2003 It has been observed that some charge nurses appeared to function

2003 it has been observed that some charge nurses

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al., 2003). It has been observed that some charge nurses appeared to function effectively given these barriers while others expressed disdain for the role (Connelly et al., 2003). Miner-Williams, Connelly, and Yoder (2000) stated that the change in patient acuity and length of stay in hospitals has increased the importance of the role of charge nurses in acute care settings. One of the major functions of charge nurses that gained more significance since the publication of the IOM reports on patient safety is the daily balance of available nursing staff with intra-shift changes in patients’ acuity and needs. Kane, Shamliyan, Mueller, Duval, and Wilt (2007) noted that the patient-acuity based staffing formulas focus on patient morbidities but did not include the effects of the actual shift-to-shift fluctuations in registered nurses’ availability. Charge nurses are particularly essential for balancing the daily staffing of a patient care unit (Connelly et al., 2003; Wilson et al., 2011 ). This intra-shift variation is also implicated in the quality of patient outcomes (Ashcraft, 2004; Kalisch, 2006). The process of staffing a patient care unit is usually done by the use of forecasting formulas that utilize staffing patterns and patient census from a previous year or financial period. The use of forecasting formulas is rooted in a study by Hadley (1978) on the methods of studying nurse staffing. The formulas produce models of nurse-patient ratios that are called hours per patient day (HPPD) and registered nurse mix. Ashcraft (2004) and Kalisch (2006) stated that many patient care needs that were not accounted for in the
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16 pre-shift calculation of a unit’s acuity and census might not get addressed due to inadequate management from charge nurses and or unit managers. This adjustment of pre-calculated HPPD involves balancing admissions, discharges, and transfers; matching patient acuity level with properly skilled nurses; accommodating changes in patient’s contagious disease status; and ensuring timeliness with all planned and emergent procedures. The juggling of organizational and patient factors is required to provide quality patient care and is usually assigned to the nurse in charge of the shift. Balancing available competent nurses with demands of patient care is an important part of the description of the charge nurse role. To better understand the role of charge nurses in staffing, a recent qualitative study was conducted with nurses from several acute medical-surgical patient units. The purpose of the study, “Mindfulness: A Qualitative Description of the Behaviors Charge Nurses Enact to Safely Staff Patient Care Units” was to describe the behaviors of charge nurses who were effective in making intra-shift decisions to safely staff nursing units ( Wilson, Talsma, & Martyn, 2011 ). Twenty four nurses (7 managers, 11 charge nurses, and 6 staff nurses) participated in the study. Several important findings emerged.
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