New Research Highlights Lacking Unified Training Standards for ED Charge Nurses

Lisa Wolf, ENA director of Emergency Nursing Research
Lisa Wolf

The charge nurse is the lynchpin of the emergency department, assigning patients and setting the socioclinical tone of the ED, yet there is no universal training for these ED nurse leaders.

“If the charge nurse is on the ball and can get stuff done, then shifts run smoothly. If they’re cranky or bad at their jobs, then shifts don’t run smoothly,” said Lisa Wolf, ENA director of Emergency Nursing Research. “It’s not as important what the conditions in the department are, it’s more about whether the charge nurse can maintain situational awareness of what’s going on.”

Wolf, an internationally known researcher with expertise in nursing environments and clinical decision-making, will present data from a mixed-methods study on ED charge nurses during the fully virtual Emergency Nursing 2021. Part of today’s Live Program, her session, It’s Fine. Everything is on Fire, But it’s Fine: The Experience, Role Identification and Training of ED Charge Nurses, will begin at 2:45 p.m. Central time. An opportunity to engage in live discussion on the topic with Wolf and other attendees will follow at 3:30 p.m.

The study, “Training and Role Expectations of U.S. Emergency Charge Nurses” is groundbreaking in its breadth, surveying more than 2,500 people — approximately 1,600 charge nurses and 1,000 staff nurses — about the role of a charge nurse, as well as the education required and training provided to be in this position. Researchers followed up by conducting focus groups to further explore the divergent responses of the two participant groups.

“What is a charge nurse in charge of? Strangely enough, a lot of the charge nurses we talked to said it’s about the flow, it’s a flow-based, task-based job,” Wolf said. “Most of the staff nurses and some of the charge nurses we spoke to said it’s about support and advocacy — it’s about being the bridge between the providers and the nurses, or the administration and the nurses, or the patients and the nurses.”

A previous study on workplace bullying, which identified the charge nurse as having a pivotal role in bullying and retention in the ED, was the starting point for Wolf’s research. Far too often, she said, charge nurses intentionally overwhelm a nurse or team of nurses by assigning too many patients or high acuity patients they can’t handle.

“The ED is such a different environment because of the unpredictability in terms of volume and acuity, so the charge nurse has to be able to do their job in such a way that nobody’s overwhelmed,” Wolf said.

Wolf and her fellow researchers, all of whom have experience as charge nurses, found the lack of standardized education and training for charge nurses opens the door to bullying and micromanagement of staff nurses.

“We need to set an experiential and training standard for charge nurses,” Wolf said. “You can’t just take somebody with a get-it-done mentality and put them in a role that is in this liminal state of leadership. You’re not really a manager, but you’re not really staff. You’re in the middle, and that requires a very sophisticated navigation of the socioclinical environment.”

EN21 session recordings will be available for on-demand viewing on the meeting platform through Jan. 31.