Abstract
Objective: To describe the development and evaluation of a permanent charge nurse role and report outcomes of this leadership model over 4 years.
Background: A permanent charge nurse role was developed to improve continuity of care and develop emerging nurse leaders. An evaluation model was constructed to measure program outcomes. Kouzes and Posner's Leadership Model served as the theoretical framework.
Methods: The permanent charge nurse role was developed, training planned, and the evaluation framework established. Measurements included two survey instruments, an investigator-developed End-of-Shift Report, and institutional patient satisfaction data. Survey instruments included Kouzes and Posner's Leadership Practice Inventory (LPI), concurrently measuring self (charge) and other (staff) perceptions of charge leadership. The McClosky Mueller Satisfaction Scale (MMSS) measured charge and staff nurse job satisfaction. Data were collected at baseline, post-implementation, and additional time periods.
Results: Charge RNs reported significantly more favorable perceptions of leadership abilities than staff. The Shift Report successfully tracked both system and charge management issues. Patient satisfaction data did not yield data due to vendor changes. Job satisfaction results showed charge nurses reported higher satisfaction with schedule, praise and recognition, control and responsibility, than staff nurses.
Conclusions: Using data to evaluate charge nurse leadership guides continued program improvements.
Leadership is critical to managing patients toward optimal clinical outcomes. Changing patterns of care delivery and constrained resources require nursing leaders to be responsive, demonstrate flexibility, and hold what Kantor describes as the "C" skills: know the concepts and principles of leadership, demonstrate competence in the role of leader, and make the interpersonal connections needed to be successful in the role. 1 Mergers, flattened organizational structures, and increased spans of control have resulted in heightened nurse executive role expectations. The literature reflects the call for extraordinary nursing leadership, with articles describing the importance of leaders incorporating multiple theories into practice, including transformational leadership, 2,3 organizational empowerment, 4 and care-centered governance. 5
Questions have been raised regarding what is the ideal management structure for organizing the leadership team in acute care hospitals. Many hospitals still have a traditional nursing management structure, with an assistant head nurse, head nurse, director, then senior director reporting to the vice president or chief nursing officer. At the University of Colorado Hospital (UCH), the nurse executive leadership team decided 6 years ago to eliminate the nurse manager role, which represented part of the hospital's traditional nursing structure, and instead initiate a director model and a permanent charge nurse role.