Incoming Nursing Excellence

Nurse Leader
Volume 11, Issue 1 , Pages 34-39, February 2013

What We Learned From Our Charge Nurses

ABSTRACT:

If you engage any group of executive nurse leaders in a conversation about today's healthcare system, they are likely to tell you that it is the most challenging environment that they have experienced in their careers. The business of caring has become exceedingly complex. During the past decade, the cost of care in the United States has skyrocketed to an average cost of over $8,000 per year per person. Left unchecked, we could spend over $13,000 per person by 2018.¹ It is not surprising that the recent debates on healthcare reform have focused on how costs can be reduced. Payment incentives are quickly moving away from volume-based incentives toward a greater focus on value of services and health outcomes, including fewer hospitalizations. These changes have increased pressure on nurse leaders to operate organizations that are more efficient while improving quality and patient outcomes. In many organizations, this has meant streamlining the number of nursing leader positions while increasing the role responsibilities and span of control of managers and directors. As an outcome of these changes, more responsibility is given to charge nurses who are leading at the frontline of care.³, ⁴ The impact of charge nurses on the smooth functioning of units and patient care outcomes is underappreciated by non-nurse executive leaders. It is not unusual for charge nurses to assume these roles without any leadership development.⁵, ⁶, ⁷ As their administrative responsibilities have expanded, nurse managers depend on these frontline leaders to assume responsibility for quality outcomes and organizational performance measures.

The nurse executive leadership of Tenet Healthcare, who have responsibility for 49 acute care facilities and 1 long-term care facility in the United States, recognized these challenges, and committed to a journey to develop frontline nurse leaders. The purpose of this article is to share what Tenet nurse executives in South Florida learned from their charge nurses about their role. The insights discussed were gained through an assessment of charge nurse learning needs and participant feedback from two workshops conducted in 2010 and 2011.

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