leadership to the next level. What they found was Catalyst Learning Company’s NCharge® Nurses Learning to Lead program. NCharge provided the detailed content and knowledge assessments they were looking for, with results that are measurable. By focusing on relevant leadership scenarios within the hospital, participants were able to easily relate and apply techniques to their everyday environment.
“Like most healthcare organizations, we are growing and changing. We were also in the process of reorganization. It was about sweeping clean on old ideas and looking for ways to be more efficient. Illinois is also tightening on funds and as a nonprofit hospital, we had to look at ways to be more efficient in how we were working and make our staff feel as if they have a way to advancement,” stated Jaqueline Napier, Manager of Talent and Development at Saint Anthony.
Leading with More Confidence
One important outcome noted by Saint Anthony management is the overall improved confidence among nursing leadership. Creating a more autonomous team has positively impacted the hospital environment and proven an effective influence regarding quality of care.
Sonia Haro, an ICU Staff Nurse and NCharge participant, committed her time to the NCharge series with specific objectives in mind. “I was looking for ways to communicate more effectively, especially when setting expectations for the team. Sometimes, not everyone feels like being a team player. I wanted to find a way to encourage my team but stay firm and reach expectations,” explained Haro. This was the type of leadership training that most staff nurses don't get with shadowing or clinical training. Haro was pleased with NCharge, which provided her with a better understanding of communication styles and techniques to handle a variety of situations confidently in the unit.
Haro wasn’t the only person who noticed a need for better communication and confidence from front-line nursing leaders. When Catalyst Learning surveyed nurse managers at Saint Anthony before the NCharge courses were implemented, less than 20% strongly agreed that the Charge Nurses in their departments displayed confidence when leading their teams. In addition, less than 30% agreed that Charge Nurses were cognizant of the key drivers of a positive patient experience. A few months after the training was held, the same nurse managers were surveyed and reported dramatic improvement with over 65% saying Charge Nurses were more confident and over 70% recognized key drivers in positive patient experience.
Cultivating Team Dynamics
A more efficient, collaborative environment was formed as a result of the NCharge leadership training. The team who completed training worked stronger and smarter together when handling obstacles. “I really wanted to work with others in the hospital in the same position. It’s nice to have others to lean on and run questions by, and share experiences with. Networking with my own colleagues was a great bonus,” stated Haro.
Elizabeth Negrete, Director of Perinatal and Pediatric Services, had staff who completed NCharge training. Staffing in OB, having the right number of staff and the right combination, had been a continuous issue. NCharge class participants looked at staffing and created plans to put the right skills and experience in the best combinations. “Now the staff are the ones doing the schedule, entering it in to the system and balancing. When the census goes down, they adjust appropriately based on the patient grid. This shows how they have been working more autonomously and are able to make important decisions with less guidance,” explained Negrete. “The Charge Nurses are working more in collaboration with the house managers. Before, staff managers were just telling them what the need was, but now the Charge Nurses are more empowered to speak up about needs.”
Haro reported that the rounding process has also gone through changes, giving the NCharge participants an opportunity to observe with fresh eyes what happens within the unit when everyone is not on board with a change. “It takes some buy-in from everyone, and there were days when we were just being run ragged. You could easily see that on days when the new process wasn’t being used, feelings and tensions were high,” conveyed Haro.
By equipping front-line leaders with the skills to embrace change, NCharge prepares staff for reaction from team members and how to move forward as a unit. This can be vitally important and impactful when trying to deal with the constant updates within hospitals. “There is always more trust from staff when changes come from Charge Nurses. There is more peer influence and impact. The staff has more of a buy-in because they know the Charge Nurses truly understand what the impact will be since they are on the frontline with them,” described Negrete.
Made evident in the impressive move of their Leapfrog Safety grade from a D in 2014 to an A in October 2016, the hospital seems to have found the key to success in increasing quality standards. Napier credits the NCharge series with being a factor in that improvement after implementation in early 2016.
The combination of increased confidence, more efficient staffing and adaptability to change have helped Saint Anthony become a more progressive, efficient hospital when it comes to patient care and standards. “The nurses are more cohesive as a team and moving towards a group environment where the charge nurses really stand out as leaders. They are really keeping their team members engaged. All of that correlates to the patient experience and how everyone is measured,” stated Napier. “Our people were skilled but now they have more confidence in those skills and their ability to engage the nurses on their team. They now understand how this all comes together to enhance the patient experience.” By giving front-line leaders new techniques to handle their day-to-day situations and changes, an environment of new ideas and proactive enthusiasm has been cultivated.
By investing in the front-line nursing leadership at Saint Anthony, stronger teams were built and the confidence instilled in the newly trained charge nurses was of great value. The return on investment for the Chicago hospital is shown through the recognition of receiving its first A rating from Leapfrog Hospital Safety Grade and becoming a top-rated hospital.
Market research tells us that many acute care facilities need to do more to equip their first-level nurse leaders with the tools to succeed. Hospitals report a need for them to be better motivators, delegators, and champions for change. In today's climate of hyper-fast transformation, also equipping the Charge RNs, Assistant Nurse Managers and other first-level supervisory nurses with "business of nursing" knowledge will assist your organization in meeting its financial goals.
The measures above are closely monitored by acute care facilities and payers, in part because of their direct impact on cost and profitability. The duties of a charge nurse touch each of these in many ways, every day. From bed assignments, patient flow, and discharges, to supply management and supporting improvement initiatives, these nurses do it all. The pressure is high and retention in these positions can be low.
CLC has conducted intensive research to learn which skills these acute care nurses need, according to their own experience. Using focus groups, surveys, and research of other qualified healthcare resources, certain trends became clear across many U.S. hospitals and medical centers:
Hospitals Need- better retention in these roles and improved ability to manage the business of nursing.
Today's Charge Nurses Need- more structured training on leadership, management and interpersonal skills - and not just online.
"Online can be bland, compliance driven. We prefer classroom-based, hands-on training. There is a benefit of getting away from the unit and getting a group together to share experiences." - Charge Nurse Focus Group Participant
The result is a series of courses accredited by the Tennessee Nurses Association (TNA) which meets all ANCC guidelines. NCharge® is dynamic, instructor led classroom training that integrates the business of nursing with the skills nurses need to perform at their best as supervisors.
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