An Evidence-Based Approach to Improving Performance Standards of the Charge Nurse Role in a Union Environment

Abstract 

Background

At Stanford and Lucille Packard Hospitals, the role of the Charge Nurse was not standardized. There were no competencies, formal training, nor mentoring. This impeded unit workflow; continuity of care; and the ability to provide adequate clinical support to staff, physicians, and patients. In addition, the role was being assigned to multiple staff, which decreased accountability and commitment. It was evident that the role needed to be more clearly enhanced and defined.

Methods

Making improvements to this position would be challenging in a union environment; therefore, staff participation and collaboration was the key. Fueled by a review of best practices found in the literature, a team of nurses including union representatives, Advanced Practice Nurses, and managers was convened to work on role development.

The work entailed an assessment of current practice, identification of characteristics of best and worst performance, development of competencies, defining the job description, and gaining consensus to decrease the number of staff performing in this capacity. Subsequently, staff were expected to reapply for this position and given a 3-month trial to meet the new competency expectations. Staff that met the new criteria or showed improvement were provided formal classroom training and informal mentoring. Surveys are currently being conducted to assess the perceived improvement in Charge Nurse performance.

Results

Outcomes from role restructure, structured classroom training, informal mentoring, and increased opportunities to perform the role has resulted in perceived and anecdotal evidence of increased accountability, satisfaction, and proficiency in role performance.

Conclusions

There has been a dramatic change in the performance of nurses in the Charge Nurse role. Results included an increased anticipation of workflow issues, a more proactive vs reactive approach to problem solving, smoother unit operations, and improvements in staff and physician satisfaction.