Navigating Through Chaos: Charge Nurses and Patient Safety

Early Career Nurses' Experiences of Engaging in a Leadership Role in Hospital Settings

BACKGROUND

Early career nurses (ECNs) can be expected to assume shift charge nurse leadership roles quickly upon entering practice. Since the emergence of the COVID-19 pandemic, junior nurses may find their leadership capabilities tested further as the challenges of leadership are made increasingly complex in the context of an infectious disease outbreak.

PURPOSE

The purpose of this qualitative study was to explore early career registered nurses' (RNs) experiences of engaging in shift charge nurse roles in hospital settings.

METHODS

This study used an interpretive descriptive (ID) approach. Semi-structured, in-depth interviews were conducted with 14 RNs across Ontario, who had up to three years of experience and who had engaged in a shift charge nurse role in a hospital setting. Recruitment and data collection took place from January to May 2021 during the COVID-19 pandemic. Interviews were recorded, transcribed, and analyzed following the principles of content analysis.

RESULTS

Content analysis of the 14 participant interviews revealed four main themes: nominated and necessitated into leadership, diverse and demanding responsibilities, factors that help and hinder, and leadership as an impactful experience.

CONCLUSIONS

Study findings provide insights into potential strategies to support ECNs in shift charge nurse roles, during the remaining course of the COVID-19 pandemic and beyond. Greater support for nurses who engage in these roles may be achieved by promoting collaborative unit and organizational cultures, prioritizing leadership training programs, and strengthening policies to provide greater clarity regarding charge nurse role responsibilities.

Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens

BACKGROUND

Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems.

AIM

To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care.

METHODOLOGY

A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis.

RESULTS

Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care.

CONCLUSION

The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Supporting Ambulatory Nurses Transitioning From Direct Care to Leadership: A Pilot Project

Frontline nurse leadership is foundational to career progression and succession planning, but preparation is often limited. COVID-19 has further complicated this process by limiting access to professional development resources typically available to new leaders. This article discusses the implementation of an innovative onboarding program that combined a web-based toolkit, mentor network, and precepted shadow shifts to navigate challenges associated with the pandemic and overcome barriers to frontline nurse leader preparation in the ambulatory care setting.

Consensus marking as a grading method for the development of evaluative judgement: Comparing assessor and students

AIM

This study explored postgraduate nursing students' perceptions, anxiety and satisfaction of an innovative and novel grading method for online vivas, consensus marking, compared with traditional assessor judgement.

BACKGROUND

Reflection, self-evaluation and feedback conversations have the potential to develop nursing students' evaluative judgement. Consensus marking is a novel method of grading students' performance that supports students to reflect, self-evaluate and grade their own work. Active engagement in a feedback dialogue supports students to calibrate their self-evaluation to the required standard in a grade negotiation. Through this approach, students are supported to develop evaluative judgement and lifelong learning skills.

DESIGN

A convergent mixed-methods parallel research design was used.

METHODS

Students enrolled in a postgraduate emergency nursing unit of study completed two online viva assessments. One viva was graded using traditional assessor judgement and the other used consensus marking, involving a two-way feedback dialogue, where students had an opportunity to actively engage in grading their own work with the assessor. Student perceptions of each grading method were explored through semi-structured interviews. Interview data were analysed thematically using a six-stage approach. Student anxiety and satisfaction were measured pre- and post each viva using valid and reliable questionnaires. Non-parametric analyses explored differences in anxiety and satisfaction between the two grading methods. Alpha was set at 0.05.

RESULTS

Forty-six participants had complete data for anxiety and satisfaction across both test occasions (82%) and were included in the analysis. Of these, 13 students participated in follow up interviews. Students perceived that the ability to self-evaluate performance and discuss their grade with the assessor using consensus marking was less hierarchical and similar to a collegial debrief. Student anxiety was significantly lower prior to consensus marking compared with the assessor judged viva (p < 0.001). Students were significantly more satisfied with consensus marking compared with assessor judgement (p < 0.01).

CONCLUSIONS

Consensus marking created an opportunity for students to identify knowledge deficits through reflection and self-evaluation of their own performance prior to external judgement. Students were more satisfied and less anxious with the consensus marking grading method compared with traditional assessor judgement. These findings have implications for the development and application of new grading methods in nursing education to facilitate the development of evaluative judgement.

Evaluating the Efficacy of an Evidence-Based Charge Nurse Professional Development Activity at a Highly Complex Veterans Affairs Medical Center

Incompetent charge nurses negatively impact quality patient care. An analysis of a charge nurse professional development activity intervention included pre- and posttests, an activity curriculum evaluation, and staff satisfaction surveys. Posttest scores improved significantly (t = 60, p = .001). All participants rated the professional development activity as highly appropriate and beneficial to their nursing practice.

Exploring the Charge Nurse Role Transition: A Qualitative Study of the Novice's Perspective

The novice charge nurse role transition is not well understood. This article reports on a qualitative descriptive study of the novice charge nurse role transition. Rubin and Rubin's responsive interviewing was used. Fourteen novice charge nurses participated in Zoom interviews. Thematic analysis revealed three phases: taxiing to the runway, takeoff, and reaching cruising altitude, each with distinct themes. Nursing professional development practitioners can use these findings to better understand and support new charge nurses through this transition.

Nurse Leaders' Experiences and Learnings Navigating Through the Chaos of a Pandemic

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework.

Logan P, Khakurel J, Vizcaya-Moreno F. Nurses' Adherence to Patient Safety Principles: A Systematic Review

Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.

The Effectiveness of Charge Nurse Training on Leadership Style and Resiliency

OBJECTIVE

The study objective was to investigate a charge nurse pilot training program as an effective, evidence-based training modality to improve leadership style and resiliency.

BACKGROUND

Leadership is inherent and necessary in the charge nurse role. Little published research about charge nurse leadership training programs exists.

METHODS

A pre-post design, with intervention and comparison groups, was conducted at an integrated healthcare system. A random sample of charge nurses was selected to pilot a standardized charge nurse leadership training program including in-person learning to foster leadership skills and nurture resiliency.

RESULTS

The sample included 19 control participants and 22 intervention participants. Significant improvement was noted in transformational, transactional, leadership outcomes, and resiliency from preintervention to postintervention for the all subjects. Of the 22 intervention participants, the training elicited higher satisfaction with leadership behavior, followed by effectiveness and their ability to motivate. Charge nurses who attended training had higher resiliency scores pre-post intervention.

CONCLUSION

The charge nurse pilot training was an effective program that led to improved leadership style and resiliency.

Understanding assessment on a hospital ward for older people: A qualitative study

AIM

To explore assessment on a hospital ward for older people from the perspectives of patients and healthcare professionals.

DESIGN

A qualitative study drawing on grounded theory was undertaken between February 2015 - January 2016.

METHODS

Interviews with 15 patients and 22 healthcare professionals, a focus group with six healthcare professionals, 45 hr of observation and review of 18 sets of patient notes. Analysis was conducted using initial and focused coding, continuously comparing data, emerging codes and themes.

FINDINGS

The core category was navigating, constructed through three themes: containing complexity, networking, and situating the process. Navigating assessment was a complex, flexible, context dependent, and social process where healthcare professionals used a combination of formal, informal, visible, and invisible ways of working. Registered nurses were at the centre of networking and focused on gathering and sharing information in the multi-disciplinary team, whilst patients had a passive role despite a variety of preferences about their involvement.

CONCLUSIONS

Navigating the assessment of older people is contextually situated, includes networking and a professional focus on containing complexity. This process may be enhanced by: (a) making informal assessment visible to others; (b) developing the nurses' role beyond chasing information towards coordinating care; and (c) asking patients and acting on how they would like to be involved in decision-making.

IMPACT

Acknowledging that navigating assessment is a social, flexible and complex process, including different ways of working to meet patient needs, may enhance the usability of current assessment guidelines and their development.