The Article: Sherman, R. O., Schwarzkopf, R., & Kiger, A. J. (2011). Charge nurse perspectives on frontline leadership in acute care environments. ISRN Nursing, 1-8.

Big Idea: The recent IOM Future of Nursing report urges that nurses at all levels receive leadership training to enhance their skills to propel health care transformation forward. Study authors surveyed 354 charge nurses from ten south Florida Tenet Health System hospitals attending a one-day training about their thoughts of being a frontline leader and examined the skills charge nurses need to be effective leaders in today’s health care environment.

Survey Says!: Survey participants had an average of 19 years of experience, and 55% of charge nurses had either a diploma or an associate degree as their highest level of education. This exploratory study found most charge nurses thought good communication, organizational skills, clinical competence, and approachability were the top skills needed to be an effective frontline leader and charge nurse. Respondents cited managing team conflict, keeping patients and families satisfied, and staying current with policies and procedures as their most challenging role responsibilities. The moments charge nurses identified as bringing them the most satisfaction in their roles included helping develop their team members (especially watching new grads become competent and confident professionals), keeping patient and families satisfied, as well as knowing they’ve effectively managed their teams. Only 34% of participating charge nurses stated they would definitely consider becoming a nurse manager. 46% were somewhat interested in the nurse manager role, and 21% were not interested in pursuing the role at all.

Quotable: “Positions such as that of the charge nurse or assistant nurse manager usually have limited formal leadership power. Their impact on patient care and outcomes is often less visible at the organizational level. Yet as their own administrative responsibilities have expanded, nurse managers increasingly depend on these frontline leaders to assume responsibility for quality outcomes and help meet the growing number of organizational performance measures” (p. 2).

“The charge nurses observed that finding the time and having the skill to work through the many conflicts that occur in work environments is difficult” (p. 4).

“The recommendation in the recent IOM report that nurses especially those working at the front line of care develop strong leadership skills is of key importance in today’s healthcare environment. With rising patient acuity, decreased lengths of stay, staffing shortages, pay for performance initiatives, and complex technologies, frontline nurses who assume charge nurse roles in acute care environments take on challenging responsibilities often without the benefit of any formal training. An investment needs to be in the ongoing education and competency development of charge nurses” (p. 7).

So What? This study helped guide Tenet Health System’s charge nurse educational efforts. Charge nurses have not often been included in leadership development; it is clear from the IOM report that they should be included to effectively manage and transform our health care system. Charge nurses are frontline leaders and should be recruited and developed as such.