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PERMANENT CHARGE NURSE POSITION: REVIEW OF THE EVIDENCE

PERMANENT CHARGE NURSE POSITION: REVIEW OF THE EVIDENCE. Gwendolyn Rook, BSN, RN Renee Twibell, DNS, RN, CNE Lynn Long, BSN, RN; Marcie Baird, BSN, RN; Angela Neeley, RN. Access Form. What are the benefits and drawbacks to having a permanent charge nurse?. Literature Search. 21 articles

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PERMANENT CHARGE NURSE POSITION: REVIEW OF THE EVIDENCE

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  1. PERMANENT CHARGE NURSE POSITION: REVIEW OF THE EVIDENCE Gwendolyn Rook, BSN, RN Renee Twibell, DNS, RN, CNE Lynn Long, BSN, RN; Marcie Baird, BSN, RN; Angela Neeley, RN

  2. Access Form What are the benefits and drawbacks to having a permanent charge nurse?

  3. Literature Search • 21 articles • 17 used in the review • 3 primary research studies • Not rigorous designs • 3 other research studies • Also not rigorous designs • 11 expert opinion articles

  4. Research • One quantitative study (Krugman & Smith, 2003) • Hired and trained 104 permanent charge nurses (CN) in one hospital and followed outcomes for four years • Results: • CN were more satisfied with self-scheduling, control and praise/recognition • CN were more positive about the position and their abilities than staff were • Fewer issues with staffing, supplies, medication delivery, IS downtime, and patient complaints • Unable to measure patient satisfaction • Frequent support and re-education was needed

  5. Research • Two studies interviewed nurses (n=42) • Found 54 competencies for CNs (Connelly et al., 2003a) • Clinical expertise • Leadership skills • Communication skills • Found 24 benefits/barriers (Connelly & Yoder, 2003) • Personal characteristics, such as flexibility, sense of humor, maturity, confidence • Organizational characteristics: staffing, administrative support

  6. Other Research Charge nurses consider factors other than acuity when making assignments (Bostrom & Suter, 1992) Consistently having a charge nurse increased teamwork and conflict resolution over 6 months (Hughes & Kring, 2005) Communication of CNs in OR could be handled by technology instead of in writing and in person. (Moss, Xiao & Zubiahda, 2002)

  7. Expert Opinion • Consensus on what charge nurses do • Oversee safe patient care on one unit • Resource to staff • Communicate to get resources • Arbitrate conflict • Educate staff

  8. Expert Opinion: Consensus on Outcomes of Having a CN Supports the research that having a CN reduces patient issues, reduces staff conflict, and creates better clinical outcomes One article calculated cost as $17,000 to start-up one CN and benefit as $179,000 savings/year in staff absenteeism, patient complaints and nurse turnover (Sherman, 2005).

  9. Expert Opinion Several articles suggest that the CN position is a professional growth opportunity for staff and a succession plan for replacing nurse managers.

  10. Expert Opinion: Consensus on Preparation for CNs Strong consensus that CNs need orientation and ongoing education and support to be effective

  11. Expert Opinion: Consensus on Requirements for CNs • Clinical expertise PLUS • Leadership Skills • Communication • Supervision • Delegation • Conflict management • Team building skills • Personal Characteristics: • Ability to manage time • Assertiveness and confidence • Flexibility • Maturity • Ability to learn from mistakes • Ability to handle stress

  12. Expert Opinion • Challenges CNs Face: • May lose clinical skills and be less helpful as a resource to staff • Peers may be resistant • Persistent short staffing increases unit tension

  13. Expert Opinion • One author strongly notes an increased legal risk for CNs (Mahlmeister, 1999; 2007) • Lawsuits often name a CN • CNs must follow up on every request from other personnel for assistance and document their actions • CNs need to know their state’s Nurse Practice Act • CNs need to know their hospital job description

  14. Permanent vs. Rotating CN The literature broadly addresses the value of having one nurse per shift who does the CN role. The literature did not clearly differentiate between having a permanent charge nurse vs rotating charge nurse responsibilities among several nurses. Since the literature did support the need for preparation and education, the implication is that a single nurse (or small number of nurses) would receive this expensive benefit.

  15. Recommendations Generally, there is benefit to having CNs but only if they are properly prepared. More research is needed on outcomes, educational needs, factors that make CN role effective, and legal risk for CNs

  16. Questions?

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