Actual clinical leadership: a shadowing study of charge nurses and doctors on-call in the emergency department

Sissel Eikeland Husebø,Øystein Evjen Olsen

doi:10.1186/s13049-018-0581-3

Abstract

BackgroundThe provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course.MethodsA qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis.ResultsThe analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme “securing patient care and treatment” was exclusive to charge nurses.ConclusionsCharge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.

Highlights

The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership
The observations revealed that charge nurses (CN) and doctors on-call (DOC) were simultaneously involved in a number of diverse activities pertaining to coordination and decision-making of patient treatment and care
Data revealed seven themes that were characteristic of the CNs’ and DOCs’ activities (Fig. 2): receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patients; and securing the priority of patients

Summary

Introduction

The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. Studies in the ED setting have mostly focused on quantification of communication patterns [17,18,19], description of emergency nurses’ proactive activities as well as barriers to and opportunities for proactive work [20], and classification of the ED physician in charge’s problem solving actions [21] These studies have revealed that providers in the ED have very high hourly task rates dominated by communication and clinical activities [18], and that staff members have to take control and make things happen, anticipating and preventing problems [20]

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