Revitalizing the charge nurse role through a bespoke development programme

A mixed-methods systematic review of interventions to improve leadership competencies of managers supervising nurses

AIM

This study aimed to synthesize evidence on interventions to improve leadership competencies of managers supervising nurses.

BACKGROUND

In recent years, numerous interventions have been developed to improve the leadership competencies of managers supervising nurses. However, researchers and nursing leaders are unclear about what aspects of interventions are effective for developing which competencies.

METHODS

We conducted a mixed-methods systematic review following the Joanna Briggs Institute (JBI) approach for evidence synthesis. The Medline (Ovid), CINAHL, Embase, Scopus, Nursing and Allied Health Database were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

A total of 69 studies (35 quantitative, 22 mixed methods, 12 qualitative) evaluating 68 interventions were included. Studies showed that interventions used modal activities such as lectures, group work and mentoring that generally had positive effects on improving leadership competencies such as supporting, developing and recognizing nurses. Opportunities to interact with peers increased managers' engagement in the interventions; however, many barriers existed for managers to use the competencies in practice including understaffing, insufficient time and lack of support from supervisors and staff.

CONCLUSIONS

Leadership interventions were shown to have beneficial effects on developing different competencies. Managers predominately felt positive about participating in leadership interventions; however, they expressed many difficulties applying what they learned in practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Leadership interventions should include multimodal activities that give managers opportunities for interaction. When considering interventions for developing the leadership of managers, it is imperative to consider the practice environments for managers to be successful in applying the competencies they learned in practice.

The experiences of physiotherapists and occupational therapists working as rehabilitation ward leaders

Background/Aims

Rehabilitation teams have piloted the deployment of physiotherapists and occupational therapists into the role of ward leader. This was the first research study designed specifically to explore the experiences of physiotherapists and occupational therapists working as ward leaders on wards with a patient rehabilitation focus and how to optimise this workforce transformation.

Methods

An interpretivist qualitative study was designed to enable the detailed exploration of physiotherapists' and occupational therapists' working experiences during their time as ward leaders. A total of 11 physiotherapists and occupational therapists with between 6 months' and 3 years' experience of working as ward leaders participated in semi-structured interviews. Thematic analysis was undertaken.

Results

Four themes were derived from the data analysis that related to participants' experiences: becoming a rehabilitation ward leader; responsibilities of physiotherapists and occupational therapists; perceptions of the role; and impact of allied health professionals in ward leader roles. Although taking on the role of a rehabilitation ward leader was reported as ‘challenging’, participants would recommend it. Success was perceived by interviewees to be relative to the presence of personal leadership qualities, the belief of the individual in their unique skill set and the confidence in the leadership team to value the unique and shared skills of the profession or individual and thus reinvent the role.

Conclusions

This study identifies the key attributes that evidence the unique contribution that physiotherapists and occupational therapists working as rehabilitation ward leaders can make. The findings of this study are significant and highly relevant for the ongoing pandemic, which has seen a need for increased rehabilitation capability.

Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study

AIMS

To explore the experiences of senior charge nurses provided with 'increased supervisory hours'.

BACKGROUND

Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase.

METHODS

An online questionnaire collected exploratory data from senior charge nurses (n = 60). Semi-structured interviews gathered in-depth qualitative data (n = 12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role.

RESULTS

The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals.

CONCLUSION

Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development.

IMPLICATIONS FOR NURSING MANAGEMENT

Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.

An exploration of the working life and role of the ward manager within an acute care hospital organisation

The ward manager’s role is a complex one that involves meeting financial targets, responding to changes in organisational structures and ensuring the delivery of quality patient care. Whilst the ward manager’s role remains key to service delivery, there has been limited research on the current role from the perspective of ward managers. A survey of ward managers, exploring aspects of their working lives and potential enablers of the ward manager role, is described. The variety of activities within the role was a source of job satisfaction despite the challenge of ‘keeping on top of everything’. Potential role enablers included having protected time for the managerial aspects of the role. The study findings indicate the need to understand the role of the ward manager with particular reference to job satisfaction, and the underpinning support required to enable ward managers to execute the role effectively.

The challenges acute care nurse unit managers face and the strategies they use to address them: Perceptions of directors of nursing and nurse unit managers

The aim of this study was to investigate the challenges that nurse unit managers (NUMs) face while working in acute care settings, the strategies they use to deal with these challenges, and the effectiveness of these strategies from the perspectives of NUMs and their supervisors. NUMs (N = 22) and directors of nursing (N = 3) were interviewed for this study. Thematic analysis revealed 14 challenges relating primarily to NUMs interactions with others, both within and outside of their wards/units. These challenges related to the managerial, but not clinical, aspects of their roles; 16 strategies for managing these challenges were identified, the effectiveness of which seemed dependent on how well they were executed. The strategies are: seeking assistance and support; trial and error; satisficing; taking responsibility for own professional development; scheduling of time; working longer hours; delegation; adaptive staffing and rostering; being a visible presence on the ward; team development; facilitating professional development for staff; being available for staff; negotiation and collaboration; communication; working with the processes of a large organisation; and complying with the demands of others, The findings make a strong case for NUMs to be supported in undertaking comprehensive management education.

The challenges acute care nurse unit managers face and the strategies they use to address them: Perceptions of directors of nursing and nurse unit managers

The aim of this study was to investigate the challenges that nurse unit managers (NUMs) face while working in acute care settings, the strategies they use to deal with these challenges, and the effectiveness of these strategies from the perspectives of NUMs and their supervisors. NUMs (N = 22) and directors of nursing (N = 3) were interviewed for this study. Thematic analysis revealed 14 challenges relating primarily to NUMs interactions with others, both within and outside of their wards/units. These challenges related to the managerial, but not clinical, aspects of their roles; 16 strategies for managing these challenges were identified, the effectiveness of which seemed dependent on how well they were executed. The strategies are: seeking assistance and support; trial and error; satisficing; taking responsibility for own professional development; scheduling of time; working longer hours; delegation; adaptive staffing and rostering; being a visible presence on the ward; team development; facilitating professional development for staff; being available for staff; negotiation and collaboration; communication; working with the processes of a large organisation; and complying with the demands of others, The findings make a strong case for NUMs to be supported in undertaking comprehensive management education.

Strengthening the role of the ward manager: a review of the literature

BACKGROUND

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care.

AIM

To identify initiatives that have strengthened the ward manager role.

METHODS

A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies.

FINDINGS

Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role.

CONCLUSION

The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position.

IMPLICATIONS FOR NURSING MANAGEMENT

The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

Crucial information needs of ICU charge nurses in Finland and Greece

AIMS

To describe crucial information needs of ICU charge nurses, and to compare these needs in two countries in Europe.

BACKGROUND

ICU charge nurses are on the front line for ensuring that the activities of their units are running smoothly. They are accountable for making sure that the right tasks are performed under the right circumstances, with the right people, at the right time.

DESIGN AND PARTICIPANTS

An online survey based on a previous observation study regarding the ad hoc decision-making of ICU shift leaders. A total of 257 Finnish and 50 Greek ICU charge nurses participated in this study, from 17 Finnish and 16 Greece ICUs for adults.

METHODS

Our survey incorporated 122 statements divided into six dimensions (patient admission, organization and management of work, allocation of staff, allocation of material, special treatments and patient discharge) with a rating scale from 0 to 10. Analysis involved descriptive statistics. Mann-Whitney U and Kruskal-Wallis tests were used to compare the answers of the two countries. Validity was verified with confirmatory factor analysis and the reliability was tested with Cronbach's α values.

RESULTS

The most crucial information needs of ICU charge nurses concerned the overall organization and management of work. Both staff-related and individual patient-related information was needed. Information needs of Finnish and Greek charge nurses concerned similar kinds of situations in ICUs. However, there were some differences that might depend on the cultural differences between the countries.

CONCLUSIONS

Accurate and real-time information is a prerequisite for ICU charge nurses' ad hoc decision-making during daily care management. Identification of the most crucial information is needed when tools for information management are developed.

RELEVANCE TO CLINICAL PRACTICE

The results of this study indicated that a major portion of immediate information needs of ICU charge nurses are internationally common in similar settings.

Mindful Staffing

Patient outcomes are linked to nurse staffing. Although charge nurses are responsible for intrashift staffing decisions, little is known about their decision-making behaviors. This study describes the behaviors of charge nurses from the perspective of charge nurses, nurse managers, and staff nurses. This qualitative descriptive study was conducted with a sample of 24 nurses. The findings revealed that staffing the unit was the most important role for charge nurses. Charge nurses reported spending up to 90% of a shift resolving intrashift staffing issues. Five effective decision-making behaviors emerged: (a) resourcefulness, (b) tactful communication, (c) flexibility, (d) decisiveness, and (e) awareness of the big picture. These behaviors of charge nurses are similar to mindful behaviors of workers in hazardous work environments, and are therefore described as mindful staffing. Practice implications and considerations for the education of charge nurses in relation to safe intrashift staffing are suggested by the findings of this study.

Different development programmes – does it make a difference?

Purpose

The purpose of this paper is to examine whether two groups of first‐line nurse managers perceived improvements in skills and knowledge regarding interpersonal skills and group management, achievement orientation, and organizational view and political savvy after participation in two different development programmes, compared to participants in a comparison group. Further, to understand the first‐line nurse managers' expectations for and experiences of the programme as well as its strengths and weaknesses.

Design/methodology/approach

A total of 13 first‐line nurse managers participated in a training programme, 14 in a self‐development programme, and 14 in a comparison group. Group interviews were used to describe the managers' expectations for and experiences of the programmes, the Leadership and Management Inventory were used to assess the impact of the programmes.

Findings

The results of the interviews showed that the programmes met many of the participants' expectations. Participants perceived significant improvements – in organizational knowledge following the training programme and in achievement orientation following the self‐development programme.

Research limitations/implications

Participation in the groups was not based on random assignment.

Practical implications

Different development programmes focussing on different issues can increase flexibility and decrease costs, as managers can apply to programmes suited to their development needs.

Originality/value

Mixed methods have been used in this study: qualitative methods to describe the participants' experiences of the programmes, and quantitative methods to describe the impact of two different leadership programmes and to contrast these results with a comparison group.