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."
Situation: Like many other healthcare organizations, Cincinnati Children’s Hospital Medical Center (CCHMC) faced a skills gap among its administrative staff. This large group of almost 850 employees includes admin assistants, customer service representatives, program coordinators, schedulers and access service representatives. The requirements and skills necessary to be a successful in an administrative role had changed over the last several years, while the talent and career development for these staff lagged behind.
At the same time, the hospital faced a shortage of external candidates resulting in constant vacancies. Adding to the challenge, on a more global scale in the healthcare industry, was that the title administrative assistant no longer reflected the skills and abilities of the professional, nor did it necessarily match the requirements of individual units within a healthcare system.
CCHMC, recognized not only as one of the “Best Places to Work” in Cincinnati for many years, but as the third in the nation for Pediatric Hospitals by US News and World Report, was facing a talent shortage— one that if not addressed, could have a significant impact on operations, employee engagement and patient satisfaction. CCHMC made a strategic decision to implement a career ladder program to improve employee versatility, and ultimately patient care.
Solution: In order to assess the career development needs among its administrative staff, CCHMC conducted a Morehead Employee Survey in 2012. The survey found that a significant number of administrative assistants wanted more support with career development and advancement opportunities.
This feedback further supported CCHMC’s overall staffing needs, prompting management to offer a tool and career coaching resource to assist administrative staff with career development and advancement. CCHMC was already successfully partnering with Catalyst Learning on School at Work® and so they decided to integrate CareerCare® to meet the Admin staff’s career management needs.
“Career development within a healthcare setting requires a variety of tools available to fit the unique needs of the various employees including their work schedules, family situations and educational goals,” said Beth Smith, BSN, employment support specialist for CCHMC. “School at Work and CareerCare provide the flexibility and scope to be able to identify the specific needs of the employee and select the appropriate tool which best meet the needs.”
CareerCare quickly became one of CCHMC’s primary tools for career development of its administrative staff, using the program in conjunction with personal career coaching and academic advising.To publicize the new service, management met with the leadership of the Administrative Assistant professional organization (C-CAP) within CCHMC to explain the new career development focus. In turn, that organization invited senior leadership and the career coach to present at their monthly membership meeting to recruit candidates to participate in the self-directed CareerCare project with career coaching.
Management continues to value CareerCare’s web-based approach because it provides flexibility for employees with different schedules, goals and educational backgrounds. Moreover, CareerCare allows employees to have a structured tool to use at their own pace to assess current skills, explore educational options, realize obstacles to achieving goals, and develop a realistic plan.
Results: Based on the reviews from the program’s participants, providing career development tools like CareerCare is essential to driving employment engagement. Elizabeth, an Administrative Assistant at CCHMC said, “I was able to complete the tool, and I found it very useful to help me identify my goals and then set my SMART goals. I have been successful in achieving a new position (one of my top goals) in Sponsored Programs-Accounting and will begin my new job as a grant accountant.”
Melinda, also an administrative assistant, voiced her support for the program as well. “I am thankful for the opportunity to be a part of CareerCare,” she said. “From my experience, it helps a lot when you are looking for direction in your career and you’re not exactly sure which way you should go.”
Cincinnati Children’s Hospital Medical Center is the third best children’s hospital in the U.S., according to Parents magazine. CCHMC was also inducted into the Cincinnati Business Courier’s “Best Places to Work Hall of Fame” after making the annual list for several consecutive years.
For more information on CareerCare, please email Brittany Gearhart at email@example.com or visit the CareerCare product page.
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: