ChargED Up for Leadership; Developing Your Dream Team

Aim: : The purpose of this work was to optimize the Magnet nursing culture, where every nurse is a transformational leader, to empower a dedicated group of charge nurses to improve the nursing care environment in the Emergency Department (ED). This work impacted the quality of our leader’s performance..

Framework:: ADKAR (Awareness, Desire, Knowledge, Ability, Reinforcement)

Setting:: The setting for this project is a community hospital, level 2 trauma center with 42,000 ED visits annually, located in the Midwest.

Stakeholder Team:: ED Clinical Director- Provided the vision for charge nurse team development, facilitator and mentor
Clinical Practice Specialist- developed case scenarios for simulation and was an ad hoc mentor
Social Worker- developed and presented standardized leadership development program, ongoing consultation, coaching and education
4 ED Clinical Shift Coordinators- participants

Methods: : Partnering with internal experts from operations and HR, charge nurses were educated in operational skills including scheduling, payroll, HR topics, orientation and onboarding, productivity and finance. For soft skills, the Professional Development (PD) social worker taught and facilitated discussion on communication styles, executive presence, emotional intelligence, self-regulation and navigating courageous conversations. The social worker collaborated with the clinical practice specialist to create case scenarios to practice the essential leadership skills in a simulation setting. Health system resources were used for self-guided education for the one-year leadership development program. Charge nurses met monthly with nurse clinical director and PD social worker to debrief situations. Advice and feedback were provided. The charge nurses grew in cohesiveness.

Outcomes:: This standardized charge nurse development program was a success. Prior to this project, the charge nurses did not have the skill set, nor comfort level to provide peer coachings, leaving much of that to the clinical director. Post-development, the charge nurses manage 100% of staff coachings and escalate to the clinical director as needed. They independently manage daily operations of the unit. Throughout this process, the ED staff were surveyed in three key areas. The ED staff surveys revealed the following: team accountability- baseline 73%, post 82% (12.3% increase); real-time feedback- baseline 73%, post 88% (20.5% increase); and acknowledgement of a job well done- baseline 65%, post 82% (26.2% increase).
There was 100% voluntary retention of the first cohort. One charge nurse in the cohort won 2022 organization Transformational Leadership Award and another has been promoted to the ED Manager role.

Implications:: Based on staff surveys, the nurse care environment has improved. Charge nurses in the ED operate autonomously, continuing to gain confidence. This standardized charge nurse development will be disseminated further within the organization. New cohorts are being developed with input from their peers. Prior to this program there was not a standardized approach to develop the charge nurse team. By providing this opportunity for growth, the department has had improved staff engagement, recruitment and retention. The cohesiveness of the charge nurse team has positively impacted the culture of the department.