RES 6041 Module 5 Synthesized Literature Review Example

Preparing Charge Nurses for Staffing Decisions: A Synthesized Review of an Uneven Literature

Student Name

American College of Education

RES6041: Scholarly Writing and Research Strategies

Module 5 Assignment

Instructor Name

November 9, 2026

Introduction

On most hospital units, the person who decides which nurse takes which patients, when to ask for another nurse and how to absorb a sick call at 0300 is the charge nurse. Those choices matter. Patients in hospitals with heavier nurse workloads have died more often within a month of admission (Aiken et al., 2002), and shifts run below target registered nurse staffing have been associated with increased inpatient mortality (Needleman et al., 2011). Staffing studies usually treat the number of nurses as a hospital-level fact, yet much of the moment-to-moment distribution of that workload falls to whoever is in charge. This review asks what is known about how charge nurses are prepared for that responsibility and whether preparation makes a difference.

How the Sources Were Found

The search reported in Module 2 was run in PubMed and then extended to CINAHL and ERIC, with citation searching from the reference lists of included studies. Studies were included if the charge nurse, shift leader or charge nurse manager was the focus of the work and if they addressed the role, its preparation or the decisions it involves. No date limit was set, because the topic is thinly studied. Eight studies met these terms. They come from the United States, Scotland, New Zealand and South Africa, and they range from a five-participant phenomenological study to a national competency survey. Titles differ by country: a New Zealand charge nurse manager runs a ward, closer to an American nurse manager than to a rotating charge nurse, and that difference is kept in view below.

What the Role Asks of Charge Nurses

Across settings, the role combines bedside expertise with the coordination of people and patient movement. A national competency study in emergency care placed assignment of nurses to patients, situational awareness and the movement of patients through the department among the highest-ranked expectations (Wolf et al., 2024). A qualitative study of U.S. charge nurses described them as holding the front line between staff, patients and management (Eggenberger, 2012). In Scotland, senior charge nurses were given protected supervisory time to lead clinical care and develop staff, but much of it went to managing staffing levels (Rankin et al., 2016). New Zealand charge nurse managers likewise carried clinical, staffing and business duties at once (McCallin & Frankson, 2010). Whatever the job title, staffing is the duty that appears in every study, even where the role was designed around something else.

How Charge Nurses Are Prepared

Preparation is the theme on which the studies agree most and the one with the least reassuring answer. In a national study of U.S. emergency departments, charge nurses described limited formal training and inconsistent ideas of what the job required (Wolf et al., 2022). Newly qualified intensive care nurses in Gauteng, South Africa, were placed in charge of shifts within months of finishing their specialty training and described the responsibility as heavier than their experience (Mtsoeni et al., 2023). In New Zealand, charge nurse managers reported moving into management with little preparation for its business side (McCallin & Frankson, 2010), and Scottish senior charge nurses listed induction, coaching and mentoring among the conditions they needed rather than among supports they had been given (Rankin et al., 2016). Learning by watching a more experienced colleague appears to be the usual route into the role in every country represented.

What Structured Preparation Has Shown

Only one study evaluated a formal program over time. At one academic medical center, a charge nurse leadership program was assessed across six data collection points between 1996 and 2012 using the Leadership Practices Inventory, and ratings improved over the period, with relief charge nurses approaching the ratings of permanent charge nurses by the final round (Krugman et al., 2013). The finding is encouraging but narrow. The measure is self-reported leadership practice, the program ran at one institution, and the authors noted that education was not delivered evenly to every charge nurse. The most recent competency framework (Wolf et al., 2024) describes what a program should cover in emergency care but has not yet been tested as a curriculum. A much older study of how charge nurses actually decide patient assignments (Bostrom & Suter, 1992) remains the only one in this set to examine the decision itself rather than the role around it.

What Stands in the Way

Barriers recur across very different health systems. Scottish senior charge nurses named workload, time and limited support as reasons their supervisory role fell short of its design (Rankin et al., 2016). New nurse shift leaders in South Africa reported stress, anxiety and exhaustion (Mtsoeni et al., 2023). American emergency charge nurses worked without a shared definition of the role (Wolf et al., 2022), and New Zealand managers balanced competing clinical and administrative demands (McCallin & Frankson, 2010). The common thread is that charge nurses are asked to do more than the time and preparation given to them allow, which may itself shape the quality of staffing decisions on a busy shift.

Where the Evidence Runs Out

Three gaps are plain. First, no study in this review connected the preparation of charge nurses with the quality of their staffing or assignment decisions, and none followed preparation through to patient or nurse outcomes. Second, most of the work is qualitative or descriptive and comes from single sites, so it describes experience well but cannot estimate effects. Third, outside the emergency department, U.S. evidence is sparse: the national competency work is specific to emergency care, and medical-surgical units, where many charge nurses rotate into the role with no protected time, are largely absent. The staffing and mortality studies show that the decisions are consequential (Aiken et al., 2002; Needleman et al., 2011); the charge nurse studies show that the people making them are often unprepared. The literature has not yet joined the two.

Implications for the Proposed Study

The gaps point to a study that examines preparation and decisions together, in medical-surgical settings, with a measure of the decision rather than only of the nurse's confidence. A feasible first step for a doctoral project would compare the assignment decisions of charge nurses who have completed a structured preparation program with those of nurses who have not, using standardized staffing scenarios and an agreed scoring rubric. Such a design would not settle the question of patient outcomes, but it would test the link the current literature assumes and leaves unexamined.

Limits of This Review

Its own method constrains this review too. Only eight studies inform it, several with small samples, and a single reviewer screened and read them, so a study could have been missed or a finding weighted differently than a second reader would weight it. Gray literature, such as hospital reports of in-house charge nurse courses, was not searched, and some programs that work well may never have been published. Comparisons across countries are also imperfect, because the duties attached to the charge title differ between health systems, as the New Zealand study shows. For these reasons the themes above are stated with caution, and the full dissertation review will add a second screener for a sample of records, a documented gray literature search and an update of every database search shortly before the proposal is defended.

Conclusion

The literature on charge nurse preparation agrees on what the role demands and on how often nurses enter it without formal preparation. It offers one long-term program evaluation with a self-reported outcome, a recent competency framework not yet tested as a curriculum and no study connecting preparation to the staffing decisions that the wider literature shows to matter for patients. That is the gap my dissertation will address.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

Bostrom, J., & Suter, W. N. (1992). Charge nurse decision making about patient assignment. Nursing Administration Quarterly, 16(4), 32-38. https://doi.org/10.1097/00006216-199201640-00007

Eggenberger, T. (2012). Exploring the charge nurse role: Holding the frontline. Journal of Nursing Administration, 42(11), 502-506. https://doi.org/10.1097/NNA.0b013e3182714495

Krugman, M., Heggem, L., Kinney, L. J., & Frueh, M. (2013). Longitudinal charge nurse leadership development and evaluation. Journal of Nursing Administration, 43(9), 438-446. https://doi.org/10.1097/NNA.0b013e3182a23b26

McCallin, A. M., & Frankson, C. (2010). The role of the charge nurse manager: A descriptive exploratory study. Journal of Nursing Management, 18(3), 319-325. https://doi.org/10.1111/j.1365-2834.2010.01067.x

Mtsoeni, L., Matlala, S., & Downing, C. (2023). Newly qualified intensive care nurses' lived experiences of being a shift leader in a private healthcare institution in Gauteng, South Africa. International Journal of Nursing Sciences, 10(3), 351-358. https://doi.org/10.1016/j.ijnss.2023.06.007

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. https://doi.org/10.1056/NEJMsa1001025

Rankin, J., McGuire, C., Matthews, L., Russell, M., Ray, D., & Leading Better Care Research and Evaluation Group. (2016). Facilitators and barriers to the increased supervisory role of senior charge nurses: A qualitative study. Journal of Nursing Management, 24(3), 366-375. https://doi.org/10.1111/jonm.12330

Wolf, L., Delao, A., Simon, C., Clark, P., & Burchill, C. N. (2024). Ensuring throughput: Development and validation of charge nurse competencies for United States emergency care settings. Journal of Emergency Nursing, 50(4), 523-536. https://doi.org/10.1016/j.jen.2024.02.009

Wolf, L., Perhats, C., Delao, A., Burchill, C. N., Clark, P., Callihan, M., Edwards, C., Frisch, S., Moon, M., & Strout, T. (2022). Role and training of emergency department charge nurses: A mixed methods analysis of processes, needs, and expectations. Journal of Emergency Nursing, 48(4), 390-405. https://doi.org/10.1016/j.jen.2022.03.009