OBESITY AND DIET

AN EDUCATIONAL TRAINING PROGRAM FOR CHARGE NURSES ON PROMOTING UNDERSTANDING AND THE BENEFITS OF INTEGRATING TRANSFORMATIONAL LEADERSHIP STRATEGIES

HUDA SHERIF RN, BSCN D’YOUVILLE COLLEGE

INTRODUCTION The charge nurse (CN) role embodies myriad of responsibilities not limited to staffing, conflict management, interdisciplinary communication, and delivery of high-quality patient care. The role is an extension of the nursing leadership team but receives limited initial and ongoing training (Spiva et al., 2020). To ensure CN success, emphasis should be placed on the importance and benefits of integrating transformational leadership (TL) strategies in the role.

STATEMENT OF PURPOSE The purpose of this project was to develop an educational training program for CNs working in an emergency department of a pediatric hospital to promote understanding regarding the importance and benefits of integrating TL strategies in their role as frontline leaders.

THEORETICAL FRAMEWORK Ø Patricia Benner (1984) From Novice to Expert Theory was utilized as the

theoretical framework for the development of this project. Ø Patricia Benner is best known for her adaptation of the Dreyfus model

of skill acquisition. The Dreyfus model of skill acquisition applied to nursing includes five stages. These are: (1) novice, (2) advanced beginner, (3) competent, (4) proficient, and (5) expert (Benner, 1984).

Ø The premise of the five stages is based on Benner’s proposition the nurse develops expertise when embedded knowledge can be applied to clinical scenarios due to possession of principle-based knowledge (Benner, 1984).

REVIEW OF THE LITERATURE Ø A review of nursing and health related literature was conducted to explore the importance and benefits of integrating TL strategies for CNs in their role as

frontline leaders Ø Keywords utilized both singularly and in multiple combinations included: charge nurse, transformational, leadership, front line, nursing, and leader. Ø With the exception of classical works, databases searched, limited to the years 2017 to 2022, included CINAHL complete, Journals@OVID, ScienceDirect,

Supplemental Index, PubMed, Gale Academic OneFile, and Gale General OneFile. The search was limited to the years 2017 to 2022 to ensure that current evidence-based literature was reviewed and summarized for the purpose of this project.

CN Roles, Responsibilities and Role Ambiguity Ø CN role and responsibilities are poorly defined, leading to role ambiguity. CN responsibilities are often learned on the job and their duties vary in some places

depending on the presence of the manager (Andronico et al., 2019; Bateman & King, 2020). This limits CN ability to engage in leadership participation, engagement, and building and contributes to a lack of clear leadership and supervision which has been identified as a threat to patient safety (Boamah, 2018; Embree et al., 2018).

Lack of Education, Formalized and Standardized Training and Mentorship Impact on CNs Ø Jones (2020) and McGarity et al. (2020) found when CN training occurred well before CNs take on the role and while not actively on the job, this facilitated

greater uptake of TL strategies.

Effects of TL by CNs on Patient Care Outcomes and Structural Empowerment Ø TL has been associated with reduced incidences of adverse patient events because it creates environments where professional nursing practice is supported

and promotes better patient outcomes (Boamah, 2018; Boamah et al., 2018; Hudson-Covolo et al., 2018; Teran & Webb, 2016).

CN Influence on Nurse Retention and Job Satisfaction Ø A study by Laut et al. (2018) identified the effect of the CN on others and lack of support as a factor for new nurses to leave the emergency department.

Communication and the CN role Ø Communication is considered essential to the CN role because CNs communicate within their care teams as well as across organizations and is viewed as a

trait that makes CNs feel successful (Bateman & King, 2020; Doherty et al., 2021; Embree et al., 2018; Spiva et al., 2020; Teran & Webb, 2016).

Impact of Secondary Traumatic Stress, Compassion Fatigue, Burnout and Resilience on CNs Ø CNs endure stress from their role, colleagues, and patients. If stress is not effectively managed, this puts CNs at risk for compassion fatigue (CF), secondary

traumatic stress (STS) and burnout (Al-Majid et al., 2018).

SIGNIFICANCE AND JUSTIFICATION Ø Findings from the initial literature review revealed a lack of knowledge

exists in nursing and patient care practice regarding the leadership development of CNs and subsequently integration of TL strategies in their roles.

Ø Most of the literature focused on leadership of managers and directors and failed to consider the critical role CNs play to the 24/7 operation of their units. CNs are integral to the running of units, coordination of patient care and communication among care teams within the department and across the organization (Bateman & King, 2020; Doles et al. 2021)

Ø CNs act as advocates for patients, colleagues, and their work environments and act as a support and resource to staff and patients (Doherty et al., 2021).

PROJECT OBJECTIVES The objectives of this project were to: 1. Conduct an extensive review of the literature exploring the

importance and benefits of integrating transformational leadership strategies for charge nurses using the following keywords both singularly and in multiple combinations: charge nurse, transformational, leadership, front line, nursing, and leader. With the exception of classical works, databases searched, limited to the years 2017 to 2022, included CINAHL complete, Journals@OVID, ScienceDirect, Supplemental Index, PubMed, Gale Academic OneFile, and Gale General OneFile:

2. Develop an educational training program; and 3. Have a panel of five content experts with extensive knowledge and

expertise in recognizing the importance of integrating transformational leadership for charge nurses evaluate and critique the project for clarity, readability, applicability, quality, organization, and evidence-based clinical relevance.

DEFINITION OF TERMS Transformational Leadership

Ø Theoretical Definition: “Leaders…who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions” (Institute of Medicine, 2011, p. 221).

Ø Operational Definition: Leadership where charge nurses work towards gaining knowledge and experience to become effective leaders to support development and growth of themselves and others to meet organizational objectives and advocate for positive change for staff, patients, families, and the organization.

Frontline Leader Ø Theoretical Definition: “Frontline…leaders direct staff and unit

systems while ensuring that quality, safe patient care is provided” (McGarity et al., 2020, p. 1). Frontline leaders refers to nurse managers.

Ø Operational Definition: The frontline leader refers to the charge nurse because they are consistently present at the position of care delivery and support staff. They make and influence decisions to coordinate patient care, staffing considerations and manage the flow of the unit.

LIMITATIONS 1. The implementation of the educational training program was not

within the context of this project; 2. The educational training program was developed in the English

language only and may benefit a more culturally diverse population if written in additional languages;

PROJECT DEVELOPMENT PLAN A detailed topical outline of the educational training program content was created based on the extensive review of evidence-based literature and the theoretical framework used to support and guide the development of the educational training program.

PLAN FOR PROTECTION OF HUMAN SUBJECTS

Ø Following approval from the D’Youville Patricia H. Garman School of Nursing, graduate faculty designee (Appendix A), five professionals with knowledge and expertise in the area/field of recognizing the importance of integrating transformational leadership for charge nurses were personally approached and asked to voluntarily participate as a content expert in the review and evaluation of the educational training program.

Ø Content experts were advised that participation or non-participation as an expert reviewer will have no effect on their employment status.

Ø The Project Author had a collegial, professional, and non-supervisory relationship with the content expert reviewers thereby protecting the participants from any risk of coercion.

Ø Content experts were guaranteed confidentiality. Ø Return of the completed content expert Project Evaluation Tool

indicated implied voluntary consent to participate as a content expert reviewer.

Ø Returned Content Expert Project Evaluation Tools will be stored according to the D’Youville Patricia H. Garman School of Nursing protocol in a locked drawer located in the Project Author’s home for a period of six years and then destroyed.

EXPERT REVIEW Ø The first content expert was a charge nurse in a pediatric emergency department with over

10 years of nursing experience. Ø The second content expert was a charge nurse in a pediatric emergency department with

over 10 years of nursing experience. Ø The third content expert was a charge nurse in a pediatric emergency department with over

20 years of nursing. Ø The fourth content expert was a master’s prepared nurse manager with previous experience

as an emergency room charge nurse. Ø The fifth content expert was a hospital administrator with a master’s degree in nursing with

previous experience as nurse manager and director.

RESULTS

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Clarity Readability Applicability Quality Organization Evidence-based Clinical Relevance

Content Expert Evaluation Tool Results

Strongly Disagree Disagree Agree Strongly Agree

IMPLICATIONS FOR FUTURE PRACTICE Ø This project highlighted the need for consideration of enhancing leadership of informal

nursing roles such as that of the charge nurse. Ø Education and ongoing professional development through combination of didactic

modalities, use of reflective practice and mentorship relationships are strategies to promote understanding and benefits of integrating TL strategies amongst CNs.

Ø Initial and ongoing investment in leadership education of informal leaders such as CNs is prudent to the sustainability of healthcare institutions and the healthcare system.

FUTURE RECOMMENDATIONS Ø The purpose and intention of this project was to address a current gap in nursing and health

related knowledge regarding the educational needs of charge nurses. Ø Future projects and research should focus on exploring and examining the following: • barriers to implementing leadership training for CNs. • cost/benefit analysis of leadership training for CNs. • effects on patient outcomes, staff engagement and workplace culture

REFERENCES Spiva, L., Davis, S., Case-Wirth, J., Hedenstrom, L., Hogue,

V., Box, M., Berrier, E., Jones, C., Thurman, S., Knotts, K., & Ahlers, L. (2020). The effectiveness of charge nurse training on leadership style and resiliency. JONA: The Journal of Nursing Administration, 50(2), 95-103. https://doi.org/10.1097/NNA.0000000000000848

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Bateman, J. M. & King, S. (2020). Charge nurse leadership training comparison: Effective and timely delivery. Pediatric Nursing, 46(4), 189-195.

Dols, J. D., Ramirez, M., Hernandez, A. D., Allen, D., Kloewer, T., Aguillon, V. (2021). Impact of evidence-based charge nurse education on charge nurse skills and nurse-specific metrics. JONA: The Journal of Nursing Administration, 51(2), 630-637. https://doi.org/10.1097/NNA.0000000000001086

Andronico, J., Getting, C., Christen, C. H., & Ciccolini, K. (2019). Developing and standardizing an orientation for outpatient charge nurses. The Journal of Continuing Education in Nursing, 50(11), 517-521. http://dx.doi.org.dyc.idm.oclc.org/10.3928/0022012 4-20191015-08

Boamah, S. (2018). Linking nurses’ clinical leadership to patient care quality: The role of transformational leadership and workplace empowerment. Canadian Journal of Nursing Research, 50(1), 9-19. https://doi.org/10.1177%2F0844562117732490

Embree, J., Wagnes, L., Hendricks, S., LaMothe, J., Halstead, J., & Wright, L. (2018). Empowering nurses to lead interprofessional collaborative practice environments through a nurse leadership institute. The Journal of Continuing Education in Nursing, 49(2), 61-71. https://doi.org/10.3928/00220124-20180116-05

Jones, T. L. (2020). Self-reported leadership practices among frontline medical-surgical nurses: An exploratory descriptive study of prevalence, patterns, and associated factors. MEDSURG Nursing, 29(3), 159-168.

McGarity, T., Reed, C., Monahan, L., & Zhao, M. (2020). Innovative frontline nurse leader professional development program. Journal for Nurses in Professional Development, 36(5), 277-282. https://doi.org/10.1097/NND.0000000000000628

Boamah, S. A., Spence Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180-189. https://doi-org.dyc.idm.oclc.org/10.1016/j.outlook.2017.10.004

Hudson-Covolo, J. L., Rivers, R., & Irwin, B. (2018). Daily intentional nurse leader rounding on patients. Journal of PeriAnesthesia Nursing, 33(1), 90-95. https://doi- org.dyc.idm.oclc.org/10.1016/j.jopan.2017.11.005

Teran, N., & Webb, P. J. (2016). Performance potential. The positive impact of formalized charge nurse training. Nursing Management, 47(11), 50-54. http://dx.doi.org.dyc.idm.oclc.org/10.1097/01.NUM A.0000502810.52671.aa

Laut, R., Wiknik, A., LaCroix, K. M., Bunting, D., & Pettorini- D'Amico, S. (2018). Leading the nurse within: Developing confident leadership skills for new graduates. The Journal of Continuing Education in Nursing, 49(8), 356-359. https://doi.org/10.3928/00220124-20180718-06Doherty, D., Hunter Revell, S., McCurry, M. & Asselin,

M. (2021). Exploring the charge nurse role transition. Journal for Nurses in Professional Development. Advance online publication. https://doi.org/10.1097/nnd.0000000000000780

Al-Majid, S., Carlson, N., Kiyohara, M., Faith, M., & Rakovski, C. (2018). Assessing the degree of compassion satisfaction and compassion fatigue among critical care, oncology, and charge nurses. JONA: The Journal of Nursing Administration, 48(6), 310- 315. https://doi.org/10.1097/NNA.0000000000000620

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington (DC): National Academies Press.