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
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."
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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