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What decision-making strategies can I teach my charge nurses?

The most important piece to add to your orientation program is the steps that each charge nurse will need to follow to make effective decisions.

The following strategies can be used to help charge nurses make appropriate clinical decisions:

  • Establish goals that are clear and are appropriate for the situation. Never compromise quality and safety in your decision-making process.
  • Understand how the decision may affect patient care delivery and department and organization operations, and whether the decision is reflective of the organizational goals and acceptable to the team.
  • Use evidence-based practice resources and other professional organizations to assist you in your decision-making, and involve all those who will be affected by the decision. For example, if the decisions affect direct patient care, frontline nurses need to participate in the process.
  • Base your decision utilizing all information and consider that patient safety is the No. 1 priority. Team members will be more apt to accept the outcome if the solution incorporates feedback from the team. A collaborative effort will have more impact and buy-in when the team is involved in the solution.
  • Decisions are not always sound when emotions are involved. Consider decisions that are made and determine whether this is based on emotions or logic.
  • Be accountable for the decisions you make. Charge nurses need to accept full responsibility for the decisions they make, despite the consequences. When leaders do not accept ownership, it can affect the team’s confidence in your decision-making capacity.
  • Evaluate the alternatives such as trade-offs, resources, and time constraints. Collaborate with the team as much as possible and weigh all the risks and benefits, keeping in mind that you must never compromise quality and patient safety.

Not listed in these steps is the importance of evaluating outcomes. Charge nurses should always be mindful of evaluating outcomes for the decisions made during their shift. For example, the charge nurse may reflect at the end of the day about the patient assignment that was given to the student nurse. Was it appropriate? Did it meet the needs of the student? Were patient safety and quality maintained? Not every decision a charge nurse makes will require a follow-up, but it is good practice to get into the habit of evaluating outcomes.

Tammy L. Berbarie, BA, RN, RN-BC

(April 2011)