Charge, Change and Accountability

Purpose:
HPPD were below the benchmark mean on a number of units. Staff was challenged to complete their work and this feeling was supported by the NDNQI RN satisfaction data. Goal was to increase the RN hours by adding a designated charge nurse without a patient load.

Significance:
CMS has requirements for patient satisfaction to be above the benchmark mean. As a Magnet facility, nurse satisfaction must outperform the mean. Patient outcome indicators must also be above the mean. The charge nurse plays a role in facilitating initiatives to improve in all these areas.

Strategy and Implementation:
NDNQI staffing and outcome indicator data and RN Satisfaction Survey data was analyzed. A plan to increase staffing by adding designated charge nurses without a patient load was developed and presented to administration and approved. Due to financial and recruiting issues the plan included a phased approach. Simultaneously, one of the charge nurses was selected to participate in the “Center for Frontline Nursing Leadership” program. The director served as mentor for her. The project that the nurse chose was “Reevaluate the Charge Nurse Role”. The four semester project included a pre and post survey. Information from the survey was used to revise the job description and develop education modules. Education was offered to all charge nurses to improve the skill set needed to be successful in the changed charge nurse role with increased accountability. Staffing was changed to allow for implementation in early 2009.

Evaluation:
On-going training was requested and has been provided. A sub-council for charge nurses has also been requested and is being developed. The HPPD data reflect the increases and the units are now all above the 50th %. The RN Satisfaction survey data will be available in August 2010.

Implications for Practice:
Charge nurses free of a patient load are available for service recovery to improve patient satisfaction; serve as a resource for staff on many patient care issues; and assist with patient flow, admissions and discharges. All these activities help the organization meet many challenges presented.