Senior Charge Nurses Research Articles

Emotional and psychological implications for healthcare professionals in disasters or mass casualties: A systematic review.

To synthesize and describe the emotional and psychological implications for healthcare professionals who provided care in a mass casualty incident or disaster. The experience of healthcare providers immersed in the actual uncertainty of an ongoing disaster is real, challenging, complex and strongly connected with emotions. Identifying these implications for healthcare professionals is essential for developing strategies to help these professionals deliver high-quality care. A systematic review was conducted in PubMed, CINAHL, Scopus, Nursing & Allied Health Database and PsycINFO using published data until February 2021 and following the PRISMA guidelines. Nineteen articles were included. Factors associated with negative psychological implications were identified and different strategies have been synthesized to prevent or reduce them when caring for the victims of a disaster. Feelings of sadness, helplessness, fear and blockage, among others, were identified as common reactions among nurses and other healthcare professionals dealing in mass casualties or disasters. These reactions may lead to post-traumatic disorder, turning professionals into hidden victims. Organizations, senior charge nurses and other health service managers need to foster resilience and flexibility among their workforce to improve self-care during a disaster, as well as ensure policies to address a lack of emotional preparedness among their personnel. Some strategies to consider include cognitive behavioural therapy, psychoeducation or meditation.

Nursing students' perceptions of identifying and managing sex trafficking cases: A focus group study.

To explore nursing students' perceptions of the identification and medical care of sex trafficking victims and how to improve the care provided based on the identified barriers. Despite the fact that more than 87% of sex trafficking victims establish contact with health professionals, their lack of awareness and training hinders their ability to assist victims properly. A descriptive qualitative study was carried out using 11 focus groups of nursing students after a simulated case of sex trafficking victim. The analysis of results was conducted through content analysis. A total of 110 fourth-year nursing students participated in this study. After performing the data analysis, three main categories emerged: (i) making a health issue visible, (ii) identifying sex trafficking victims: resources based on evidence-based practice, and (iii) educational resources on sex trafficking in nursing degree. Our results show that through clinical simulation, integrating content regarding the medical care of vulnerable groups can be useful for developing the skills necessary to provide effective care from a trauma-informed approach. Health institutions, senior charge nurses, and other health service managers should be aware of the current need for sex trafficking training, structural-level changes, and updated evidence-based guidelines and protocols with other service providers and law enforcement to provide high-quality care.

GASS-tly side effects: antipsychotic monitoring for inpatients across NHS Lanarkshire

AimsBest practice in the prescribing of antipsychotic therapy includes monitoring for medication side effects. National guideline SIGN 131 advises the use of a validated side effect scale, for example the Glasgow Antipsychotic Side-effect Scale (GASS). Local recommendation in NHS Lanarkshire advises that patients prescribed antipsychotic therapy should be offered GASS at each contact and after initiation or titration. We aimed to improve compliance with antipsychotic side effect monitoring for inpatients in general adult psychiatry across two hospital sites in NHS Lanarkshire.MethodWe conducted a full-cycle audit. In October 2020, we took a cross-sectional sample of inpatients in general adult psychiatry in University Hospital Hairmyres and University Hospital Wishaw who were prescribed antipsychotic therapy for a functional psychotic disorder. For these inpatients, if applicable, we identified whether GASS had been completed on admission (OA), whether GASS had been completed after initiation or titration of antipsychotic therapy (I/T), and whether GASS had been acknowledged and discussed at consultant-led multi-disciplinary team meeting (MDT). Thereafter, we implemented several targeted interventions in order to improve compliance. In January 2021, we completed the cycle by taking a new cross-sectional sample of inpatients fulfilling identical parameters.ResultFirst cycle in October 2020 (n = 27) showed compliance OA of 4.2%, I/T of 9.5%, and MDT of 3.7%. Our interventions included a presentation at trust-wide clinical governance meeting; a presentation at one of the weekly departmental teaching sessions in psychiatry; an email summarising the audit to consultants in general adult psychiatry; meetings with senior charge nurses for each ward; and inclusion of GASS as part of routine admission paperwork. Re-audit in January 2021 (n = 23) showed compliance OA of 11.1%, I/T of 40.0%, and MDT of 21.7%.ConclusionOur full-cycle audit led to modest improvement in documented monitoring for antipsychotic side effects. There was relatively greater improvement in prescriber-led outcomes I/T and MDT, suggesting increased prescriber awareness. However, rather than reliance on individual prescribers to ensure compliance, consideration of GASS alongside monitoring of other physical health parameters would likely result in greater and more sustained improvement. In NHS Lanarkshire there is ongoing work to this end, ultimately with the intention to set up a defined antipsychotic physical health monitoring schedule, integrated across inpatient and community care.

Improving the care management of trans patients: Focus groups of nursing students' perceptions.

To know the perspectives of nursing students in trans patients' care and their access to health services and how to improve the quality of care in trans patients, related to the barriers identified by nursing students. Lesbian, gay, bisexual, transgender, queer and plus (LGBTQ+) find barriers related to the health care access, including stigma, discrimination and lack of education. In addition, to the transphobia reported in some health care providers. A descriptive qualitative study was performed through 12 focus group interviews in nursing students. Data analysis was based on content analysis. 124 first-year nursing students participated. The qualitative analysis resulted in three major themes: (a) Exposing an invisible reality, (b) Interprofessional communication: a starting point to arise awareness and (c) Care with pride as a link between individuality and professionalism. Our findings suggest that both LGBTQ+ content and institutional resources are the cornerstone for nursing students and professionals' practice in order to develop and provide a well-informed and high-quality care delivery to these patients. Policymakers, senior charge nurses and other managers should be aware of the structural-level changes identified and ongoing mentoring needed to guarantee trans patients' privacy and safety.

Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial

BackgroundImproving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme...

Learning from errors: assessing final year medical students\u2019 reflection on safety improvement, five year cohort study

BackgroundInvestigation of real incidents has been consistently identified by expert reviews and student surveys as a potentially valuable teaching resource for medical students. The aim of this study was to adapt a published method to measure resident doctors’ reflection on quality improvement and evaluate this as an assessment tool for medical students.MethodsThe design is a cohort study. Medical students were prepared with a tutorial in team based learning format and an online Managing Incident Review course. The reliability of the modified Mayo Evaluation of Reflection on Improvement tool (mMERIT) was analysed with Generalizability G-theory. Long term sustainability of assessment of incident review with mMERIT was tested over five consecutive years.ResultsA total of 824 students have completed an incident review using 167 incidents from NHS Tayside’s online reporting system. In order to address the academic practice gap students were supervised by Senior Charge Nurses or Consultants on the wards where the incidents had been reported. Inter-rater reliability was considered sufficiently high to have one assessor for each student report. There was no evidence of a gradient in student marks across the academic year. Marks were significantly higher for students who used Section Questions to structure their reports compared with those who did not. In Year 1 of the study 21 (14%) of 153 mMERIT reports were graded as concern. All 21 of these students achieved the required standard on resubmission. Rates of resubmission were lower (3% to 7%) in subsequent years.ConclusionsWe have shown that mMERIT has high reliability with one rater. mMERIT can be used by students as part of a suite of feedback to help supplement their self-assessment on their learning needs and develop insightful practice to drive their development of quality, safety and person centred professional practice. Incident review addresses the need for workplace based learning and use of real life examples of mistakes, which has been identified by previous studies of education about patient safety in medical schools.

Facilitators and barriers to the increased supervisory role of senior charge nurses: a qualitative study.

To explore the experiences of senior charge nurses provided with 'increased supervisory hours'. Designated supervisory time is essential for senior charge nurses to provide effective clinical leadership. It is important to explore the impact arises of such an increase. An online questionnaire collected exploratory data from senior charge nurses (n=60). Semi-structured interviews gathered in-depth qualitative data (n=12). Findings were analysed for common themes associated with implementation of the increased senior charge nurse supervisory role. The majority of senior charge nurses were unable to use their full allocation of supervisory time. They struggled to accomplish leadership goals because of managing staffing levels, increased workload, time constraints and limited support. Factors that facilitated the role included preparation and support, adequate staff capacity, effective leadership skills and availability of supervisory time. The senior charge nurses took pride in providing clinical leadership, promoting staff development and delivering patient care. Support, in terms of preparation, capacity building and ongoing mentoring, was a key factor for achieving senior charge nurse goals. Senior charge nurses should be supported to maximise supervisory time through the provision of an induction programme, formal coaching and ongoing training and development. Preparation and support is essential for senior charge nurses to deliver enhanced clinical leadership through increased supervisory time.

Developing a general ward nursing dashboard.

The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice.

Implementing supervisory status for senior charge nurses.

This article is the fourth in a series of seven articles relating to the implementation of Leading Better Care (LBC). It describes two projects that were undertaken concurrently within NHS Lanarkshire to support senior charge nurses to work effectively within the role framework of LBC, with enhanced supervisory status. The article discusses the background and aims of the projects, their findings and the resulting action taken by NHS Lanarkshire.

Enhancing the clinical leadership of band 6 staff.

This is the third article in a series of seven articles on an initiative in NHS Lanarkshire. Visible clinical leaders can have a significant effect on patient care and standards of practice. Over the past decade the development of clinical leadership has focused on senior charge nurses or midwives and team leaders, that is, band 7 practitioners or above. Band 6 staff 'act up' in these roles and therefore need to develop the associated knowledge, skills and attributes for their current practice and future progression into such roles. This article reports on the establishment, implementation and evaluation of a clinical leadership programme developed specifically for band 6 nurses, midwives and allied health professionals at one Scottish NHS board.

NHS nurses’ fight against infection

In the NHS and across all four UK countries, nurses at all levels working with the multidisciplinary team contribute positively to the control and prevention of infection. In addition to the recent publication of the epic3 Guidelines, there are numerous other guidelines and policies in place emphasising the importance of the nurse’s role in the context of prevention and control of infection. In Scotland in particular, the NHS Scotland Health Department Letter, NHS HDL (2005) 7, emphasises the need to restore public confidence by achieving tangible improvements in infection control and standards of cleaning. In order to assist this process, senior charge nurses (SCNs) receive infection control safe patient environment audits based on the Infection Prevention Society’s template, which are carried out in every ward and department at least once a year. Across the UK, nurses along with colleagues in estates and facilities are also required to populate and complete action/improvement plans to address any issues identified. The results of the infection control (IC) audits are included in the performance management review for all wards/departments across the NHS. In addition, SCNs in Scotland are required to participate in and sign off the results of audits conducted to comply with the 2010 Monitoring Framework for NHS Scotland National Cleaning Services Specification and Estates HAI Issues. Standard infection control precautions (SICPs) must be applied to prevent cross transmission from both recognised and unrecognised sources of infection (and transmission-based precautions (TBPs) should be applied in cases such as when a patient has an infectious disease, e.g. influenza, MRSA, etc). SICPs are basic infection prevention and control measures of which there are ten elements as follows: ■ Patient placement ■ Hand hygiene ■ Respiratory hygiene and cough etiquette ■ Management of care equipment ■ Control of the environment ■ Safe management of linen ■ Management of blood and body fluids ■ Safe disposal of waste ■ Occupational exposure management (e.g. sharps) ■ Personal protective equipment.

Senior charge nurses’ leadership behaviours in relation to hospital ward safety: A mixed method study

BackgroundHigh standards of quality and patient safety in hospital wards cannot be achieved without the active role of the nursing leaders that manage these units. Previous studies tended to focus on the leadership behaviours of nurses in relation to staff job satisfaction and other organizational outcomes. Less is known about the leadership skills of senior charge nurses that are effective for ensuring safety for patients and staff in their wards. ObjectivesThe aim of the two studies was to identify the leadership behaviours of senior charge nurses that are (a) typically used and, (b) that relate to safety outcomes. MethodsIn study one, semi-structured interviews were conducted with 15 senior charge nurses at an acute NHS hospital. Transcribed interviews were coded using Yukl's Managerial Practices Survey (MPS) framework. In study two, self ratings of leadership (using the MPS) from 15 senior charge nurses (SCN) and upward ratings from 82 staff nurses reporting to them were used to investigate associations between SCNs’ leadership behaviours and worker and patient-related safety outcomes. ResultsThe interviews in study one demonstrated the relevance of the MPS leadership framework for nurses at hospital ward level. The SCNs mainly engaged in relations-oriented (n=370, 49%), and task-oriented (n=342, 45%) behaviours, with fewer change-oriented (n=25, 3%), and lead by example behaviours (n=26, 3%). In demanding situations, more task-oriented behaviours were reported. In study two, staff nurses’ ratings of their SCNs’ behaviours (Monitoring and Recognizing) were related to staff compliance with rules and patient injuries (medium severity), while the self ratings of SCNs indicated that Supporting behaviours were linked to lower infection rates and Envisioning change behaviours were linked to lower infection and other safety indicators for both patients and staff. ConclusionThis study provides preliminary data on the usability of a standard leadership taxonomy (Yukl et al., 2002), and the related MPS questionnaire, on a nursing sample. The findings indicate the relevance of several leadership behaviours of SCNs for ensuring a safer ward environment and contribute to the evidence base for their leadership skills training.

The new clinical leadership role of senior charge nurses: a mixed methods study of their views and experience.

To investigate the experience and views of senior charge nurses in relation to the implementation of a national clinical leadership policy. The role of the senior charge nurse in providing clinical leadership is evolving. However, recent evidence suggests that research is needed to inform the development of leadership and quality improvement and to connect them. Data were collected using an electronic survey to all senior charge nurses in one locality and semi-structured interviews with a subsample of respondents. Fifty (54%) senior charge nurses responded to the survey and nine were interviewed. Senior charge nurses reported mainly positive perceptions of clinical leadership, clinical team performance and improvement of care delivery for patients following the leadership programme implementation. Themes related to confidence, quality improvement and team performance were generated. 'Leading Better Care' was reported to enhance senior charge nurse clinical leadership, with some development needed to link the details of change management with the wider strategic direction. Nurse managers may wish to ensure that their clinical leaders have clarity of role in order to inspire confidence. Some challenges were noted in achieving improvement in quality and it is possible that if improvement in quality is the cornerstone of patient-centred care then it needs to be placed centrally in workload considerations.

Exploration of transformational and distributed leadership

Throughout government policy in Scotland, a new emphasis has been placed on clinical leaders as a way to improve quality and restore the public's confidence in health care. This article reports on a study that explored the leadership styles of senior charge nurses and the effects these may have on clinical teams. Findings suggest that, where there is transformational leadership and sharing of leadership roles across teams, staff are more engaged and organisational goals are met. The findings also highlight the need for better communication between senior management and clinical teams to ensure sustainable, good services.

Workload and workforce planning: developing a learning toolkit

The second article in this series described the tools for which there is a consensus for use in nursing and midwifery workload and workforce planning (NMWWP) in Scotland, and the national programme of education and training support developed for the staff who would be using the tools in NHS boards. To help senior charge nurses, midwives and others support and manage their staff resources effectively, a learning toolkit has been developed by the NMWWP programme in partnership with NHS Education for Scotland. The NMWWP learning toolkit (NHS Education for Scotland 2008), described in this article, is a flexible, practical, work-based resource for use in NHS boards. Intended primarily for senior charge nurses, it can also be used by other professionals who aspire to senior charge nurse positions and by nurse managers as a knowledge-refresher.

Learning and development.

A framework for senior charge nurses (SCNs) who want to plan their career development, or enhance their levels of knowledge and skills, has been launched on the NHS Education for Scotland website.

Bullying of Staff Registered Nurses in the Workplace: A Preliminary Study for Developing Personal and Organizational Strategies for the Transformation of Hostile to Healthy Workplace Environments

The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.

College to debate 'matron' role'.

The changing role of senior charge nurses in Scotland will come under scrutiny during a series of RCN 'listening events'.

New hygiene responsibilities for senior charge nurses.

The roles of Scotland's senior NHS charge nurses are to become more like those of traditional matrons, with extra responsibilities for 'signing off' cleaning and hygiene standards every day.