1. McKinney, Cheryl French MSN, RN-BC, CRRN

Article Content


Debbie did not actively seek the position of clinical charge nurse on the unit, but her natural abilities as a leader and gift for organization had made her an obvious candidate for the job. As a bedside nurse, she had occasionally filled in as "relief charge," and when the current charge nurse relocated and left the hospital, Debbie suddenly found herself doing the job full time. Basic nursing education had not really prepared her for this role, and the hospital had no formal program to prepare her for these new responsibilities.


Nurses are often placed in managerial positions without sufficient educational preparation, leaving them without the skills needed to function effectively (Heller et al., 2004). In the three hospitals within the Health First system in Central Florida, there were more than 130 nurses functioning as clinical charge nurses in 2004. Although most received an orientation to the position and spent some time with a preceptor, there was no formal preparation for their move into clinical management.


Early in 2004, equipping charge nurses to better carry out their responsibilities became a priority of both the clinical educators from the Health First Center for Learning and nursing leadership in the three Health First hospitals. There was increased awareness within the organization that a lack of management skills and clarity regarding role expectations could lead to inefficiency and dissatisfaction in the job (Staten, Mangalindan, Saylor, & Stuenkel, 2003).



In late February of 2004, the Health First Center for Learning conducted a needs assessment of 133 charge nurses within the organization. The charge nurses were asked to list their top four educational needs, focusing on areas that would enhance their ability to successfully carry out their responsibilities.


The following responses were mentioned by multiple charge nurses and were ranked by the number of times mentioned:


1. Conflict management/communicating with difficult employees


2. Basic finances/budget


3. Time management/balancing administrative duties versus clinical duties


4. Conflict management/communicating with patients and families


5. Conflict management/communicating with physicians and offices


6. Writing and presenting evaluations


7. Delegation


8. Stress management


9. Scheduling


10. Motivating employees/obtaining employee buy-in.



The clinical charge nurse job description was reviewed to validate that the needs identified fell within the scope of the charge nurse. Several nurse managers and directors were also contacted and asked to review the identified needs and validate the need for education from a work performance perspective. All of the needs identified by the charge nurses were validated by work performance observations of nurse managers and directors. Four others education needs were also identified:


1. Management pitfalls to avoid


2. Understanding of evidence-based practice/research


3. Job responsibilities


4. Diversity in the workplace




Nursing leaders at all three hospitals were strongly supportive of this educational endeavor and met to discuss options. They agreed to financially support the attendance of all the charge nurses at a series of eight 4-hour classes and to pay for a textbook for each charge nurse as well as a commemorative pin for those who completed all of the classes. Initially, each class would be held at two different locations in the organization to better facilitate attendance. At one location, the classes would be offered one class per week over an 8-week period. At the other location, classes were offered over a 4-week period, with two classes offered the same day once a week for the 4 weeks. The target date for initiating classes was October 2004.


Learning needs were grouped into categories for classes, and learning objectives were developed. At that point, a search was initiated to identify content experts for each of the planned classes. It was believed by the planning team that it was important to use experts within the organization if at all possible. These internal experts in many cases had already established credibility with the charge nurses and were familiar with their work environment. It was believed that those experts might more easily relate to the nurses and their concerns. In addition, as is the case in most hospital organizations, the need for conservative fiscal management was a must.


A search also began for a textbook that charge nurses could use for reference. Several books were reviewed, and the text by Yoder-Wise (2003) was selected. Copies were purchased for each nurse who would be attending the program.



Eight classes made up the program:


Class 1: "The Role of the Charge Nurse" addressed such topics as role identification, responsibilities and accountabilities, decision making and shared governance, evidence-based practice, and professional development.


Class 2: "Delegation" addressed delegation guidelines and expectations, with attention to recommendations from American Nurses Association, regulatory agencies, and the Florida Nurse Practice Act. It also addressed the challenges of delegating, including budget considerations, staffing levels, and competencies.


Class 3: "Ensuring Value" addressed an area that was high on the list of educational priorities. This was the area of finance and budgeting. Many of the new charge nurses did not even know what an FTE was or how staffing habits could affect the budget.


Class 4: "People-Part A" discussed communication techniques and skills and customer service with a focus on service recovery. This learning need was one that was high on the list of priorities. Basic communications skills are a necessary foundation for other skills that the charge nurses needed to do their job well. Some basic information on biomedical ethics was also included on this day.


Class 5: "People-Part B" provided charge nurses with some ideas for motivating staff through rewards and recognition. In addition, different styles of management were discussed as well as the effect of management styles on retention. This was followed by practical conflict management techniques.


Class 6: "People-Part C" addressed diversity in the workplace. In this class, the focus was not on patient diversity but on staff diversity. Cultural, generational, educational, and religious diversity was addressed with time spent on identifying areas of potential conflict and how to avoid them.


Class 7: "Interviews and Evaluations" included improving interviewing skills, writing objective evaluations, and providing coaching and discipline in a constructive manner.


Class 8: "Taking Care of Yourself" was designed to help the charge nurses develop skills to avoid burnout. It included tips on time management, identifying stress, and developing stress management techniques.



Speakers selected for these classes were a diverse group of professionals from the organization. They included the vice president of patient care services, the director of pastoral care, human resource professionals, nurse managers and directors, and clinical nurse specialists as well as the educators from the Health First Center for Learning.



The first classes were scheduled to begin in October of 2004. Rooms were booked, speakers were confirmed, and flyers and registration material went out to the three hospitals. However, plans had to be revised and classes rescheduled after Central Florida was hit by Hurricanes Frances and Jeanne in September of that year. The difficult aftermath of the hurricanes and the challenge of providing for not only patients but also affected staff became the priority for everyone.


Although that obstacle changed the timetable for delivering the education, it was a relatively minor obstacle compared with the challenge of designing and delivering a program in a multihospital system. The most challenging obstacles were those often inherent to working within a multihospital system. It was very important to get "buy in" across the organization, and that required obtaining the cooperation and support of nursing leaders from three different hospitals. Each group was understandably concerned with ensuring that the needs of the nurses from their hospital would be met. It was very important that individual nursing leaders recognized the importance of a program that would meet the needs of not just the nurses in their individual hospital but also all the charge nurses throughout the organization. Accomplishing that goal was sometimes frustrating but was essential. Using the results of the corporate-wide needs assessment helped secure support for the curriculum, as did allowing for two methods of course provision to assist in meeting individual scheduling needs.



The first class was given on November 16, 2004, and repeated the next day. A total of 67 nurses attended those first classes. Since that time, the entire eight-class program has been repeated several times. Evaluation by those attending the program has been very positive. The charge nurses have indicated that the learning objectives were met, and as a result, they felt better prepared to do their jobs. Many expressed regret that they had not had the classes available to them before taking on their role.


Of the 60 nurses who completed all of the classes in the Charge Nurse Development Program in the first 18 months it was offered, only 4 no longer worked for the organization 2 years later, all of whom left their positions to relocate outside of the area. Several of the charge nurses who have completed the program have moved into the role of nurse manager.



As the organization recognizes the need for both succession planning in the nursing profession (Bolton & Roy, 2004) and professional development, more nurses who provide relief for charge nurses or who are interested in moving into that role will be encouraged to attend the program. It is also important that the curriculum be dynamic and education needs be periodically assessed to determine the continued relevance of individual classes in the program and the need to add additional topics.




Bolton, J., & Roy, W. (2004). Succession planning: Securing the future. Journal of Nursing Administration, 34(12), 589-593. [Context Link]


Heller, B. R., Drenkard, K., Espisito-Herr, M., Romano, C., Tom, S., & Valentine, N. (2004). Educating nurses for leadership roles. Journal of Continuing Education in Nursing, 35(5), 203-210. [Context Link]


Staten, D., Mangalindan, M., Saylor, C., & Stuenkel, D. (2003). Staff nurse perceptions of the work environment: A comparison among ethnic backgrounds. Journal of Nursing Care Quality, 18(3), 202-208. [Context Link]


Yoder-Wise, P. S. (2003). Leading and managing in nursing (3rd ed.). St. Louis, MO: Mosby. [Context Link]