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Cultivating Collaboration

8. Give Charge Nurses a Whole Universe of Wisdom

Empowering through innovative training

Wisdom of the group: New Lead Charge Nurse Maegan Gillis receives tips and training from members of our human resources, staff development, finance, patient experience, and leadership teams.

Empowering unit leaders with expanded, hospital-wide training

We all want our charge nurses to see the big picture. But how can they fully view it when we give them such a narrow lens? This is the question we began asking ourselves when we noticed that many of our charge nurses were relying too heavily on agency staff, avoiding crucial conversations on their units and making decisions without considering their impact on the hospital as a whole.

It was the kind of setting that can impact unit operations, and we knew it needed to change. But the problem wasn’t the charge nurses themselves, it was the training we were giving them. Like most hospitals around the country, ours had always trained new charge nurses on the unit level, with information passed down from one charge nurse to another. It was an intimate and personalized approach, but it was also seriously limited.

Tap into the hospital’s knowledge base

$253,059 saved in the first eight months

With financially-savvy charge nurses running the shifts, the pilot unit has seen a labor savings of $253,059 in the first eight months.

To change the culture, we moved from using a large pool of nurses who charged periodically to designating a few charge nurses who could be dedicated to the role. Next, we piloted a new charge nurse orientation program on one of our busiest acute care units. Instead of orienting charge nurses in the pilot based on one person’s individual view of the hospital, we incorporated ideas and perspectives from across the organization to create a truly collaborative training and mentoring program. This allowed our newest leaders to see beyond the unit, so they could begin to understand our health system from a global perspective.

“I wanted to empower our charge nurses to think creatively,” says Laura Adams, the nursing director over the pilot unit. To begin broadening the charge nurse mindset, Laura worked with a multidisciplinary team to create a full-day training program with sessions conducted by senior leaders in our administration, finance, human resources, staff development and patient experience departments. Together, they brought data, stories, advice and passion from all corners of our health system and shared it with our new unit leaders.

Teach the true costs of labor

One of the biggest lessons from the training came from Nursing Finance Director Eric Allen, who showed charge nurses the true impact that labor decisions have on a unit’s operating margin and our hospital’s financial health. He explained that if charge nurses call off just one agency nurse per shift, the extra costs add up to $450,000/year. It’s enough to deplete a unit’s contingency budget—impacting everything from equipment purchases to staff raises.

“Before, adherence to a staffing grid was something you just did or else your manager would be mad at you,” says Trevan Biddulph, the nurse manager on the pilot unit. “Now, our charge nurses embrace the philosophy.” They’ve replaced angst over grids with daily financial stewardship, coming up with new ways to rearrange patient assignments, evaluate close observation patients and readjust staffing to work more efficiently than ever before—all while providing the same excellent care. What’s more, as nurses on an acute care unit, they’re actively seeking out patients from the ICU and ED to improve the transfer process and decrease “dead bed” time.

And when their unit’s slow? They call charge nurses on other units and offer up the staff resources they’re about to send home, so that other units don’t have to call agency nurses, either. “It’s true collaboration in action,” says Laura. “They’re living it each shift, every day.”

“Now, our charge nurses are collaborating for the good of the whole hospital instead of just focusing on their unit.” —Laura Adams, Acute Care and Rehab Nursing Director


Help charge nurses truly take charge

The orientation didn’t just focus on fiscal responsibility. It also taught charge nurses how to handle difficult conversations with staff and hold them accountable for their performance. Staff Development Educator Derek Cook equipped charge nurses with the skills they needed to have “crucial conversations” with staff, so they could create open dialogue around high-stakes and emotional issues. “We don’t like to step on each others toes or risk ruining relationships,” says Laura. “But sometimes we have to. It’s part of our responsibility. When you’re afraid to speak up, bad things happen, and, ultimately, the patient suffers.”

Charge nurses leading the way

With comprehensive training and ongoing mentoring, we’ve helped our lead charge nurses to do the following:

  • Comprehend the financial consequences of staffing decisions
  • Gain the authority to take corrective action right on the unit
  • Learn to communicate effectively when the stakes are high
  • Understand how practitioners are graded in patient satisfaction surveys

Along with crucial conversation skills, Senior Employee Relations Consultant Rosemary Norton gave charge nurses the information—and authority—that they needed to handle low-level staff corrective actions immediately, instead of pushing every issue up to their managers. “It’s so much better than the old ‘wait-till-your-father-gets-home’ approach,” says Laura. “Behavior is best corrected when it’s directly observed and dealt with immediately, and these charge nurses can do it beautifully, because we’ve empowered them in their new role.”

The expanded role was also facilitated with a rewritten “Lead Charge Nurse” job description, a pay increase, ongoing mentoring from experienced charge nurses and nursing managers, and opportunities to take additional leadership classes. “This is the pool of people we’ll be looking at for our future leaders,” says Laura. “Those who excel will be our next nurse managers.”

Make the shift from me to we.

The Lead Charge Nurse Orientation program hasn’t just prepared our newest unit leaders for success—it has also connected our health system in surprising new ways, so that we can all learn and grow together. “The orientation has seeded other pockets of collaboration,” says Laura. “Our human resources representatives and patient experience team have learned from our nurses, too. They know each other much better now, and they routinely work together to solve problems.”

It all adds up to units that run better, and patients who are more satisfied. With more training and empowerment, our charge nurses have become experts at assigning the right nurse to the right patient, and creating open lines of communication between nurses, doctors and patients.

“We have a whole group of excellent, established leaders who can step up, speak with authority and make decisions that are better for our hospital and better for our patients,” says Laura. “They’re the kind of charge nurses that every manager wants.”

How much impact can multidisciplinary training have? Share your views.