I contacted Mary Jane, M.D., Ph.D., for an informed discussion about the significance of strong nurse leadership. Dr. Jane is an expert in the field, having practiced for five years and published high-profile research studies concerning applied leadership in nursing. Dr. Jane is a registered nurse who works as a charge nurse at a government hospital. Her role is to supervise and support nurse colleagues, and treat patients when necessary. Besides, she also maintains standard patient care, evaluate other nurses and act as an informative source for nursing staff. That said, Dr. Jane’s role as a nurse leader makes her a suitable participant in this project. I conducted a one-to-one interview with Dr. Jane at her office to obtain essential information.
To assess the aspects of leadership within the purview of a charge nurse, I asked Dr. Jane, “What are the aspects of leadership within your role?” Dr. Jane answered, “We as charge nurses act as frontline managers in the hospice setting and that is why we are called lead nurses or unit supervisors.” (M. Jane, personal communication, February 21, 2019). Also, Dr. Jane adds that charge nurses operate in various healthcare milieu, including clinics, hospitals, and acute care facilities. Their role is less rigid; hence they can partake their obligations on a temporary-permanent basis. The rate of their retention depends on the needs of the facility or the existence of a practice gap (personal communication, February 21, 2019). Dr. Jane also adds that some of the fundamental obligations of a charge nurse are to supervise other nursing staff, oversee staffing needs, design duty timetables, undertake performance assessment and human resourcing, and provide daily and spasmodic reports.
My next question to Dr. Jane was about the essential aptitudes that a charge nurse should exhibit to deliver effectively. “Doctor, what are the skills and attributes needed in your role that help you to be successful?” Dr. Jane gave me a precise and clear answer: “Firstly, all charge nurses must be licensed Registered Nurses (RNs). They must have three years of experience to partake the position. Dr. Jane contents that having additional credentials, good personality, and work experience increase a person’s chance of becoming a charge nurse (personal communication, February 21, 2019). According to the doctor, a nurse leader, a charge nurse must exhibit exceptional skills in communication and organization. Moreover, they must be proficient in making quick conclusions, assessing the quality of care provided, litigating disputes, and forestalling faults.
What does success means to you in terms of your position?” I asked Dr. Jane. “Having the ability to coordinate care provision among nurses, doctors, patients and kinfolks, administration and other parties to ensure patient healing and recovery is my best achievement.” Dr. Jane Answered. “I measure personal success based on my ability to ensure the delivery of safe and efficient care, which abide by supervisory necessities and guarantees a monetary return.” She added. “Also, my role as a nurse leader having a direct impact on a patient’s healing and recovery, and the economic growth of the healthcare facility is a key accomplishment.” (M. Jane, personal communication, February 21, 2019). Besides, Dr. Jane is proud of mentoring many nurses who are now competent and capable of performing their duties with minimal supervision (personal communication, February 21, 2019).
The next question asked, “What are the challenges of this practice role that you have experienced?” I also asked her to state some of the perceived advantages of this practice role. Dr. Jane answered, “The primary challenge is ensuring the nursing staff is sufficiently proficient, and the units are adequately staffed. Staffing is often challenging and in short supply.” Another key challenge faced by charge nurses is the implementation of change. This problem is prevalent because some staff has difficulties embracing change. Therefore, implementing new ideas can be stressful and demanding. Apart from applying and aiding change, nurse leaders must also evaluate and intercede staff who have trouble embracing new policies or are resilient to change (Cathcart & Greenspan, 2013).
Dr. Jane outlines some of the perceived advantages of the role of a charge nurse. Firstly, the role of a charge nurse of coordinating teamwork helps to keep the staff engaged. Hence, this promotes the intermittent delivery of patient care. Moreover, the position of a charge nurse puts him or her in the frontline to deal with conflicts within the organization. Thus, they are in a position to solve any dispute before it escalates. Besides, healthcare organizations that empower charge nurses to partake leadership responsibilities often receive improved outcomes. Even so, nursing staff views the charge nurse as the frontline manager. Therefore, this implies that other nurses consider charge nurses as mentors and often seek guidance and instructions from them. Moreover, a charge nurse is an embodiment of impartiality, reliability, advocacy, and recognition of personal efforts. These qualities are supported by the nursing codes of ethics hence must be upheld by the nursing staff. As mentors, charge nurses are in a better position to impart these principles to their juniors and colleagues.
To ascertain the role of a charge nurse as leader of quality improvement (QI), I asked Dr. Jane, “What are some of the QI processes that you are involved with or that are currently in place in your organization?” Dr. Jane stated some of the ways nurse leaders can engage nurses in QI activities, including subscribing to programs involving filling in of self-administered online modules to acquire knowledge about quality improvement. Another QI process entails recruiting expert coworkers to assist newly registered nurses to apply acquired QI knowledge into action. Dr. Jane stated that another way to involve nurses in QI activities entails facilitating adequate staffing levels and giving nurses ample discharge time to take part in QI activities. That said, allowing nurses to access a clinical database that provides sensible, well-timed and actionable QI data is another quality improvement strategy worth implementing (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2016).
I wanted to know if there exist any barriers that impede the execution of the stated QI processes. According to Dr. Jane, poor communication is a common barrier which hinders the implementation of QI activities. Poor communication channels within the clinic setting limit the ability of a nurse leader to convey essential information or give instructions. The existence of the theory-practice gap hinders the proper application of QI knowledge into action. Also, there is a lack of adequate research on the implementation of QI processes. Lack of sufficient study on the field means that many healthcare providers are utilizing obsolete QI processes (personal communication, February 21, 2019). Nevertheless, there are techniques that nurse leaders can employ to avert these barriers, including instituting useful, up-to-date information framework to foster effective organizational communication. Besides, encouraging nurse students and RNs to undertake sufficient science practical and seek advice from mentors and experienced staff can help nurse leaders to reduce the theory-practice gap.
There is a possibility that there are some legislative issues that impact advanced nursing practice (APN), particularly the role of a charge nurse. From the interview, I identified some key legislative issues and public policy concerns affecting this practice. For example, laws such as the “Summary of APN Legislation: Prescriptive Authority” defines the core duties of nurse practitioners in America. Besides, the “Summary of APN Legislation: Legal Authority for Scope of Practice” describes state regulation concerning APN legal scope of practice. Failure to abide by these statutory requirements can lead to the closure of the healthcare facility and the suspension of licenses of practicing nurses. Some opportunities influence public policy in the role of nurse leaders. For instance, the need for mentors and role models necessitates the presence of a charge nurse. Moreover, a person with a master’s degree or graduate degree in nursing has a chance to apply for a role as a charge nurse because of his or her credentials.
Lastly, I asked Dr. Jane to list some of the social, economic and politic forces affecting the future of her role as a nurse leader. According to her, factors like health care needs, cost containment, moral dilemmas, technological advancements, nursing shortage, and the oversupply of practitioners have a significant impact on the role of occupational health nurses. For example, lack of nurses makes it difficult for charge nurses to coordinate care provision because of the presence of a practice gap. Furthermore, political matters like nurses’ strikes and boycotts impact the role of nurse leaders. In such instances, nurse leaders often face moral distress implementing priority concerns. They have to make the appropriate decision to ensure that both the rights of APNs and patients are protected.
Some lessons were learned from this interview. Firstly, the respondent mentions some of the critical roles of a nurse leader. In this case, as a charge nurse, Dr. Jane must ensure adequate staffing by designing an active work schedule. Moreover, as a leader, Dr. Jane should act as a role model for colleagues. However, challenges like small studies about nurse leadership impede the capacity of nurse leaders to dispense their authority appropriately. Also, according to the interviewee, some legislative issues must be considered before discharging their duties. Upholding these laws prevents poor care delivery and fosters transparency in the recruitment of expert nurse leaders. According to my opinion, the role of Dr. Jane as a charge nurse is necessary for improving care provision because she acts as a liaison among various practitioners to ensure efficient delivery of patient care.
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