Susan LaGrange

Today more than ever, we hear about the importance of PROACTIVE approaches to prevent as many unfavorable events as possible. One of the key essential proactive approaches that we can implement is to PREPARE our charge nurses for success!  There are times, when new nurses start their position that the orientation or teaching period is cut short because they are “doing just fine” and they are “needed” to take a shift by themselves.

The new employees are bombarded with so much information that it can be overwhelming! Over time, education is provided for “mandatory” topics as well as topics that show a need for improvement (usually related to an unpleasant event) and the proactive education sometimes gets squeezed to the side of the road due to time and resources. Yet, in the end, if we adequately prepare the charge nurses for success and put systems in place for support and oversight, we may find success happens quite naturally! 

Several key areas for ongoing education and ongoing support include:

  1. Role and Responsibilities
    a.    Managing the resident care on the shift – discussion of job description
    b.    Using the care plan
    c.    Duties (medications, treatments, assessments, processing MD orders, communication, etc.)
    d.    When to call the DON, administrator, etc.
    e.    Responsibilities with abuse/resident protection
  2. Organization and Time Management
    a.    Strategies for resident care management while still staying on time with medication pass!
    b.    Precise and comprehensive communication can save time!
    c.     Organization of the day
  3. Admission Assessment Process
    a.    Review of types of assessments
    b.    Importance of assessment process
  4. Ongoing Assessment Process
    a.    Quarterly and annual assessments
    b.    Change of condition assessments
    c.     Expectations of assessments with documentation
  5. Regulations
    a.    State – State Specific Regulations
    b.    Federal – Review of the top nursing F-tags and how to operationalize in the day to day activities in order to translate to quality of care
    c.     New/updates to regulations
    d.    Nurse Practice Act – At least once a year, review with the nurses.
  6. Supervision of the certified nursing assistants
    a.    Oversight of CNAs
    b.    How to handle pitfalls with CNA. oversight
    c.     Discussion on authority to hold CNAs accountable
    d.    Employee handbook
  7. Documentation
    a.    Documentation of assessment process
    b.    Documentation of notifications
    c.     Documentation of adequate follow-up
    d.    Objective vs. subjective documentation
  8. Accident/Incident and Root Cause Analysis
    a.    Training and demonstration of root cause analysis
    b.    Documentation necessary to substantiate root cause analysis and in-depth investigation
    c.    How to problem solve and adequately care plan for success based on root cause analysis
  9. Audits:  Have the charge nurses complete a few audits each month!  It sure helps them remember the process when they are auditing for it!

With the ongoing education, it helps to mix it up a bit—role playing, case studies, scenarios and examples. It is also crucial to end the session with a discussion to address if the objectives were met, if the information was valuable, what other topics should be addressed in future meetings and if there is additional information requested.  Once the process is comfortable, send the nurses to new educational activities and have the nurses take turns in hosting the meeting. One key to success is to include the nurses in the process!

Spending the time proactively to address the importance of the charge nurse responsibilities and roles could assist with a smooth running unit, quality outcomes and better understanding of expectations!

Susan LaGrange, RN, BSN, NHA, is the national education coordinator at Pathway Health Services.