Planning, Development, and Implementation of a Tailored Evidence-Based Charge Nurse Education Program (CNEP)

Presenters: Monica N. Ramirez PhD, RN

Vincent Lloyd Wilt, BSN, RN, PCCN Project Partners: Emma Caballero MSN, RN, CNL, Stephanie Martinez, BSN, BC-RN & Jean Dowling Dols PhD, RN, NEA-BC, FACHE

• Private, faith-based university

• Largest Catholic university in Texas

• Total enrollment of approximately 10,000

• UIW ranks #1 nationally among private, not-for-profit universities in conferring the most bachelor’s degrees to Hispanics.

• Nursing is the oldest and one of the largest schools at UIW

• 267-Bed Facility

• One of six faith-based hospitals in the Methodist Healthcare System (MHS) in San Antonio and the surrounding area

• Serves a predominantly Hispanic population from both large cities and rural areas.

• Largest Live Donor Kidney Program in the Nation

• TOP quartile in the Nation for patient experience

• Key Service Lines:

• Bariatric surgery• Behavioral health• Cardiology• Emergency care• Gastroenterology• Inpatient rehabilitation

• Robotic Surgery• Transplant Services• Vascular• Urology

Academic-Practice Partnership

• Established in 2014• Vision: Strengthen the nursing practice environment at Methodist – Specialty & Transplant• Partnership Goals: Growth in professional practice and improved patient outcomes

• Implementation of Evidenced-based practice• Nursing research & dissemination • Innovative clinical experiences• Clinical redesign• Leadership education

Background

• Education and development of frontline nurse leaders are essential to the success of a healthcare organization and quality care delivery.

• Role clarity and clearly defined expectations is required for charge nurse leaders to be effective.1

• An evidence-based Charge Nurse Education Program (CNEP) tailored to the nursing setting was developed as a response to an identified priority within an academic-practice partnership.

Interviews

Goal Process•35 nurse leaders (charge nurses, assistant nurse managers, nursing directors, and nursing vice presidents were interviewed

•Interviews included structured questions with an opportunity to convey the nurse leader’s perceptions related to the charge nurse (CN) role

•In-depth assessment of the current state, climate, and perceptions of nurse leaders within Methodist – Specialty & Transplant Hospital

• CN is perceived as important to the success of the organization.

• CN role is highly stressful.

• Increased role stress related to confusion about role responsibility and expectations

• Inconsistent methods of being selected for CN role

• Variation in education and orientation process

• No progressive evaluation of the CN

• Senior leadership supportive of a CNEP

• Charge nurses welcomed more role-related education

Current State, Climate, and Perceptions of the Charge Nurse Role

• Need for CN role clarity and expectations is a priority for all nursing leadership

• CN competencies need to be identified

• A tailored CNEP is key to meet the needs of the organization’s CNs

• The interviews assisted in identifying key nurse leaders to form the Charge Nurse Advisory Group

Interview Outcome

Charge Nurse Advisory Group

• Included charge nurses, assistant nurse managers, nurse educators, and a nursing vice president.

• Organized and facilitated by university nursing faculty.

• Met on 6 occasions over a 4-month timeframe

• Assured CNEP was tailored to organization and charge nurse needs while maintaining evidence-based methodology for delivery.

Charge Nurse Advisory Group Objectives

• Develop CN Competencies Evaluation Tool

• Assist in developing CNEP delivery structure

• Identify CNEP content

• Identify content experts

• Select members were educators in CNEP

Charge Nurse Competencies Checklist

• Evaluation tool based on the evidence in the literature4

• Pre-post CNEP and progressive CN role evaluation tool

• Competency Categories• Technical Skills• Problem Solving Skills• Team Building Skills• Communication Skills• Leadership Skills• Professional Development Skills

The Charge Nurse Education Program Cohort

• 28 charge nurses

• 25 females & 3 males

• 1 year - 40 years of nursing practice

• <1 year – 18 years as a charge nurse

• 14 ADN/AA and 14 BSN

Charge Nurse Education Program

• CNEP content was organized and based on the categories of charge nurse competencies

• Delivered using evidence-based methodologies• Short time segments6

• Information relevant to the charge nurse role2

• Directly involving unit-based experiences and simulation7

• Internal content experts used as faculty 1,2

• Small groups of no larger than 15 to enable active engagement6

CNEP Structure

Charge Nurse Education Program Tailoring

• Tailored to the organization• Interviews provided essential background information • Advisory perspective • Content specific to daily role responsibilities• Unit-based experiences and simulation included frequently encountered situations

CNEP: Evaluation of Course

01

0

13

15

8

14

11

19

0

2

4

6

8

10

12

14

16

18

20

Teaching Methods Variety Learning Materials Enjoyed

Strongly Disagree Disagree Undecided Agree Strongly Agree

CNEP: Evaluation of Course

10

15

1111

16

0

2

4

6

8

10

12

14

16

18

Motivating Suitable to Learning Style

Strongly Disagree Disagree Undecided Agree Strongly Agree

Summary

• 1-hour debriefing session 3 months post CNEP

• Charge Nurses

• Found their network of support growing

• Appreciated that the content was helpful to their day-to-day responsibilities

• Encouraged self-advocacy and advocacy for the teams they lead.

References

1.Hernandez, G., Oreo, G., Meneses, J., & Rodolfich, L. (2016). Charge Nurse Leadership Academy: Developing Front Line Leaders. Puerto Rico: Sigma Theta Tau.

2.Delamater, L., & Hall, N. (2018). Charge nurse development: What does the literature say?. Nursing management, 49(7), 34-40.

3.Normand, L., Black, D., Baldwin, K. M., & Crenshaw, J. T. (2014). Redefining “charge nurse” within the front line. Nursing management, 45(9), 48-53.

4. Swihart, D., & Gantt, K. J. (2015). The charge nurse leader program builder: A competency-based approach for developing frontline leaders. Brentwood, TN: HCPro[BLR].

5. Regan, S., Wong, C., Laschinger, H. K., Cummings, G., Leiter, M., MacPhee, M., ... & Young-Ritchie, C. (2017). Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice. Journal of nursing management, 25(4), 246-255.

6. Teran, N., & Webb, P. J. (2016). The positive impact of formalized charge nurse training. Nursing management, 47(11), 50-54.

7. Clark, T. J., & Yoder-Wise, P. S. (2015). Enhancing trifocal leadership practices using simulation in a pediatric charge nurse orientation program. The Journal of Continuing Education in Nursing, 46(7), 311-317.