By Rose O. Sherman, EdD, RN, FAAN
This week, I am attending the Sigma Theta Tau 41st Biennial Convention in Dallas, Texas. For those of you not familiar with Sigma Theta Tau, it is an international nursing honor society with chapters in 86 countries. I am attending the conference to present the findings of a research study that was done in 2010 involving charge nurses and their perspectives on their role. Many of you reading this blog may be charge nurses or ward sisters. The study was designed to examine what qualities charge nurses need today, their challenges, role satisfiers and whether the charge nurses surveyed would consider applying for a nurse manager role. 354 charge nurses from ten hospitals in a large health care system participated in the study. Here are some of our key findings:
Qualities needed by Charge Nurses Today
When considering nurses for charge nurse roles, nurses currently in the role identified communication as a critical quality for success. Study participants noted that communication is challenging in today’s rapidly changing health care environment where many different staff are involved with the care of patients. Good communication was viewed as being critical to patient safety. The role of the charge nurse was described as being similiar to an air traffic controller. Charge nurses need strong organizational skills to organize the work of their teams. They also need to effectively manage their own time and control their own stress levels. Clinical competence in one’s area of assignment was identified as being important to effectively coach and mentor others. The quality of being approachable and non-judgmental was seen as critical. Younger, less experienced staff need to feel safe when seeking help to avoid making errors.
Charge nurses identified managing conflict on their teams as the most signficant challenge they face in their roles. This conflict can occur between nursing team members, with physicians or other departments. With four generations in the workplace, team members have different values, beliefs, ideas about loyalty and preferred methods of communication. In the past, conflict was usually confined to the workplace. The rise of social networking sites such as Facebook have added a new dimension to relationships and discussion among team members. Charge nurses reported that finding the time and having the skill to work through conflict is difficult.
With frequent changes in regulatory requirements related to patient safety, pay for performance initiatives, technology and organizational expectations, charge nurses reported difficulty staying current with policies and procedures. Many noted that they were finding the pace of change to be exhausting. Delegation of care in hospital environments with high patient acuity was also noted to be challenging. Charge nurses need to carefully consider the competency level of their staff and the needs of the patient when making an assignment. Knowing when to step in to help staff and when to step back to allow staff to manage complex situations is a balancing act.
Although there are challenges in the role, charge nurses were readily able to identify what they enjoy in work. The opportunity to develop staff was a theme that resonated with many of the charge nurses. They wrote about the joy of watching new graduates develop into confident professionals under their mentorship. Although keeping patients and families happy was noted to be challenge, the ability to help patients achieve good outcomes was a strong satisfier. Hearing positive feedback about their leadership from their team members and knowing that they are making a difference are strong motivators for charge nurses. Some charge nurses reported that seeing their own growth in their leadership role led to a sense of achievement.
Moving into the Nurse Manager Role
Succession planning is a key concern for many organizations today. When nurse manager vacancies become available, charge nurses are often considered excellent potential candidates. In this study, only 34% of charge nurses indicated that they would definitely consider a nurse manager role with 21% indicating that they definitely would not consider the role. Charge nurses have a strong appreciation of what is expected of their nurse managers. Some charge nurses reported that with overtime and shift differential, they made more money than their manager. There was also concern about losing clinical skills and connections to patients.
This was a small study conducted in one geographic area. The findings may or may not be applicable to charge nurses in other settings. There is very little research that has been done with nurse leaders at this level of the organization. Authors who have studied the role agree that being a charge nurse in today’s healthcare environment is a skillful balancing act and not all organizations provide the type of leadership training that the charge nurse may need. Because they usually have roles that involve limited formal leadership power, their impact on patient care and other outcomes is often less visible at the organizational level. Yet as the administrative responsibilities of nurse managers have increased, more is expected of the charge nurse. Hopefully in the future, we will see more research directed at examining this important nursing role.
Read to Lead
L.M. Connelly, L.H. Yoder and D. Miner-Williams, “A qualitative study of charge nurse competencies,” MEDSURG Nursing, vol.12, no.5, pp. 298-306, 2003.
M.A. Jasper, L. Grundy, E. Curry, E. and L. Jones, “Challenges in designing an all-Wales professional development programme to
empower ward sisters and charge nurses,” Journal of Nursing Management, vol.18, no. 6, pp. 645-653, 2010.
Sherman, R.O. Frontline Nurse Leader Nurse Leader Development. Sigma Theta Tau Biennial Conference. 2011 Charge Nurse Research
*Sherman, R.O., Schwarzkopf, R. & Kiger, A. (2011). Charge nurse perspectives on frontline leadership in acute care environments. International Scholarly Research Network: ISRN Nursing, 11(Article ID. 164052), doi:10.5402/2011/164052. Click Here for Article
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