On Leading the Charge for Charge Nurses

This morning, I was glad to read that the American Society of Consultant Pharmacists has come out strongly in favor of nurses being able to “act on behalf of physicians in prescribing pain medications.”  I agree with their position, and blogged on this topic when the DEA first decided to start a drug war in the hallways of our facilities.

While long-term care calls its nurses “charge nurses,” historically we have not really known how to put them in charge.
We'll put a charge nurse in the station to deal with physicians, residents, families, visitors, regulators, vendors, lost and found, emergent and urgent issues such as abuse allegations, falls, changes of condition and risk-related events, wheel chairs, CNAs, activities, tray accuracy, and of course med passes and charting. Yet, our charge nurses are offered little in the way of supervisory development so they can have the skills needed to be successful in managing these complex stakeholders and all their competing and varied interests.

Truth be told, we in long-term care work around our charge nurses quite a bit.
When the director of nursing or director of staff development is on duty, she or he often problem solves directly with CNAs, RNAs, families and visitors, leaving the charge nurse out of the communications loop.  Then on weekends while visiting our residents, families often address their questions, issues and concerns to the one person who tends not to be included in problem solving: the charge nurse.  So why are we surprised to learn that "I don't know" is the most common response families and visitors hear from the charge nurse?  Clearly this response offers no comfort or sense of confidence to the family or visitor, and colors their perceptions about our facilities.

As an expert in organizational change, I have worked with companies to build supervisory strength in their charge nurse core. Improving charge skills and also ensuring that they can really use their new skills in the work place are both essential components of developing supervisory strength. Generally the role of RN supervisors and the DNS and DSD also come into play and need to be sorted out to ensure that the charge nurses are well positioned to use their supervisory skills. Companies that have been successful with this endeavor have seen improved customer satisfaction, reduced charge nurse and CNA turnover, a downward trend in work-related injuries while providing care, and in some cases even improved quality indicators (i.e., favorable trends in weight loss, falls, and participation in activities, among others).

All of this leads me to believe that empowering charge nurses to be in charge is an idea whose time has come.
By giving charge nurses not only supervisory skills development training but also including them in communications about problem issues and problem solving.

The charge nurse is the hub of the wheel of change.
With all the demands facing long-term care today and the incredible pace of sweeping change coming with health care reform, QIS surveys, MDS 3.0, RUGS IV, among others, we are in a place of not knowing and not being able to predict how the environment will change and how we will have to adapt in the coming years. What we do know is that those who can shift fast enough with confidence and strength will come out ahead. At the facility level, the charge nurse is the hub of the wheel of change—and the key to rapid and effective adaptation in times like these.

What are your thoughts about strengthening the role of the long-term care facility charge nurse?