A charge nurse role can often come with competing demands: overseeing daily operations, supporting less experienced nurses, ensuring clinical protocols and smooth patient flow, while also sometimes managing their own patient assignments.
Samantha Hendricks, a patient care manager, gained valuable insight when she helped implement a patient-free charge nurse role in her previous employer’s progressive care unit. It was a change that improved staff satisfaction and also delivered measurable improvements in patient care metrics.
The Challenge: Managing While Providing Care
Hendrick’s motivation to advocate for assignment-free charge nurses in her previous role came from lived experience. Having worked in a patient-free charge nurse role when opening a new unit during the pandemic, she witnessed firsthand the positive impact this new model could have.
"I was able to step away from patient care and really see what we were able to give," Hendricks said. "All the additional support that we were able to provide – being a constant change agent, managing all these things that no one had ever gone through before."
When she moved to a new role with her previous employer managing a 44-bed modified care unit, she quickly recognized a similar challenge. The charge nurses were managing two to four patients, while simultaneously handling complex clinical situations, supporting new staff and responding to codes throughout the hospital. The demands were overwhelming, and Hendricks knew there was a better way.
"Within the first six months, I said this will be the hill that I die on before I leave this place … I will get a patient-free charge nurse," she recalls.
The Power of Persistence
Hendricks continued to advocate for the role, gathering data and waiting for the right moment. It came when leadership asked her to open another inpatient unit.
"I said to them, 'What if my charge nurse has no patients and runs both units?'" Hendricks recalls. This is finally my opportunity to get them to say yes.
Her strategic thinking paid off. By proposing that one assignment-free charge nurse could manage both units initially, she provided a win-win scenario. Leadership got the coverage they needed for the new unit, and Hendricks piloted her idea. If it worked, her original unit would keep its assignment-free charge nurse when the units eventually separated.
Overcoming Staff Concerns
At first, Hendricks encountered some concerns from her team about patient ratios.
"They said at the end of the day, we do not want our ratios to go up for our staff. They said they will not do this if any staff member has to go into a five-patient ratio," she explains. "So, not only did I have to then get approval for an extra nurse on top of this, but they kind of just fixed everything."
The solution created ideal staffing ratios while providing an assignment-free charge nurse role. But other concerns emerged as the new role was implemented. Some nurses worried about charge nurses without direct patient care responsibilities – would they still be available to help when needed? Others in permanent charge nurse roles were concerned about losing their clinical skills if they had patient assignments.
Hendricks addressed these concerns through creative scheduling rotations, ensuring that dedicated charge nurses could occasionally take patient assignments to maintain competency, and having other charge nurses step into the assignment-free role on a regular basis.
Measuring Success
Within months of implementation, Hendricks’ unit saw improvements across multiple metrics:
- Patient satisfaction scores consistently remained above 80% for almost five months, compared with the previous range of 72%-75%.
- Staff were regularly taking lunch breaks, essential for staff satisfaction and patient safety.
- Incremental overtime decreased as nurses could leave their shifts on time.
"If your nurses are happy, then your patients are going to be happy, and it's going to be this trickle-down effect," Hendricks said. "I could just walk around the unit and see that it was happening."
Lessons to Share
For nurse managers and assistant managers who want to implement similar changes, Hendricks offers practical advice born from experience:
- Be the squeaky wheel: Persistence is essential, even when initial attempts don't succeed.
- Come prepared with data: Having data and evidence readily available can make the difference between a dismissed suggestion and a serious proposal.
- Propose a trial: Rather than presenting the change as permanent from day one, frame it as a pilot program. You can always go back if it doesn’t work for the team.
- Stay flexible: Be prepared to make adjustments as you learn what works and what doesn't.
Even after Hendricks moved to a new health system, the assignment-free charge nurse position continued at her former unit – proof that the change was valuable.
"To hear that it's still happening there is just probably my proudest thing," she said.
Additional Resources
Share Your Story
Do you have a successful staffing solution that works in your unit or facility? We want to hear from you.
Submit your solution.