So You're A Charge Nurse. Now What?

by: Beth Hawkes

charge-600-x-853-PinterestCharge nurses are top performing nurses who are seen as having leadership potential by their managers. While charge nurses are top bedside nurses, they need to develop a new set of skills for the Charge Nurse role. Good charge nurses make it look easy…and it’s not, at least at first.

Meet Tiffany

Tiffany was surprised and flattered when her manager approached her. “Tiffany, you have done very well here on Med Surg 3 South and we’d like you to make you Charge Nurse.” Within a short time, Tiffany had attended a four-hour class on productivity and spent 3 shifts orienting with another Charge Nurse. Her name badge was changed to Nurse Leader and she was given a modest increase in salary. The first day of her new job, she came in early, eager to make the assignment. Halfway through, she received a text from her friend Jessica. “Tiffany, please change my assignment today. I don’t want the patient in 3115.” Obligingly, Tiffany moved the assignment around which resulted in a downstream effect of every nurse’s assignment being changed. It was almost 0700 and Tiffany was racing to get the assignment sheet done for report when the House Supervisor called. “Send one of your nurses to ICU. Someone didn’t show down there and you’ll have to make do.” It was 0715 before Tiffany posted the assignment sheet. Immediately Jenifer took one look and protested. “Seriously, Tiff? My patients are on different ends of the floor and you gave me 3115?” Tiffany said, “I’m sorry, Jen, I did my best, we have to get started.” Tiffany was not prepared for the role shock. She felt awkward when she noticed handoff report being given in the hall and not at the bedside as administration had recently mandated. Should she say something? If so, what? And how? She was torn with conflicting loyalties. You must identify your need to be liked and be willing to subjugate it for the role.

Here are some tips to ease the transition.

Provide a Rational

 

“Jenifer, I understand you don’t want two isolation patients, but you had them both yesterday. Continuity of care is why I am keeping your assignment the same today.” When you provide patient-centered rationales to your decisions, your staff may not always like your decisions…but they will respect you.

Resource

 

One day you are a staff nurse, and the next, by virtue of your title, you are viewed as a clinical resource for the new nurses on your floor. When a nurse asks your opinion, help develop their critical thinking skills by asking: “What do you think?”

Role Model

 

As a charge nurse, you are a role model.  Take a self-inventory and identify any shortcuts or workarounds you may have incorporated in your practice. Now that you are charge, you are representing the organization with every word you speak. Whatever you say and do carries an authority bias. Nurses will repeat what you say “Tiffany says we change central line dressings every 72 hours.” and “Tiffany said that it’s not too late to ask for time off on the next schedule.” You will be quoted (and misquoted!). What you say goes. Know your facility’s practice policies and look things up that you don’t know. Establish and maintain your credibility.

Flexible

 

The very nature of the job is planned chaos, because, as you know…nothing goes as planned. So a wise charge nurse PLANs for the unexpected.Always have a back-up plan ready. What is your back-up plan if a nurse goes home sick three hours into the shift? Think it through and don’t be taken by surprise, so you can maintain composure under fire.

Appreciative

 

Always say “please” and “thank you” even (or especially) when it’s crazy busy. Yes, it’s their job to do whatever it is you are thanking them for doing…but the person who is generous and gracious under pressure is a true leader. Give props to the housekeeping person who turns over the rooms fast so you can admit. To the 68 year old nursing assistant who is dutifully working past retirement age because she has no retirement. Round on your staff regularly so that your staff nurses know that you are reliable and available.

Know Your Staff

 

New nurses are overwhelmed and need your support. Experienced nurses want you to recognize their clinical expertise. Every nurse has a different capacity and stress tolerance level. Know their strengths and weaknesses. You will learn that when Ashley says she can’t admit another patient right now, it means she is genuinely sinking, whereas “I’m drowning!!” is Lindsay’s go-to response.

Competency Based Assignments

 

Follow your facility’s policy on assignments. Know which of your staff has ACLS.  Surveyors will ask charge nurses how they made the patient care assignment, and the answer is: “We make competency-based patient care assignments.”

Don’t be the Room Mother or an Enabler

 

It is not your responsibility to solve all employee problems. Put it back to them. If someone wants a non-emergent day off on short notice, and it will leave you short, ask them how they plan to cover it. What attempts have they made to trade shifts with a co-worker? If it is their assigned shift, it is not necessarily your job to fix it. Jena comes to work and immediately makes it known that she doesn’t feel well. Martyr-like, she describes her symptoms, including bathroom urgencies in detail.  If someone comes to work sick and basically wants to be sent home by you to avoid an occurrence, or avoid the responsibility of leaving the floor short-staffed, say  “I’m sorry you don’t feel well. Are you staying or are you going home sick?” This puts the decision back on them.

Know When to Break the Rules

 

There are times when a wise leader breaks the rules. You have to know the rules before you can break them. Know the policies and procedures. You must have a defendable rationale that you can articulate based on patient safety.

Be a Can-Do person

 

Everyone wants to work with a positive person. Be as positive and agreeable as possible. Strive to make things easier, not harder. Be a problem solver. If post partum is overflowing, agree to take one of their patients onto Med Surg so they can admit a C-section.

At the same time…Know When to Draw a Line in the Sand

 

Just because you are asked to float a staff member off your unit, you don’t always have to blindly do so. Consider that another unit, another charge nurse, was also asked to float a staff member off and basically refused. Are you concerned that it would be unsafe to float a nurse to ICU or be short a secretary? Always frame your responses as what’s best for the patient. Pick your battles and know what hill to die on.

Credible

 

Don’t make promises you can’t keep and follow through on what you promise. You are building your own reputation daily.

Pitch in

 

Bedside nurses do not view deskwork as pitching in. Bedside nurses highly appreciate charge nurses who jump in when the going gets tough and it’s busy. Create a sense of teamwork when you’re on duty.

Set the tone

 

As the charge nurse, if you are frazzled and anxious, the entire floor will respond. Likewise, if you are calm and professional, the whole floor will respond in kind. The best change nurses make their job look easy, no matter what’s going on.

 

If you are a new Charge Nurse, congrats to you, friend!! You have been chosen to lead and that is not to be taken lightly. Until next time friend, Nurse Beth

 

Author

Beth Hawkes

Beth Hawkes

StaffGarden Contributor

Author Nurse Beth, MSN, RN-BC,  is a Nursing Professional Development Specialist, and a well-known career advice columnist and writer. For more of Nurse Beth’s articles, visit  nursecode.com

 

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