Evaluation of a charge nurse orientation program

Optimization of patient safety is critical to high-quality healthcare, and “nurses are the key to improving quality through patient safety” (Mitchell, 2008, pp. 1-5). In the inpatient hospital setting, charge nurses are lead nurses who ensure optimal, safe, high-quality care is delivered on their units. Patient safety and quality of care improve with proper training and skill development. Charge nurses should possess basic clinical and leadership skills to pilot the affairs of their units, but a prevalent, significant challenge is a lack of adequate training and orientation for the charge nurse role (Andronico et al., 2016; Spiva et al., 2020; Strong, 2014). Although a few charge nurses receive formal training (Dols et al., 2021), most charge nurses stepped into leadership positions without formal leadership training, and as a result, they lack the confidence to function optimally in this role. Many healthcare organizations have formal orientation only for new graduate nurses despite the established research supporting significant positive impacts on patient safety and quality of care afforded to patients secondary to proper charge nurse training programs (Delamater et al., 2018; Kramer & Davies, 2021). Today, healthcare organizations clamor for improved patient outcomes with the rise of attention to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores and their direct impact on hospital reimbursement. Of the approximated US $1.9 billion available value-based incentive payments in 2020, 25% was based on the HCAHPS scores (Indovina et al., 2021). The quality of care delivered in acute care settings is directly reflected in patient satisfaction and is a significant component of HCAPS. Bilyeu et al. (2023) examined patient satisfaction using isolated questions of the HCAPS and observed an improvement from 1.5% to 5.75% above the national benchmark. Similarly, these authors noted that of their 45 study participants, 98% reported improved role confidence and satisfaction with course information after formal charge nurse training. One of the strategies to improve nurse satisfaction is providing adequate training and support. Nursing job satisfaction directly impacts the turnover rate and effective charge nurse education enhances job satisfaction markedly (Dols et al., 2021; Lockhart, L., 2020). Elevated nurse turnover rates have been identified as a significant factor contributing to the cost burden in healthcare organizations today. According to the 2023 National Healthcare Retention & RN Staffing Report, the current RN turnover is 22.5%. This analysis suggests that the average cost of turnover for a bedside RN is $52,350, and each percent change in RN turnover costs or saves an average hospital nearly $400,000 per year. Melnyk et al. (2023) identified nurse education as an organizational evidence-based practice (EBP) attribute and discovered that increasing budgetary investment in EBP significantly reduces nursing turnover. Therefore, to reduce their financial cost burden, organizations must promote training and orientation programs for their staff, especially those at the frontline of patient care.--Background and significance.