Of all the clinicians on interprofessional care teams, nurses spend the most one-on-one time with patients. As frontline clinical leaders responsible for overseeing patient care on the unit, charge nurses (CNs) play a crucial role in maximizing patient safety and minimizing harm.
In hospitals, for example, CNs can have a strong influence on various hospital-acquired conditions (HACs) such as mortality rates, falls, hospital-acquired pressure ulcers, hospital-acquired infections, and medication errors, to name a few.
Although CNs have held important roles in hospitals for many years, there is a lack of knowledge specific to the CN's influence. Heather Cathro, PhD, RN, ambulatory practice coordinator at Kaiser Permanente, San Diego, Calif., set out to develop a knowledge base of the CN role as it relates to patient safety. Her research is featured in the April 2016 issue of the Journal of Nursing Administration (JONA) in the article titled, "Navigating Through Chaos: Charge Nurses and Patient Safety."
Three main categories emerged from observing the actions and processes CNs engage in to keep patients safe: balancing multiple roles, maintaining a watchful eye, and working with and leading the healthcare team.
CNs serve many roles in clinical care and beyond. They assist with tasks and skills ranging from toileting patients, starting intravenous therapy, assisting with admissions and discharges, and actively intervening when changes in patients' conditions jeopardized their safety. One CN provided the example of activating the rapid response team when a patient was in acute respiratory distress.
All CNs noted being resources for the staff, especially for policies, protocols, and procedures. As key resource people on their units, CNs discussed the need to guide, support, and actively assist staff with problem solving. CNs are educators for staff, patients, and family members. Shift huddles provided a means to disseminate information to all staff and receive staff input about patient safety issues, including patients most at risk of falls or most acutely ill.
Teaching and mentoring new graduate nurses were also identified as important to patient safety. One CN explained, "I try to let them know that I am very approachable. There are no dumb questions."
Ensuring that patients receive timely and appropriate interventions was identified as a priority for CNs, and they often personally contact the physician to clarify plans of care. Advocating for safe practice environments, with sufficient staffing, is a priority. The process of assigning patients to nurses was also identified as an important part of the CN role and patient safety by all CNs. Making safe patient assignments involved knowing the acuity and complexity levels of patients coupled with the capabilities of the nursing staff considered within the context of the available resources.
CNs are constantly on the lookout for ways to prevent negative events such as falls, pressure ulcers, and hospital-acquired infections (HAIs).
The prevention of falls was of particular importance to all CNs interviewed and observed. They identified the following actions and processes: rounding on patients to ensure their bed exit alarms were on and educating patients on their importance, ensuring patient rooms were free of clutter, verifying call lights were within reach, asking patients if they required assistance with getting to the bathroom, and advocating to move patients at high risk of falls closer to the nurses station.
When a patient has complicated skin issues, CNs assist staff in determining the nature of the problem and how to document. CNs assume a leadership role in overseeing initiatives to prevent hospital-acquired infections, such as Clostridium difficile, central line-associated bloodstream infections, and catheter-associated urinary tract infections.
CNs also hold an important role in facilitating collaboration among the multidisciplinary team. CNs reported using role modeling and promoting a culture where everyone was responsible for the safety and well-being of all the patients on the unit. Building a high-functioning team involved having confidence in their teams' abilities and genuinely liking the people on their team.
In addition to taking care of patients, CNs expressed the need to ensure that other clinical staff were safe and taken care of too. CNs took care of staff by ensuring they received their breaks, by assisting with repositioning patients, and by promoting a collegial work environment.
CNs have knowledge of patients, staff, and the dynamics of complex healthcare environments, putting them in opportune positions to influence patient safety. What role do CNs play in safety measures in your department?