Mahbobeh Yaghobian  ( Department of Nursing, Tarbiat Modares University, Tehran, Iran )
Hassan Navipour  ( Department of Nursing, Tarbiat Modares University, Tehran, Iran. )
Zohreh Vanaki  ( Department of Nursing, Tarbiat Modares University, Tehran, Iran. )

Objective: To determine the competencies of charge nurses.

Methods: The systematic review and thematic synthesis study was done at Iran from1 Apr 2018 to 31 Jul 2018. Five electronic bibliographic database (Science Direct, Pro Quest, Scopus, Pub-Med, Scientific Information Database) were systematically searched for relevant literature published from 1980 to 2018. Content analysis was done to categorise competency of charge nurses.

Results: Of the 1285 articles, 24(1.86%) were reviewed. Through thematic synthesis, six themes identified were self-management, others' management, clinical competency, conceptual-cognitive competency, professional-legal competency and competency in communication. There is need to improve knowledge and skills in the domains of management, leadership, communication and perceptual/cognitive competency.

Conclusion: The findings may help nurse administrators and nurse directors in designing training programmes for charge nurses who could improve their competencies.

Keywords: Competence charge nurse, Systematic review.

DOI: https://doi.org/10.5455/JPMA.38686

 

Introduction

 

Nurses have different roles in health centres around the world. One of these roles is that of charge nurses (CNs), and, according to the definition of the National Labour Relations Board, they are directly responsible for all duties and tasks of their unit staff and even assess the performance of nursing staff.¹ Studies show that CNs as front-line leaders and the nursing staff are effective in improving patient outcomes and the satisfaction of health workers. Therefore, they must be trained and encouraged to improved their managerial competencies. Unfortunately, nurses without formal training are often found in the role of CN. The placement of nurses in roles without training will lead to a lack of readiness for various roles, such as head nurse, nurse assistant, manager, supervisor, CN, and team leader.² Lack of attention to the role of CNs cause confusion and ambiguity about their role. In most studies, ambiguity in the role of nurses has been reported.^1,3 Despite the key role of nurses, organisations generally pay little attention to the issue. Current standards for educating and preparing nurses to take on the CN role are inadequate. Considering the importance of CNs in healthcare, it is necessary to understand their specific role. The current systematic review was planned to determine the competencies required to be an effective CN.

 

Methods

 

The systematic review and thematic synthesis study was done at Iran from 1 Apr 2018 to 31 Jul 2018. Studies and dissertations that were peer-reviewed and published in academic journals from 1980 to 2018 in English or Persian languages were extracted from Science Direct, Pro Quest, Scopus, Pub-Med, Scientific Information Database (SID). The search strategy was the same for all databases. The search was conducted with the following terms: CN or front-line leader, CN needs, CN roles, CN and competency, CN and managerial competency, and CN and leadership competency. All authors independently reviewed relevant documents. Articles that were excluded from the study were those published prior to 1980, non-academic journals, not related to the research question and those where full text was not available. PRISMA checklist was used for items and flow chart.⁴To increase the quality of the review for selected articles, two authors independently reviewed related documents to reduce any selection bias. Titles and abstracts of the articles were screened. Each study was subsequently reviewed at least twice in the light of 27-item PRISMA checklist to include sections / topics covering title, abstract, introduction, methods, results, discussion and funding. Also noted were author, year, country of origin, purpose, methodology and sample. Data analysis and synthesis began after the extraction phase. Thematic synthesis was used for identifying and coding recurring issues from the selected texts. Finally, the themes were coded.

 

Results

 

Of the 1285 articles initially identified, 799(62.2%) were discarded for being unrelated. Subsequently, 422(32.8%) were discarded in line with the exclusion criteria, and 64(5%) were shortlisted for detailed review. The third screening discarded 23(1.78%) articles for being duplicates and 17(1.32%) for inappropriate content, leaving 24(1.86%) texts as the study sample (Figure-1).

Among these 24 papers, the majority were from the United States 14(58%); 11(45.8%) were qualitative; 7(29%) were quantitative; and the rest were mixed and reviewed (Table-1).

Using thematic content analysis and in consultation with scholars, determinants of CN competencies were classified into 6 themes, 14 categories and 36 sub-categories (Table-2).

 

Theme 1: Self-management

 

Most studies emphasized the theme of selfmanagement.^5-9

 

Theme 2: Others' management

 

CNs with the skill to manage others, like nurses and students, are empowered by preparation and training preceptor-ship,¹⁰role of coaching,^6,11 maintaining and enhancing the ability of nurses staff and nurses,^12,13 and clinical supervision.^1,3,11,14

 

Theme 3: Clinical competency

 

The clinical competence of CNs has been emphasised by the authors in most of the reviewed articles. They are responsible for day-care patients,⁶ write day-to-day programmes for departmental employees, and also get involved in short-term and long-term planning of the organisation.¹¹ Budgeting and cost control^15,16 patient care auditing⁸ and considering cost-effective patient care¹¹ are part of the responsibilities of managerial and organisational CNs.

 

Theme 4: Conceptual-cognitive competency

 

CNs are supposed to be equipped with the knowledge of personnel management¹¹ to make creative decisions with problem-solving skills^3,6,11,14,17 creative thinking^16-18, and critical thinking.^3,6

 

Theme 5: Professional-legal competency

 

The ability to apply organizational authority through the recognition and application of laws and regulations^6,11,14,19 and optimal use of organizational power is achieved^3,11,17,20 They advocate for nurses,¹⁹ know the methods of litigation¹¹ and work to promote the organization.¹⁹

 

Theme 6: Competency in communication

 

Communication skills as a requirement for CNs have been addressed by several studies^{7,10,11,14,17} including the skill of building and leading teams, reporting to senior officials, participation in organisational meetings, counselling, written and oral communication, excellent professional qualifications and being a model for the employees.^7,11 The ability to coordinate and lead a team with leadership skills was also emphasised.^{11,13,14,19,21,22}

 

Discussion

 

Six themes were identified on the basis of studies that had been conducted to determine the needs and competencies^{1,8,11,14,17,20,22,23} of CNs, or to define and determine their role^1,8,11 in terms of implementation workshop, fellowship and toolkit design,^9,16 or to qualitatively determine the perceptions and experiences of nurses^{8,11,18,24,25} CNs should have knowledge and skills such as planning, organising, monitoring, controlling, coordinating and evaluating themselves and their colleagues.^{1,3,6,11,12,13,14} The findings from recent studies indicated the key role of CNs in leading the nursing staff.^{8,12,18,19,22,26} On the other hand, according to the provision 5 of the American Nurses Association (ANA) Code of Ethics for Nurses issued in 2016, "The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth".²⁷ As such, these skills are vital for CNs. Studies in this area showed that nursing leadership is effective in staff retention, satisfaction and safety of patient outcomes.^28-31 These factors have encouraged researchers to design and implement educational programmes for CNs.^{7,16,24,32-36} This review found that having human-relationship skills is considered necessary for CN competence. Communication is the method by which information is transmitted and is the basis of organisational interactions. Relationships include those with patients, staff, doctors, head nurses, managers and patients' family. CNCNs require learning the skills and techniques of communication. The CN should be able to build and lead the team and use methods, such as preceptor-ship and mentorship, to provide satisfaction to patients and their families. Learning the skills of human relationships for CNs has been emphasised by several studies.^{7,11,13,14,19,21,22} Other findings relate to clinical competence. Duffield and Sheet believe that it is necessary for CNs to have clinical and technical skills and be able to apply it to provide standardised care.^7,10 Standards-based care enables CNs to design and update a guideline based on evidence.^9,18 Standard care enhances the safety and performance of the CNs in the clinic and ultimately improves the quality of care. Having perceptual/cognitive competence enables CNs to analyse problems, indulge in creative decision-making, opt for risk management, and to develop proper planning. In addition, they should be able to identify staff problems and solve them as well as to encourage the staff to make clinical decisions continuously and instantaneously with professionally critical thinking.^{3,6,9,11,16,17,18} Other findings relate to stress control and management. Assigning multiple roles and tasks, and ambiguity in task assignment create a tense and stressful environment. Managing one's own stress and that of the staff, management of the day-to-day operations, and crisis management are considered mandatory skills for CNs.^7,11,17,32 And, finally, the CNs should have legal and professional competence to protect the rights of both the patients and the nurses.^6,7,11,17

 

Conclusion

 

The role and competence of CNs are multidimensional in nature, and no single factor is more important than the rest. The findings are applicable to nursing organisations, hospitals and professional educational centres.

 

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

 

References

 

1. Eggenberger T. Exploring the charge nurse role: holding the frontline. J Nurs Adm 2012;42:502-6. doi: 10.1097/ NNA.0b013e3182714495.

2. Cathro H. Navigating Through Chaos: Charge Nurses and Patient Safety. J Nurs Adm 2016;46:208-14. doi: 10.1097/ NNA.0000000000000326.

3. Nel E, Muller A, Colyn A. The competencies of the shift leader in the intensive care unit setting, in a private hospital group in South Africa. Health SA Gesondheid 2011;16:e425. doi:10.4102/ hsag.v16i1.425

4. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. doi: 10.1371/ journal.pmed.1000097.

5. Hewko SJ, Brown P, Fraser KD, Wong CA, Cummings GG. Factors influencing nurse managers' intent to stay or leave: a quantitative analysis. J Nurs Manag 2015;23:1058-66. doi: 10.1111/jonm.12252.

6. Nunn GM, Braye R, Petkovich M, Bray NW, Linberg K. The perceived leadership skills needed to improve the effectiveness of charge nurses: A grounded theory study. [Online] 2008 [Cited 2018 December 06]. Available from URL: h t t p s : / / s e a r c h . p r o q u e s t . c o m / openview/662944db671cf42ae96398570bf1d88d/1?pqorigsite= gscholar&cbl=18750&diss=y

7. Sherman RO, Schwarzkopf R, Kiger AJ. Charge nurse perspectives on frontline leadership in acute care environments. ISRN Nurs 2011;2011:e164052. doi: 10.5402/2011/164052.

8. Thomas PL. Charge nurses as front-line leaders: development through transformative learning. J Contin Educ Nurs 2012;43:67- 74. doi: 10.3928/00220124-20111003-05.

9. Sheets B. Charge Nurse Fellowship. [Online] 2015 [Cited 2018 December 06]. Available from URL: https://search.proquest.com/ openview/5de803914abde51a20af2646fb40a63c/1?pqorigsite= gscholar&cbl=18750&diss=y

10. Allison EG. Building leadership capacity in the charge nurse. [Online] 2008 [Cited 2018 December 06]. Available from URL: https://search.proquest.com/docview/304813072?accountid=46 139

11. Duffield C. Nursing unit managers: defining a role. Nurs Manage. 1994;25:63-7.

12. Homer R, Ryan L. Making the grade: Charge nurse education improves job performance. Nurs Manage 2013;44:38-44. doi: 10.1097/01.NUMA.0000427183.65177.76.

13. Connelly LM, Yoder LH, Miner-Williams D. A qualitative study of charge nurse competencies. Medsurg Nurs 2003;12:298-306.

14. Connelly LM, Nabarrete SR, Smith KK. A charge nurse workshop based on research. J Nurses Staff Dev 2003;19:203-8. DOI: 10.1097/00124645-200307000-00010

15. McGilton KS, Bowers B, McKenzie-Green B, Boscart V, Brown M. How do charge nurses view their roles in long-term care? J Appl Gerontol 2009;28:723-42. Doi: 10.1177/0733464809336088

16. Ferland-Jamali E. Building Charge Nurse Leadership Programs: A Toolkit for Emergency Departments. [Online] 2015 [Cited 2018 December 06]. Available from URL: https://search.proquest.com/ docview/1694871228?accountid=46139

17. Connelly LM, Yoder LH. A qualitative study of barriers and facilitators of the charge nurse role. Nurs Leadersh Forum 2003;7:157-64.

18. Agnew C, Flin R. Senior charge nurses' leadership behaviours in relation to hospital ward safety: a mixed method study. Int J Nurs Stud 2014;51:768-80. doi: 10.1016/j.ijnurstu.2013.10.001.

19. Sherman RO, Schwarzkopf R, Kiger AJ. What we learned from our charge nurses. Nurse Lead 2013;11:34-9. Doi: 10.1016/ j.mnl.2012.11.006

20. Smith JE. A study of leadership training programs for charge nurses in nursing homes. [Online] 1983 [Cited 2018 November 12]. Available from URL: https://search.proquest.com/docview/ 303282164?accountid=46139

21. Ghamari-Zare Z, Pourfarzad Z, Vanaki Z. Managerial competencies of charge nurses. Iran Journal of Nursing (IJN) 2011;23:54-62.

22. Johnson J, Shaiju B. Leadership competencies of frontline nurse leaders and its effect on the job satisfaction and performance of staff nurses. Nurs J India 2017;108:57-60.

23. Bambao JR. Needs assessment for the development of a charge nurse program at one tertiary academic teaching hospital. [Online] 2017 [Cited 2018 November 12]. Available from URL: https://search.proquest.com/openview/4f70c0e30ff35c01b33591 d5203a3314/1?pq-origsite=gscholar&cbl=18750&diss=y

24. Rankin J, McGuire C, Matthews L, Russell M, Ray D. Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study. J Nurs Manag 2016;24:366-75. doi: 10.1111/jonm.12330.

25. Willmot M. The new ward manager: an evaluation of the changing role of the charge nurse. J Adv Nurs 1998;28:419-27. DOI: 10.1046/j.1365-2648.1998.00635.x

26. Shupe R. Improving Front Line Leaders Through Front Line Leader Educational Boot Camp. [Online] 2015 [Cited 2018 December 06]. Available from URL: https://search.proquest.com/docview/ 1925343206?accountid=46139

27. American Nurses Association. Code of Ethics for Nurses. [Online] 2016 [Cited 2019 July 24]. Available from URL: https://anacalif.memberclicks.net/assets/Events/RNDay/2016%2 0 c o d e % 2 0 o f % 2 0 e t h i c s % 2 0 f o r % 2 0 n u r s e s % 2 0 - %209%20provisions.pdf

28. Alilyyani B, Wong CA, Cummings G. Antecedents, mediators, and outcomes of authentic leadership in healthcare: A systematic review. Int J Nurs Stud 2018;83:34-64. doi: 10.1016/j.ijnurstu.2018.04.001.

29. Boamah SA, Spence Laschinger HK, Wong C, Clarke S. Effect of transformational leadership on job satisfaction and patient safety outcomes. Nurs Outlook 2018;66:180-9. doi: 10.1016/j.outlook.2017.10.004.

30. Cummings GG, Tate K, Lee S, Wong CA, Paananen T, Micaroni SPM, et al. Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. Int J Nurs Stud 2018;85:19-60. doi: 10.1016/j.ijnurstu.2018.04.016.

31. Husebo SE, Olsen OE. Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department. Scand J Trauma Resusc Emerg Med 2019;27:2. doi: 10.1186/s13049-018-0581-3.

32. Krugman M, Heggem L, Kinney LJ, Frueh M. Longitudinal charge nurse leadership development and evaluation. J Nurs Adm 2013;43:438-46. doi: 10.1097/NNA.0b013e3182a23b26.

33. Gunawan J, Aungsuroch Y, Fisher ML. Factors contributing to managerial competence of first-line nurse managers: A systematic review. Int J Nurs Pract 2018;24. doi: 10.1111/ijn.12611.

34. Shin S, Han J, Cha C. Capacity building for global nursing leaders: challenges and experiences. Int Nurs Rev 2016;63:580-7. doi: 10.1111/inr.12323.

35. Gunawan J, Aungsuroch Y. Managerial competence of first-line nurse managers: A concept analysis. Int J Nurs Pract 2017;23:e12502. doi: 10.1111/ijn.12502.

36. Gottlieb T, Gotzsche-Astrup O. The predictive validity of charge nurse personality on objective and subjective performance of subordinates. J Nurs Manag 2019;27:388-95. doi: 10.1111/jonm.12696.