The positive impact of formalized charge nurse training.

Abstract

Nurses play an important role in patient satisfaction, which impacts hospital reimbursement.1 Value-Based Purchasing (VBP), a program designed by the Centers for Medicare and Medicaid Services (CMS), compensates hospitals with “incentive payments for the quality of care they provide to people with Medicare.”2 VBP has led to a focus on quality and patient satisfaction in acute care hospitals. One study demonstrated that a one-point increase in the nursing domain scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (hcahps) survey can increase the odds of achieving a top-box patient satisfaction score by 4.9%.3 The researchers concluded that hospitals can improve patient satisfaction and maximize Medicare compensation by focusing on nursing care.3 A separate but important finding is how nurse turnover affects quality and patient satisfaction.4 Stabilizing the workforce through retention ensures continuity of care and practice.1 Within our 530-bed health system in south Texas, with 100%+ capacity during the winter months, it isn’t unusual for those nurses identified as highly skilled clinicians to be promoted to the charge nurse role with an expectation to excel— often with little or no training. The orientation provided to charge nurses at our health system is informal and frequently limited to unit routines, such as checking crash carts, collecting census, counting controlled substances, staffing for the oncoming shift, and contacting the house supervisor. On many of our units, after a brief orientation usually performed by an equally unprepared peer, the new charge nurse is left to manage the shifts without any further training. This lack of structured training leads to charge nurses who are unprepared to deal with the complexities of the shift. They’re often unable to manage or prioritize a nurse unhappy with his or her assigned patients, a missing tray from dietary, or a family member requesting to speak with the charge nurse. Charge nurses lead our units; focusing on their development through leadership training that emphasizes communication, mentoring, and coaching skills will result in charge nurses who have the authority to ensure assignments are based on patients’ needs, delegate tasks successfully, supervise care, and provide assistance to those with less experience.5,6 We describe how a formalized charge nurse training program can benefit the health system by improving patient satisfaction and nurse retention.