INSTRUCTIONAL EXERCISE: Magdalena Go, RN, (blindfolded) follows instructions of Maryann Lovallo, RN, during an exercise in the charge nurse leadership program at Bayfront Medical Center. Looking on from left are Susan Alexander, BSN, RNC, ONC, instructor Evelyn Velazquez, RN, and John S. Vrabel Jr., BSN, RN. (photo by Jay Wiley)

As a relief charge nurse, Jennifer Hardman, BSN, RN, found it difficult to constantly switch between working the floor and staffing the desk.

"You're working side-by-side on the floor with the same nurses you'll supervise the next day," said Hardman, who works on a med/surg oncology unit at Bayfront Medical Center. "It can be a challenge - especially if you have to correct a mistake or counsel someone. Yesterday you were their peer, and today you're their supervisor."

In addition to the pressures novices like Hardman felt, the role of all charge nurses throughout the hospital differed on practically every unit.

Even the most experienced agreed there needed to be some standardization and a way to make all charge nurses feel more confident in their roles as front-line leaders.

In response, the St. Petersburg-based hospital launched its Charge Nurse as Leader program, a six-part series of 4-hour courses led by nurse managers and directors.

"Our chief nursing officer stood in front of us and told us what valuable resources we are for the hospital," said Dee Desper, RN, a seasoned labor and delivery charge nurse. "The mission of the hospital is to provide excellence in customer service and family-centered care. They really need the charge nurses to have the tools to do this."

"If they don't have leadership training it's an equation for failure," added Tim Eixenberger, DNP, RN, RRT, vice president of patient care. "The environment is much better now, largely because charge nurses take an active role in making it that way."

To date, 120 Bayfront charge nurses - from novice to expert - have participated in the program.

Starting Point

Bayfront knew its charge nurses played a crucial role in impacting quality of care, safety and patient satisfaction, but individual job descriptions differed among the hospital's many units, said Sue Adair, human resources manager.

In the beginning of 2008, the hospital wanted to assess the leadership qualities of the current nursing team. Nursing leadership closely examined the role each employee played on the unit, as well as the associated job descriptions. The efforts were part of an overall initiative that sought to define the direction of nursing as well as leadership qualities and structure needed for Bayfront's future, Adair said.

Ultimately, Bayfront revised and standardized the role of charge nurses across the organization, placing an even greater emphasis on leadership education and development opportunities, Adair said.

Next, to determine charge nurses' perceptions of their roles, they were asked to complete a self-assessment. That information was crucial to create and design the Charge Nurse as Leader program, Adair said.

Common Ground

By their nature, charge nurses are a hands-on and tenacious group, preferring to share experiences to sitting through hours of presentations and lectures.

"They love to present real-life challenges," said Amanda Maxim, BSN, RN, emergency department clinical manager and interim director. "They're very candid when they role-play, they make it real."

"Sharing of ideas created a lot of synergy between units as well - sort of a byproduct we didn't anticipate," Eixenberger added.

The retreats blended presentations, group activities and self-assessments to help the nurses learn about topics ranging from team motivation and dealing with difficult people to conflict intervention and resolution and the role of family members in patient-centered care.

Added Adair, "There's really not a lot of opportunity for our charge nurses to interact only with one another. When you focus on them and give them that chance, it's huge for them. These are people they know and deal with all the time but they might not know that well."

For instance, Bayfront's charge nurses learned how they deal with similar issues when it comes to counseling employees, staffing patterns, acuity and managing fluctuating censuses, Desper said.

"We all get in our silos and departments and think what we deal with is unique. It's nice to see where the common ground is," she said. "There's a feeling of camaraderie - knowing I can call [a certain person] if I have a question about something."