The Roles of and Challenges Faced by Charge Nurses in Improving the Quality of Nursing at Acute Hospitals

Abstract

Objective: To clarify the roles of and challenges faced by charge nurses in improving the quality of nursing at acute hospitals.

Method: A qualitative study was conducted using semi-structured interviews to ascertain the roles of charge nurses and the challenges that arise in executing these roles. Focus group interviews were conducted with 4–6 charge nurses with at least 5 years' experience as a charge nurse from 10 different acute hospitals charging a basic hospitalization fee for a patient-to-nurse ratio of 7:1, and with 300 or more beds in 3 prefectures in the Chugoku region of Japan. Narratives were created from the data obtained and parts related to the roles and challenges in role execution of charge nurses were extracted and subject to qualitative descriptive analysis.

Results: Forty-seven charge nurses from 10 hospitals were subject to analysis. The roles of charge nurses were classified into 7 categories: "collaboration with the nurse manager," "staff empowerment," "activities with the objective of healthcare safety," "establishing mechanisms for improving operations," "coordination with a broad range of people," "action with a focus on hospital management," and "personal development as a charge nurse." Two categories were extracted as the challenges faced in performing these roles: "administrators' personal experience with lack of competence" and "uncertainty regarding career development."

Discussion: The charge nurse at an acute-care hospital assumes a wide variety of roles. These include implementing management in collaboration with the nurse manager that is focused on hospital management in an era of healthcare reform based on the nurse manager's vision for improving nursing care, and personnel development aimed at increasing department expertise and providing high-quality care. The charge nurse faces a dilemma between recognizing the need to improve their ability in assuming and actually performing these roles, and this gives rise to uncertainty regarding career development.