1. Hughes, Candace RN, MSN
  2. Kring, Daria RN, BC, MSN


Team perception on a medical-surgical department improved after the implementation of a dedicated charge nurse staffing strategy.


Article Content

Nurses on a busy, 40-bed medical-surgical nursing department were averaging six to seven patients per assignment, with ancillary support from nursing technicians. During each shift, one nurse assumed charge nurse duties that included staff assignments, management of call-outs, communication with bed control, and supervision of problems and concerns during the shift.


Though charge nurses received an orientation before taking on this added duty, different nurses experienced implementation differently. These differences led to staff confusion and dissatisfaction regarding expectations for assistance and resourcing. Nurses assigned to the charge role often were unaware of problems that had surfaced the previous day.


Charge nurse redesign

In an effort to improve department workflow and nurse satisfaction, the department director secured an added RN position that would act solely as a dedicated charge nurse. The new hire's hours stretched over the department's busiest time, from 8:30 a.m. to 5 p.m., Monday through Friday. The department was committed to maintaining the purity of the role by agreeing to stop the rotation of charge nurse duties and avoiding charge nurse patient assignments, even when call-ins increased staff-to-patient ratios. The position has included all former duties of the role, plus increased accountability for complex patient care conferences and attendance at a daily house-wide bed meeting.


The charge nurse is the constant in the center of all activities, as his or her role is to oversee the efficient functioning of the department. He or she has a responsibility to the nursing staff to ensure available resources in order to provide safe patient care. 1


Nursing staff looks to the charge nurse as the frontline manager. Charge nurses are recognized for their communication and organizational skills, as well as their ability to delegate, think critically, troubleshoot, and remain proactive. Experts indicate that behaviors the charge nurse may use to gain trust, foster cooperation, and promote job satisfaction include fairness, consistency, support, recognizing individuals for their efforts, and checking with them during their shift. 2


Results realized

To measure success of the program, staff completed a team success survey before implementing the dedicated charge nurse role. The measure was a 15-question Likert scale survey that explored staff's perceptions of teamwork in the department. Six months after implementation, the same survey tool was readministered. Improvements in staff perceptions of teamwork were consistent for every question. The postimplementation surveys showed a significant increase in perception of teamwork. The biggest change in team perception occurred around improvements in conflict resolution.


Having a strong, consistent charge nurse can improve teamwork in nursing departments. The dedicated charge nurse can refine skills in communication, conflict resolution, and handling department-specific issues.




1. Mahlmeister, L., and Koniak-Griffin, D.: "Professional Accountability and Legal Liability for the Team Leader and Charge Nurse,"JOGNN: Journal of Obstetric, Gynecologic, & Neonatal Nursing. 28(3):300-309, 1999. [Context Link]


2. Sonnenberg, D.: "Life in the Fast Lane: Helpful Tips for the OR,"AORN Journal. 69(5):941-944, 1999. [Context Link]