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1. MEDSURG NURSING
CE Objectives and Evaluation Form appear on page 306,
A Qualitative Study
Of Ch£u:ge Nurse Competencies
Little information exists
regarding competencies re-
quired to function as a charge
nurse. This qualitative study
identified charge nurse com-
petencies. Data sources were
interviews (N=42) with charge
nurses, head nurses, staffnurs-
es, and supervisory personnel.
A total of 54 competencies
were identified in four cate-
gories: clinical/technical, criti-
cal thinking, organizational
and human relations skills.
The charge nurses who were
interviewed primarily came
from medical-surgical and
intensive care units. The com-
petencies derived from their
interviews reflect leadership
and management skills that
medical-surgical nurses need
to function as effective charge
nurses.
Lynne M. Connelly, PhD, RN, is a
Colonel (Ret,), Army Nurse Corps, and
an Assistant Professor, University of
Texas Health Science Center, School of
Nursing, San Antonio, TX,
Lynne M. Connelly
Unda H. Yoder
Denise Miner-Williams
Effective nursing leadership is
paramount in the modern
health care setting, v^^here com-
plex, high-acuity inpatients are the
norm. The best clinical leaders
possess competencies in a variety
of cognitive and behavioral areas.
The charge nurse role evolved
from a need to have unit leaders
other than the head nurse manage
patient care in the absence of the
head nurse or during evening and
night shifts. The charge nurse role
is critical because of current
staffing issues, the use of agency
and/or foreign nurses, and the
need for a proficient nurse to be
accountable for issues arising in
the unit. In short, charge nurses
must take ownership for all unit
activities during their shift.
Effective charge nurses mesh
administrative, educational, and
clinical expertise with an under-
standing of basic leadership princi-
ples (Cartier, 1995). Charge nurses
generally come from the most
obvious pool of nurses, clinical
staff nurses. Unfortunately, these
nurses are often academically and
administratively unprepared to
assume clinical leadership posi-
tions (Cartier, 1995),
Unprepared charge nurses cre-
ate problems of first-line leader-
ship, such as failure to adequately
supervise other staff. Quality can
be affected, especially in areas
where the most acutely ill patients
receive care. Orienting nurses to
the charge nurse role and planning
leadership education courses can
be difficult because few clearly
delineated competencies appear in
the literature. Because there is a
lack of research, or even current.
Unda H. Yoder, PhD, MBA, RN, AOCN, is a Colonel (Ret,), Army Nurse Corps, and
Wcis assigned cis the Senior Nurse Researcher, Walter Reed Army Mediccil Center,
Washington, DC, at the time this article Wcis written,
Denise Miner-A^llliains, MSN, RN, wcis a Resecirch Associate on this study and is
presently a Doctorjil Student, University of Texcis Health Science Center, School of
Nursing, San Antonio, TX,
Note: This research (TSNRP #N96045) was sponsored by the TriService Nursing
Research Program, Uniformed Services University of the Health Sciences, The
information or content and conclusions do not necessarily represent the official
position or policy of, nor should any official endorsement be inferred by, the
TriService Nursing Research Program, Uniformed Services University of the
Health Sciences, the Department of Defense, or the U,S, Government,
298 MEDSURG Nursing—October 2003—Vol. 12/No. 5

2. A Qualitative Study of Charge Nurse Competencies
general information concerning
this clinical role, a study Wcis con-
ducted to determine the compe-
tencies necessary to be a success-
ful charge nurse. The findings
from the research are presented
along with application for current
practice.
Background
Although many hospitals use
charge nurses, there is a lack of
clear guidelines concerning the
role, competencies needed for
optimum role performance, and
criteria for evaluating perfor-
mance. Many recent articles offer
advice to the new charge nurse
(Costello-Nickitas, 1997; Shermont
& Russell, 1996; Sonnenberg,
1999), to managers about the role
(Zimmerman, 2000), or about the
legal responsibilities of the team
leader and charge nurse based on
litigation (Mahlmeister & Koniack-
Griffin, 1999).
In one of the few studies about
the role, Bostrom and Suter (1992)
examined charge nurse decision
making concerning patient assign-
ments. They concluded that expe-
rienced charge nurses considered
more factors in making assign-
ments and relied less on the acuity
system than did novice charge
nurses. Some authors have
described the role of the charge
nurse as multifaceted, including
duties of patient care, hospital
protection, and staff interaction.
In an Australian survey study,
Chaboyer, Najman, and Dunn
(2001) found no difference
between Level I (staff nurses) and
Level 11/111 (charge nurses) on per-
ceptions of cohesiveness in their
interactions with each other in the
working environment at three
large, tertiary care hospitals
(N=555). All nurses reported a
moderate amount of cohesion
among themselves.
Overall, the charge nurse has
been considered to be responsible
for maintaining appropriate stan-
dards of care and professional
staff/patient interactions (Hinkle
& Hinkle, 1977). Now, with increas-
ing patient acuity levels and short-
er hospital stays, the role of the
charge nurse has become integral
to optimum patient care in moder-
ate-to-large sized medical facilities
throughout the United States,
especially in military facilities. In
addition, this position often pro-
vides the first opportunity for
exercising the leadership skills
that nurses will use throughout
their careers. Therefore, identify-
ing the competencies is needed by
the charge nurse for achieving
effectiveness in this role and was
the aim of the study reported in
this article.
Conceptual Framework
Competencies were conceptu-
alized as the expectations that pro-
fessionals have for a particular
role. Therefore, it was considered
appropriate to interview nurses at
various levels who interact with
charge nurses to determine the
competencies for that role.
Generally, qualitative researchers
do not propose a framework to
guide the research prior to a study.
The researchers desire to stay
open to what the informants are
saying and develop a theory based
on the research. In this study,
researchers took a slightly different
approach. In order to provide a
starting point for the semi-struc-
tured, open-ended interview ques-
tions, they used Katz's (1974) three
broad categories of management
skills — technical, human, and con-
ceptual — to form the initial inter-
view questions. For example, one
question was, "What technical
skills do you think a charge nurse
needs to possess?" However, infor-
mants were allowed to explore
what they perceived to be impor-
tant to the subject of charge nurse
competencies.
Methodology
An exploratory, qualitative
research design was used in this
study. The research question was:
"What do nurses at various levels
perceive to be the competencies
needed to effectively carry out the
role of charge nurse in a military
medical center?" Although mili-
tary nursing has certain differ-
ences when compared to civilian
nursing (such as readiness to
deploy and functioning in a variety
of settings), the research team
believed the study would have
applicability to both military and
civilian nursing. A stratified, pur-
posive sampling technique
(Patton, 1990) was used to select a
heterogeneous group of infor-
mants representing each level of
nurses (staff, charge, head nurse,
supervisory) from a variety of dif-
ferent clinical areas until there
was saturation of data categories.
As mentioned above, competen-
cies were conceptualized as the
expectations that professionals
have for a role; therefore, it was
important to include a wide range
of people involved with the role. In
addition, a qualitative interview
approach was thought to be the
best means of exploring expecta-
tions people had for the role.
A total of 42 interviews were
conducted to ensure all manage-
ment levels of nurses were includ-
ed, as well as a variety of intensive
care, medical, and surgical Inpa-
tient units. The participants
included staff nurses (11), charge
nurses (12), head nurses (10), and
nursing supervisory personnel (9)
assigned to a military medical cen-
ter in the Southwest. Interviews
continued until data saturation
was reached. The sample consist-
ed of 33 females and 9 males with
an average of 8 years experience
(median=5; range=l-25 years).
Most participants had a BSN
(64%) or MSN (29%). The partici-
pants had an average of 5 years of
charge nurse experience, ranging
MEDSURG Nursing—October 2003—Vol. 12/No. 5 299

3. A Qualitative Study of Charge Nurse Competencies
from less than a year to 22 years.
Head nurses in the study had an
average of 6 years of management
experience. All informants gave
written informed consent and the
study was approved by the hospi-
tal's institutional review board.
During the piloting of the
questions, the word conceptual
was changed to organizational
because the informants did not
seem to understand it when asked
about competencies in the inter-
views. Katz (1974) defined concep-
tual skills as "the ability to see the
enterprise as a whole; it includes
recognizing how the various func-
tions of the organization depend
on one another, and how changes
in any one part affect all the oth-
ers" (p. 93). The research team
believed that organizational skills
fit that category.
The informants also described
personal organizational skills
related to time management as
well as organizational skills relat-
ed to understanding the entire
hospital. This probably reflects
the level of management with
which the charge nurse is con-
cerned. As the study progressed,
the research team found that a
modified group of broad cate-
gories of skills worked better for
understanding charge nurse com-
petencies than those posited by
Katz (1974). In addition, infor-
mants shared a set of characteris-
tics they thought charge nurses
should possess. These adapta-
tions will be covered in the results
section.
Descriptive qualitative method-
ology using constant comparative
analysis was used to ancdyze the
interviews (Crabtree & Miller, 1992).
This interpretative process of
analysis looks for similarities and
differences in narrative data. The
analyst identifies underlying uni-
formities in the data and produces
coded categories or concepts.
Each category/concept is then
compared to more data and to
other categories/concepts to sharp-
en the understanding of the concept
and to look for alternative inter-
pretations (Katz, 1974).
In this study, methodological
rigor was maintained by the use of
standard qualitative techniques,
specifically an audit trail, process
and analj^ic memos, peer-briefing
procedures, and member check-
ing. An audit trail is the process of
maintaining records of the study
by documenting in memos the
process and analytic decision
making throughout the process.
Peer briefing was conducted with
periodic meetings of colleagues
knowledgeable about the topic
and qualitative research. This
process helped prevent early clo-
sure and reduced biases the team
may have had. Member checking
is the process of asking informants
to discuss the findings of the
study and validate if the findings
are representative of their experi-
ence. Member checking was
accomplished by having a small
number of nurses, similar to the
interview informants, meet as a
group. They were asked to review
the codes representing charge
nurse competencies, and indicate
if each should or should not be
included in a list of competencies
of charge nurses.
Results
In analyzing the data from the
interviews, the authors identified
54 specific competencies that
were grouped into four categories:
clinical/technical (15), critical
thinking (13), organizational (9),
and human relations skills (17).
Specific competencies for each
category are included in Table 1.
After the competencies were iden-
tified, the authors further clarified
each competency. A competency
statement was developed, along
with a paragraph clarifying the
competency as an expectation of
the charge nurse, and representa-
tive quotes from the interviews
were provided (see Table 2). In
addition to clarifying the compe-
tencies, the quotations help to
illustrate how the competency
was grounded in the interview
data.
Themes and Discussion
Based on the findings of this
study, the charge nurse role meets
the definition by Katz (1974) of an
administrator: "The administrator
is one who (a) directs the activi-
ties of other persons, and (b)
undertakes responsibility for
achieving certain objectives
through these efforts" (p. 91). The
charge nurse directs the staff of a
nursing unit for a particular shift,
undertaking responsibility for the
objective of providing appropriate
nursing care for unit patients.
Review of the literature clearly
indicates that this role is not often
considered an administrative or
managerial position. Consistently,
the head nurse is considered the
entry level or first-line nurse man-
ager (Beaman, 1986). Participants
in this study saw the charge nurse
as the front-line manager as
described in the following pas-
sage:
The charge nurse equates to
the on-the-ground leader;
(the) front-line person who
has the responsibility and
hopefully the capability to
assess the day-to-day situa-
tion and initiate the actions
needed to take care of the
issues at hand, operationally
day-to-day. They probably
don't have the need to be
much of a forward thinker, not
too much strategic planning,
(but) the really operational,
tactical on the ground, ready
to go. But dealing with every
issue that comes up and facili-
tating the things that are nec-
essary to make the ward run
correctly, as well as making
sure that the patients get the
first-line care that they need.
300 MEDSURG Nursing—October 2003—Vol. 12/No. 5

4. A Qualitative Study of Charge Nurse Competencies
Table 1.
Charge Nurse Competencies
Clinical /Technical Competencies: Responsibilities
directly related to patient care or some tectinicat aspect of
working on a clinical unit.
1. Calculate patient acuities and enter them in the
computer (or ensure these are done).
2. Connplete administrative duties (examples: complete
24-hour report, pre-op charts, update board).
3. Assist staff in completing their work.
4. Act as a clinical resource, sharing knowledge.
5. Use computer skills to chart and complete reports.
6. Delegate workload appropriately and fairly.
7. Check emergency equipment, handle unit
emergencies.
8. Conduct initial unit-wide patient assessments.
9. Use knowledge of medical equipment to provide
care.
10. Use knowledge of avaiiabie clinical resources when
needed.
11. Use knowledge of unit, type of patients, procedures,
etc., to plan work.
12. Maintain a safe, clean physical unit environment.
13. Provide direct patient care as needed, balancing
patient care with charge nurse duties.
14. Give an effective change of shift report.
15. Provide for patient safety.
Critical TMiricing Competmcies: Responsibitities that
address effective decision making and problem solving
involving both clinical and operational issues on the unit.
1. Anticipate patient needs, staffing requirements;
engage in anticipatory planning and generating
solutions.
2. Assess/evaluate clinical and operational information.
3. Manage crises as they occur.
4. Make decisions.
5. Use good judgment.
6. Prioritize — decide the order of importance of tasks.
7. Use knowledge of patient status to plan care.
8. Use knowledge of staff capabilities to plan care.
9. Troubleshoot — problem solve to prevent a potential
crisis.
10. Manage time effectively.
11. Assess requirements and take action to provide
adequate staff.
12. Know and deal with personal limitations.
13. Deal effectively with change.
OrganiaHrtional Competencies: Responsibilities to
understand and operate in the organizational environ-
ment on the unit as well as in the larger institutions (hos-
pital, agency, etc.}.
1, Coordinate multiple tasks in order to keep unit
operations flowing.
2, Deal with interrufrtions.
3, Use a method to keep organized.
4, Prepare prior to the beginning of shift.
5, Know and use hospital/unit policies and patient
procedures appropriately.
6, Oversee unit functions to ensure overall quality of
care/practice.
7, Understand what is happening in whole hospital in
order to adjust running the unit.
8, Manage cost and supply issues.
9, Accept the primary role of the charge nurse.
Human Retedons SltWs Compirtancias:
Responsibilities to interact effectively with other person-
nel to accomplish the requirements of patient care as well
as administrative activities.
1. Be accessible — identify self as the charge nurse.
2. infiuence atmosphere of unit in positive manner.
3. Demonstrate caring for others.
4. Communicate effectively with head nurse,
on-going/off-going shift, physicians,
patients/families, staff, supervisors.
5. Deal with difficult people, situations, shifts.
6. Use diplomacy with people.
7. Get along with people.
8. Interact positively with head nurse.
9. Provide leadership during the shift.
10. Motivate staff to accomplish the mission.
11. Protect staff.
12. Address patient complaints.
13. Role model effectively.
14. Supervise the work of the nursing staff (including
agency nurses).
15. Develop and train the staff.
16. Support staffs personal needs.
17. Team-build — develop cooperative efforts.
MEDSURG Nursing—October 2003—Vol. 12/No. 5 301

5. A Qualitative Study of Charge Nurse Competencies
Table 2.
Example of a Competency Statement
Title of
Compatsncy
Category
Stetoment
Explanation
ItepreMntative
Quotes
Coordinate multiple tasks in order to keep unit opera-
tions flowing.
Organizational skills
The charge nurse Is responsible to ensure operations
on the unit flow smoothly, multiple tasks are handled
simultaneously, and patient/staff/ancillary support traffic
is coordinated so all required tasks are accomplished.
The charge nurse must be able to coordinate not only
the care of individual patients, but also the operations
ofthe unit. This is evidenced by the charge nurse's abil-
ity to communicate and negotiate with other profes-
sionals, units, and departments in the hospital, as well
as his/her own staff. This may be the coordination with
physicians to discharge patients in order to "make
room" for new patients or negotiation with other units
on when to receive patient transfers. This also involves
working with the staff on the unit to ensure they have
the support they need to complete all care.
• "Make sure your patients get to the right place at the
right time."
Kind of triage nursing."
• "Organizational flow of patients through the unit and
working with physicians to get patient flow can be
hectic and tedious."
• "You can talk to them and negotiate a time for those
patients (to) come in, so that then you have at least
the ability to control the traffic coming into your
ward."
• "They (charge nurses) wiil be facilitating care
between the medical staff, the ancillary staff, all the
other services, you know, whether it's physical ther-
apy, nutrition care, any of those, social work, what-
ever happens to be needed."
This quotation identifies the
charge nurse as problem-solver
and manager of the quality of care
delivered on a particular shift. As
noted earlier, a great deal of atten-
tion has been paid to the head
nurse role, and this study is not
intended to minimize the impor-
tance of that role. However, on a
daily, shift-by-shift basis, the
charge nurse has direct responsi-
bilities that are both clinical and
operational in nature. This is
clearly supported by the nature of
the competencies identified in this
study. Frequently charge nurses
have only the preparation they
have received in their formal edu-
cation. As noted by Beaman
(1986) and Stevens (1980), educa-
tion for management has been
eliminated from many schools'
curricula. Charge nurses clearly
need further development for
their managerial role.
Because charge nurses have a
tremendous amount of responsi-
bility, the nursing profession may
need to examine closely the
expectations and types of support
nursing leaders provide to individ-
uals in charge nurse roles. The
findings of this study agree v/ith a
great deal of the literature con-
cerning the role of administrators
and first-line managers, although
little of that literature is research
based (Noll, Hix, & Hawley 1989;
Osguthorpe, 1997).
One of the major themes of
this study was the importance of
human relations competencies.
This is supported in the literature
about management, as well as the
literature about retention. For
example, a study of two 500-bed
hospitals found the most satisfy-
ing attributes of nurses' jobs were
positive relationships with the
supervisor and co-workers (Longo
& Uranker, 1987). In a qualitative
study of nurse retention, Connelly,
Hoffart, and Taunton (1997) found
the reason most frequently men-
tioned by nurses for staying in
their position was cohesive co-
workers. The second most fre-
quently mentioned reason was the
atmosphere of the unit or hospi-
tal. Furthermore, charge nurses
play an important role in deter-
mining the atmosphere and team-
work of a unit. This is reflected in
the following quote from this
study: "Trying to have a cohesive
atmosphere, too. And I really think
units function so much better if
everybody looks at it as, you
know, a joint effort.,.the atmos-
phere is teamwork..."
Making the best use of all
resources, whether on the unit or
in other areas, was another theme
in this study. The nurses who were
interviewed frequently mentioned
the need for charge nurses to
know their available resources
and how to use them to facilitate
patient care. As one charge nurse
said:
That means having the basic
knowledge, but not necessari-
ly knowing it all...And also
knowing who their resources
302 MEDSURG Nursing—October 2003—Vol. 12/No. 5

6. A Qualitative Study of Charge Nurse Competencies
are. In the organization you
can be a charge nurse when
you're fairly junior as long as
you know who's available to
help you out if you get your-
self in a corner.
This thought is consistent
with the views of Bostrom and
Suter (1992), who indicated that
assigning nursing resources to
individual patients was an impor-
tant function of charge nurses.
In addition, having the ability
to use critical thinking skills to
troubleshoot and think ahead has
become increasingly important.
One comment from this study that
reflects the ability to think critical-
ly is, "I guess you have to triage
the situation, if you will, meaning
you have fo ultimately decide
what has to happen for the patient
and work backwards." The duties
of fhe charge nurse have expand-
ed as the acuity of the patient pop-
ulation has increased, technology
has become more complex, and
the quick turnover of patients has
made rapid problem solving the
norm (Noll et al., 1989). Also, lead-
ers within health care organiza-
tions expect nurses to be intelli-
gent stewards of the various
resources within their manage-
ment control.
In addition fo the importance
of using human relations skills and
making the best use of available
resources is the crucial relation-
ship between the head nurse and
charge nurse. Head nurses stated
that charge nurses represented
them on a particular shift, that they
were an "extension of the head
nurse." Llnderstanding the philoso-
phy of the head nurse was impor-
tant in order to support the head
nurse's policies: "If the head nurse
feels that we will bend over back-
wards and go that extra mile for
our patients, then the charge nurs-
es usually accept that and go with
if." Mutual respect, trust, and con-
stant communication are neces-
sary for both to do their job effec-
tively. In addition, the head nurse is
responsible for developing, coach-
ing, and teaching the charge nurse.
As one head nurse asserted, "And
they tend to get molded (by) their
head nurse, I think you (head
nurse) play a big role in that." The
following quotation illustrates the
importance of the relationship
between fhe head nurse and the
charge nurse, and how assessment
of a charge nurse's abilities can be
accomplished:
Then she was talking about a
nurse, a charge nurse, who
she described as a natural
charge nurse, was the words
that were used. And it was a
young, newer nurse that
wouldn't be expected to have
good charge nursing skills and
this was a time when (name)
was a head nurse, and this
new nurse insisted that she
was ready to be charge, but
she wasn't sure that (the new
nurse) was (ready). So she
allowed her to be charge on
weekends, but then came in
and supervised her (when)
she was charge nurse. And
questioned her, 'Why are you
doing that?' 'What are you
thinking about?' 'How are you
going fo do that?' So just fry-
ing fo ascertain (the new
nurse's) knowledge about
what was going on and (the
head nurse) said the maturity
level that (the new nurse) had,
was very interesting. This was
a very organized person; the
thing fhat gave her the most
confidence was that this
charge nurse knew when to
call for help, knew when to
call the physician, when there
was something that was not
right. So (the new nurse) had
early signs of clinical exper-
tise in terms of looking at the
cues a patient would be pre-
senting physically and inter-
preting fhose properly to
know when she (was) going to
be needing assistance and to
call a physician for it.
Characteristics of an
Effective Charge Nurse
In addition to the competen-
cies, study participants provided
a description of 15 characteristics
cm effective charge nurse should
possess. Rather than specific com-
petencies, they are similar to per-
sonal traits or attributes. An indi-
vidual may be able to develop
some of these over time, but they
are more difficult for others to
teach or develop in another per-
son. The principal criterion for a
competency must be effective
action under varying conditions
(Katz, 1974). In addition, a compe-
tency should be a skill that can be
developed as opposed to charac-
teristics, which are traits or attrib-
utes an individual possesses at a
point in time. Many of the charac-
teristics mentioned were seen as
prerequisites for the charge nurse
role. Some of the nurses who were
interviewed thought a head nurse
would be wise to assess these
characteristics in nurses assigned
to the position of charge nurse.
The characteristics were:
Accountability
Assertiveness
Positive attitude
Authority
Confidence
Need to control
Fairness
Flexibility
Humor
Image
Initiative
Maturity
Ability to learn from mistakes
Command respect
Responsibility
The characteristics, along with
the competencies, provide a
detailed examination of what is in
the charge nurse role. Figure 1 out-
lines the relationships among
characteristics, competencies, and
developmental programs.
MEDSURG Nursing—October 2003—Vol. 12/No. 5 303

7. A Qualitative Study of Charge Nurse Competencies
Figure 1.
Competency Framework
New Nurse Comes with and has Developmental Experiences Developing Competencies for Charge Nurse Role
- Characteristics
- Demographics
- Competencies
from past
experiences
- Educational
- Developmental
relationships, such
as coaching
- Experiences with
other charge
nurses
- Clinical/Technical
- Organizational
- Human relations skills
- Critical thinking
Effective
functioning
Modification of Conceptual
Framework Based on Data
At the beginning of the study,
Katz's (1974) three categories of
administrative skills (technical,
conceptual, and human relations)
were used as the basis of probing
questions in the interviews. As
previously mentioned, the word
conceptual was changed to organi-
zational. Katz's (1974) three cate-
gories of administrative skills did
not fully account for all the data.
After reviewing the data, the
research team decided to add the
category of critical thinking
because this category reflects
many things charge nurses do and
defines an area that new gradu-
ates clearly need to develop. In
one study that used Katz's cate-
gories, the technical skills category
was used very broadly, including
critical thinking (Duffield, 1994).
However, a broad approach to
technical skills did not appear to
provide sufficient explanation in
light of the data for the current
study. Cartier (1995) supported
the idea that critical thinking is
part of the charge nurse role:
"Critical thinking and expanded
decision-making skills, as well as
increased delegation to peers and
subordinates, would be required
of staff nurses acting as (charge
nurses)" (pp. 277-278). The cate-
gories in Table 1 are a useful way
to group and think about the com-
petencies when charge nurse
skills are being developed; each
area can be developed in a variety
of ways as outlined in the next sec-
tion of this article.
Developmental Programs
Educational and developmen-
tal programs are needed for
charge nurses, especially those
who are relatively new graduates.
Based on findings of this study,
educational programs should
include role playing, analysis of
cases, and debriefing specific situ-
ations. Although some didactic
information is important, it is per-
haps more important for charge
nurses to practice handling cer-
tain problematic situations and
receive feedback from a support-
ive person. The number of human
relations skills competencies
demonstrates the importance of
this category. Charge nurses need
these skills, which will also be
needed throughout a nursing man-
agement career. The data from
this study are rich with descrip-
tions of effective and ineffective
charge nurses. Material from the
interviews of nurses at any facility
could be used in writing educa-
tional scenarios that will be help-
ful in developing effective training
programs for charge nurses in var-
ious settings.
New charge nurses comment-
ed that a checklist of critical tasks
would be beneficial. They believed
such checklists could assist them
in organizing the required duties
of the shift. Examples of items on
such a checklist could include
checking emergency equipment,
recording patient acuities, and
checking the schedule of the
oncoming shift to assure staffing
to prevent later problems. The
charge nurse would not have to
perform all the tasks but would
need to assure that duties are
assigned to staff members and
accomplished by the end of the
shift. As junior charge nurses
mature in their roles, they no
longer rely on such lists. However,
a list initially provides a frame-
work for them to manage or assign
essential tasks.
Developmental relationships,
especially with the head nurse, are
very important to help mold
charge nurses. Because the charge
nurse represents the head nurse
on a particular shift, it is critical
they understand each other and
work as a team. Therefore, it is
essential that head nurses clearly
304 MEDSURG Nursing—October 2003—Vol. 12/No. 5

8. A Qualitative Study of Charge Nurse Competencies
communicate their philosophy for
care provision and the expecta-
tions related to assuming and suc-
cessfully performing the charge
nurse role. In addition, the charge
nurse role is an important devel-
opmental role for a nurse aspiring
to become a head nurse because
the best performers of the charge
nurse role are often selected for
advancement opportunities.
Conclusion
The charge nurse role is com-
plex and serves as the clinical
nurse's exposure to first-line man-
agement. This study fills a major
gap in the literature by providing
research-based information about
the role of the charge nurse. The
number and complexity of the
identified competencies reflect the
importance of this role in hospi-
tals. Further work is needed in the
areas of appropriate selection of
nurses for the role, training pro-
grams, coaching relationships with
the head nurse, and recognition
programs for those who excel in
the role. Although this study was
conducted in a military setting, the
findings clearly have applicability
to most settings that use the
charge nurse position. The compe-
tencies outline specific leadership
skills that any charge nurse either
possesses or needs to develop to
be effective in the role. •
References
Beaman, A. (1986). What do first-line nursing
managers do? Journal of Nursing
Administration, /6(5), 6-9.
Bostrom, J., & Suter, W. (1992). Charge
nurse decision making about patient
assignment. Nursing Administration
Quarterly, ?6(4), 32-38.
Cartier, T. (1995). Development and imple-
mentation of a leadership skills course
for the charge nurse. The Journal of
Continuing Education in Nursing, 26(6),
276-279.
Chaboyer, W., Najman, J., & Dunn, S.
(2001). Cohesion among nurses: A
comparison of bedside vs. charge nurs-
es' perceptions in Australian hospitals.
Journal of Advanced Nursing, 35(4),
526-532.
Connelly, L.M., Hoffart, N., & Taunton, R.
(1997). Why nurses stay: A qualitative
study. Surgicai Services Management,
3(5), 44-48.
Costello-Nickitas, D.M. (1997). Get ready to
take charge. American Journai of
Nursing, 97(5), 16B- 16J.
Crabtree, B., & Miller, W. (1992). Doing quai-
itative research. Newbury Park, CA:
Sage.
Duffield, C. (1994). Nursing unit managers:
Defining the role. Nursing Management,
25(4). 63-67.
Hinkle, M.J., & Hinkle, B.J. (1977). Priorities
of the charge nurse B Part I. Supervisor
Nurse, 8(11), 47-54.
Katz, R. (1974). Skills of effective administra-
tors. Harvard Business Review, 52(5),
90102.
Longo, R., & Uranker, M. (1987). Why nurses
stay: A positive approach to the nursing
shortage. Nursing Management, 18{7).
78-79.
Mahlmeister, L., & Koniack-Griffin, D.K.
(1999). Professional accountability and
legal liability for the team leader and
charge nurse. Journai of Obstetric,
Gynecoiogic. & Neonatal Nursing.
2S(3), 300-309.
Noll, M., Hix, C, & Hawley, D. (1989). Re-
evaluating the role of the charge nurse.
Dimensions of Critical Care 8(5), 298-
309.
Osguthorpe, S. (1997). Managing a shift
effectively: The role of the charge nurse.
Criticai Care Nurse, 17(2), 64-70.
Patton, M.Q. (1990). Quaiitative evaiuation
and research methods. Newbury Park,
CA: Sage.
Shermont, H., & Russell, G. (1996). Making
assignments that really work. American
Journai of Nursing, 96(1), 16M-16N.
Sonnenberg, D. (1999). Life in the fast lane-
helpful tips for OR charge nurse. AORN
Journai, 69(5). 94^-944.
Stevens, B. (1980). Improving nurses' man-
agerial skills. Nursing Times, 76(46),
2022.
Zimmerman, P.G. (2000). Charge nurse
(Manager's Forum). Journai of
Emergency Nursing, 26(2), 164-165.
fed/Surg Clinical
Nurse Specialist
In the Med/Surg Department, this most compiex of spe-
cialties, we look for Ciinicai Nurse Specialists with a
passion for their profession, excellent communication
and strong criticai thinking skiiis. The Med/Surg experi-
ence at Prince George's offers chaiienge and variety —
from orthopedics to neuroiogy to trauma to oncoiogy. As
a Ciinicai Nurse Specialist, you wiil have the opportunity
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We asi( more of our nurses—both in certification and in
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return to you great reward in the breadth of experi-
ences you'll encounter—and in the depth of apprecia-
tion you'll receive from your both the patients and the
nursing team.
if you're a l<nowledgeable, self-confident, independent,
and highly organized caregiver, our Med/Surg
Department is the place for you.
We offer great careers
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Dimensions Healthcare System
Prince George's Hospital Center
MEDSURG Nursing—October 2003—Vol. 12/No. 5 305

9. A Qualitative Study of Charge Nurse Competencies
MSN J313
Answer/Evaluation Form:
A Qualitative Study of Charge Nurse Competencies
This test may be copied for use by others.
COMPLETE THE FOLLOWING:
Name:
Address:
City: State:
Preferred telephone: (Home)
State where licensed and license number:,
AMSN Member Expiration Date:
. (Work)_
Registration fee: AMSN/ISONG Member:
Nonmember:
$10.00
$13.00
Answer Form:
1. Name one new detail (item, issue, or phenomenon) that you
learned by completing this activity.
2. How will you apply the information from this learning activity to
your practice?
a. Patient education.
b. Staff education.
c. Improve my patient care.
d. In my educational course work.
e. Other: Please describe.
Objectives
This educational activity is designed for
nurses seeking leadership and management
skills that medical-surgical nurses need to
function as effective charge nurses. For those
wishing to obtain CE credit, an evaluation fol-
lows. After studying the information present-
ed in this article, the nurse will be able to:
1. Discuss the role of charge nurses in hos-
pital settings.
2. List four charge nurse competency cate-
gories.
3. Describe a competency statement.
CE Instructions
1. To receive continuing education credit for
individual study after reading the article,
complete the answer/evaluation form to
the left.
2. Detach and send the answer/evaluation
form along with a check or money order
payable to Jannetti Pubiications/MED-
SURG Nursing to MEDSURG Nursing, CE
Series, East Holly Avenue Box 56, Pitman,
NJ 08071-0056.
3. Test returns must be postmarked by
October 31, 2005. Upon completion of the
answer/evaluation form, a certificate for 2.2
contact hour(s) will be awarded and sent to
you.
3. I verify that I have completed this activity.
(Signature)
Evaluation
The offering met the stated objectives.
1. Discuss the role of charge nurses in hospital
settings.
2. List four charge nurse competency categories.
3. Describe a competency statement.
4. The material was new for me.
5. Time required to complete reading assignment and posttest:
Comments
Strongly
disagree
1 2
1 2
1 2
1 2
posttest:
3
3
3
3
Strongly
agree
4 5
4 5
4 5
4 5
Minutes
This independent study activity is pro-
vided by Jannetti Publications/
Anthony J. Jannetti, Inc., which is
accredited as a provider and approver of
continuing education in nursing by the
American Nurses Credentialing Center's
Commission on Accreditation (ANCC-
COA). Anthony J. Jannetti, Inc. is an
approved provider of continuing educa-
tion by the California Board of
Registered Nursing, CEP No. 5387.
This article was reviewed and formatted for
contact hour credit by Dottie Roberts, MSN,
MACI, CMSRN, RN,BC, ONC, MEDSURG
Nursing Editor; and Sally S. Russell, MN,
CMSRN, AMSN Education Director.
306 MEDSURG Nursing—October 2003—Voi. 12/No. 5

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