Charge Nurse Jamie is finishing her shift in a bustling medical-surgical unit when she overhears a heated argument between two colleagues, Sarah and Mark. Their conflict has escalated over patient assignments, causing tension on the floor.

Feeling the strain in the air, Jamie knows she needs to step in. She approaches them, saying, "Hey, your arguing is really affecting the team. Can we take a moment to talk it out?" Sarah crosses her arms, clearly upset. "I had two patients in Mark’s assignment last night; why did you give them to Mark? You knew I was back tonight," she snaps. Mark replies, "My assignment last night was very heavy, and it isn’t fair to assign those patients together!"

Jaime is new to the charge nurse role and unsure how to navigate this argument. Her two days of orientation did not prepare her for this conflict. Frustrated, Jaime is considering telling her nurse manager she no longer wants to be a charge nurse.

Did You Know?

More than 80,000 nurses are expected to retire in 2025 (Bognar et al., 2021). This mass retirement will create an acute need for nurses to assume leadership positions. Despite this, many institutions offer limited formal leadership training before promotion into these roles. Limitations in formal leadership training often require new leaders to develop leadership skills on the job. This can result in burnout and poor job satisfaction.

Why Leadership Skills Matter

Leadership skills are essential for frontline nurses working in complex, fast-paced healthcare environments. Empowering bedside nurses with these skills can foster healthy work environments, improving patient safety and satisfaction. Research shows that when nurses feel empowered, safety climates improve, which impacts nurses' self-efficacy, leadership behaviors, and job satisfaction (Spiriva et al., 2020).

Unfortunately, nurses often lack the tools to navigate challenging situations with patients or colleagues, leading to workplace incivility. Over time, this may contribute to a negative organizational culture, resulting in excessive stress, burnout, and compassion fatigue. If unaddressed, these issues can negatively impact team dynamics and compliance with safety standards, ultimately hurting patient clinical outcomes (Isler et al., 2021).

Leadership development for nurses in pre-management roles, such as charge or resource nurses, has been shown to improve bedside nurse retention, patient outcomes, and overall job satisfaction. Although there is clear evidence of the benefits, formal leadership training is often omitted in hospital orientation and competency programs (Bognar et al., 2021; Fitzpatrick et al., 2016; Miles & Scott, 2019).

No Time to Be Away From the Bedside?

Many nurse leaders hesitate to take nurses away from the bedside for training that doesn’t involve clinical skills. However, studies support leadership training in nurses early in their careers or when beginning to assume leadership roles (Bognar et al., 2021; Fitzpatrick et al., 2016). The dynamic, fast-paced healthcare environment makes it hard for nurses to reflect on their leadership skills. Offering a combination of interventions, including online learning, face-to-face discussions, and role playing, can increase effectiveness of the training over time (Guibert-Lacasa & Vázquez-Calatayud, 2021). Including strategies for protected time away from patient care may help foster deeper self-reflection, allowing participants to gain clarity about their leadership style and understand how it impacts others (Bond et al., 2022). When bedside nurses are given the opportunity to step away, they can reflect on interpersonal dynamics, team processes, and strategies to improve unit culture.

Creative solutions are needed to address the challenge of finding time for nurses away from the bedside. Allowing nurses to attend training before their scheduled shift could facilitate attendance. In units with a fluctuating census, scheduling sessions during quieter times, such as early mornings or weekends, would also be beneficial to learners. Ultimately, successfully implementing the training requires commitment from the unit leadership and bedside nurses.

Effective Leadership Training: A Case Example

On a busy orthopedic unit, leadership skills training was implemented to address the need for better communication and handling emotionally charged situations. Though finding time away from patient care was challenging, 90-minute sessions were scheduled on Monday mornings during low patient census periods. Pre- and post-training surveys were used to assess participants' knowledge, confidence, and skill retention.

The training incorporated a variety of teaching strategies to cater to diverse learning styles, increase learner engagement, and promote a deeper understanding of leadership concepts. The lecture and discussion about effective communication were followed by a game where nurses were asked to follow verbal instructions to fold paper airplanes with closed eyes. This highlighted the importance of clear communication and the ability to use senses beyond words to clarify a message.

Then, nurses practiced nonverbal communication skills through role playing. One partner portrayed a nurse who was distracted or disinterested, while the other shared a personal story. Reflecting on these experiences helped participants recognize the impact of poor communication. Empathetic listening skills were similarly taught using lecture, discussion, and role-playing methods. The interactive nature of the sessions kept the participants engaged with the content. The second part of the training focused on giving and receiving feedback, emphasizing its role in personal and team growth. While time constraints prevented role playing this skill, the content still resonated with participants.

Outcomes

Over the course of five sessions, 15 bedside nurses volunteered to participate. Nurses appreciated the opportunity to discuss leadership issues and practice skills in a supportive environment, away from the bedside. The training program positively impacted the nurses’ leadership skills, particularly in the areas of closed loop communication, empathetic listening, and feedback techniques. Skills learned through active participation — like role playing — showed increased retention and confidence over time, reinforcing the idea that hands-on practice in a supportive environment is highly effective.

Immediately following the 90-minute class, participants reported a 55% improvement in their confidence to use closed loop communication. Confidence in applying empathetic listening and providing effective feedback to colleagues improved by an average of 28%.

Interestingly, when surveyed 30 days after the training, leadership skills practiced using role play and classroom-based discussions showed increased retention and confidence. Closed loop communication, which saw the most significant improvement, was a skill practiced using role play. The 30-day follow-up survey indicated that participants continued to demonstrate growth in this skill, suggesting both knowledge retention and further development. In contrast, skills learned through lecture alone showed a decline, highlighting the importance of in-person training with active participation over passive learning.

Conclusion

Investing in leadership development for nurses at all levels is essential to creating healthier work environments, improving patient care, and preparing the next generation of nurse leaders (Bognar et al., 2021). By providing leadership training early in a nurse’s career, hospitals can equip nurses with the skills to handle difficult situations, whether managing patient care or resolving conflicts with colleagues. This can lead to improved outcomes for both staff and patients.

References

Bognar, L., Bersick, E., Barrett-Fajardo, N., Ross, C., Shaw, R. (2021). “Training aspiring nurse leaders: A mixed-methods study of a leadership academy.” Nursing Management, 52(8), 40-47.  DOI: 10.1097/01.NUMA.0000758688.41934.dc. PMID: 34397671.

Bond, C., Stacey, G., Charles, A., Westwood, G., & Hearn, D. (2022). “In Nightingale's footsteps: A qualitative analysis of the impact of leadership development within the clinical learning environment.” Journal of Nursing Management, 30(7), 715-723. DOI: 10.1111/jonm.13732

Fitzpatrick, J., Modic, M., Van Dyk, J. & Hancock, K. (2016). “A leadership education and development program for clinical nurses.” JONA: The Journal of Nursing Administration, 46 (11), 561-565. DOI: 10.1097/NNA.0000000000000405

Guibert-Lacasa, C., & Vázquez-Calatayud, M. (2022). Nurses' clinical leadership in the hospital setting: A systematic review. Journal of Nursing Management, 30(4), 913–925. https://doi.org/10.1111/jonm.13570

Isler, C., Maddigan, J., Small, S., Jarvis, K., Swab, M. (2021). “Strategies and interventions that foster clinical leadership among registered nurses: a scoping review protocol.” JBI Evidence Synthesis, 19(10), 2839-2846. DOI: 10.11124/JBIES-20-00342

Miles, J. & Scott, E. (2019). “A new leadership development model for nursing education.” Journal of Professional Nursing, 35(1), 5-11. DOI: 10.1016/j.profnurs.2018.09.009