“Raising The Bar For Nursing Excellence: Exploring An Innovative Approach To Labor and Delivery Charge Nurse Selection, Orientation and Evaluation”

Purpose for the program:

Charge nurses are frequently selected and placed into leadership positions without adequate educational preparation, leaving them without the skills needed to function to their fullest potential. As a result, this organization set out to expand their current charge nurse selection, orientation and evaluation processes and to develop a more robust plan to meet the needs of the unit and organization. We felt this would allow us to reach the level of excellence expected of a tertiary center and to tap into the abundant leadership potential of the newly-appointed charge nurses.

Proposed change:

On a daily basis, charge nurses are providing the minute-to-minute leadership at the unit level and are typically selected based on their skill and knowledge or, sometimes, simply by default. We felt we could do better! The new selection process not only looks to those nurses with a desire to advance their level of leadership, but also includes a thorough application process to identify the key elements needed to succeed in the role. It includes a self-evaluation of their leadership skills and two peer-reviews that ultimately play a key factor in the decision making process. We also developed a plan to provide early support in their orientation period and to continue to expand on those skills over time. It included a thorough orientation packet of essential resources and the development a charge nurse workshop focusing on leadership skills necessary to be an effective change agent on the unit.  We also developed a competency assessment for ongoing evaluation that builds on previously learned skills and identifies areas of opportunities for professional growth in the role.

Implementation, outcomes and evaluation:

Historically, the selected nurse would shadow an experienced charge nurse for two to three shifts and that would complete their orientation to the role. We know, through evidence in the literature, that charge nurses need broader skills necessary to influence organizational outcomes, foster teamwork and promote nursing excellence. The new processes allow for building a better foundation of understanding to the new role and making the group of charge nurses more cohesive in their management styles thus creating a feeling of stability and support on the unit.

Implications for nursing practice:

Through this new comprehensive program, the charge nurse role will be preserved, strengthened, and validated giving the charge nurses the skills to become successful in their new position.

Keywords: Charge Nurse; Leadership; Orientation; Competency