8 Successful Strategies for the Charge Nurse

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A Charge Nurse or Resource Nurse is the nurse in charge of many things including supervising nursing staff, making patient assignments, mentoring other staff when needed, and acting as a liaison between family, physicians, and administration.

More often than not, the Charge Nurse also is expected to carry and maintain a patient assignment in addition to all the other duties.  Being in charge can hold many pressures  and it takes a long time to feel comfortable moving into this new role.

For the majority of the time, Nurses will not be asked to do charge until they've been working on a unit for two years or more with a proven capacity to deal with adverse situations.  Everyone has different personalities and nurses are naturally great leaders but when it comes to being the charge nurse, many nurses are apprehensive due to the vast responsibility that goes along with it.

Read on for some tips to remember if you've been asked to start Charging to help you succeed...

1. Become a Good Delegator

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You suddenly have to wear the hat of "Charge Nurse" and now some of your duties are to assign who is going to get the next admission, who gets the patients with the difficult family, or who has to float to another unit, for example.

Sometimes we have to make choices that will affect our co-nurses and the way their shift is going to go.  It's hard, but there's no way around it.

When you have to assign a new admission or increase the workload for a fellow nurse try to be as fair as possible and be prepared.  Try to have a game plan in mind even before you know there will be a need.  This helps to be mentally prepared should you need to approach a nurse and add to her assignment.

Master the art of delegating to your co-nurses, be assertive and clear.  Give a full picture of the task that needs to be done.  Above all else, remember that you are all on the unit for the same purpose: to provide safe, patient care.

2. Always be as fair as possible:

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We all have our favorite staff members we like to work with, and those we don't.  There are nurses who are particularly good at dealing with certain patient assignments, and those who I wouldn't want to take care of my dog.  Most often, there are nurses who will GIVE YOU A HARD TIME ABOUT AN ADMISSION... and those that will take an assignment easily and willingly without a second of gruff.

It's easy to want to be "nice" to your friends, or always give the great nurse the challenging patient because you know she can handle it, or to give it to the easy going nurse (who won't give you a hard time), but as the resource nurse you must always remember to be fair and balanced.

Your colleagues will pick up on your bias and it will foster a disgruntled environment.  When you make an assignment you should stick with your plan.  If you are fair, the staff will trust your skills at delegating and will be more likely to have willingness to take on a new assignment.

3. Don't Expect to make Everyone Happy:

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You can try to be as fair as possible, make sure everyone gets a dinner break, spread out the workload, and provide as much support as possible for your staff, but there will always be someone who feels you're are "picking" on them.

Some people constantly feel like they are being singled out negatively or that they always get the "bad" assignments.  These people think the world revolves around them and do not see the big picture.

As hard as it is, listen to this persons complaint and in an objective way explain why you made the assignment that you did.  If you are fair and unbiased in your assignment making there should be no argument.

Suggest a meeting with your manager if you are consistently having difficulty assigning certain nurses patients.  In the end, your consistent fairness should speak for itself.

4. It's not Personal:

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You cancelled an RN because the unit was slow and were just following protocol.  It turns out three more admissions came in and now staff that is left has to run around to keep up with the surge of workload.

You don't know for sure, but you're pretty sure you see glares coming from the pyxis room and disgruntled rumblings among staff.  Everyone seems P-O'd at you for cancelling the RN because now they have to work even harder... you feel terrible because you think it's your fault and you wonder why they thought you were qualified for this job!

It's not your fault, sometimes people just are looking for someone to blame, not that it's right.

Like many things on the unit, you do your best with what you know.  You can't foresee the future and sometimes we can make mistakes with staffing.  I have been known to cancel RN's right before a surge of patients and keep extra RN's because it was a notorious Friday night on a full moon only to have no patients be admitted.  Both times I heard about it from the staff.

I've gotten good at taking constructive criticism but at the end of the day, you do what you can with what you have!  If you are consistently trying to do what's best for the unit and the staff, your co-workers will see that, so don't beat yourself up!

5.  No News is not always No News:

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As a charge nurse you should try to check in with your staff periodically throughout the shift.   Some nurses can get stuck in a patient room with a long dressing change, an overly needy patient, or a confused patient and they need rescuing.  If you haven't seen one of your nurses in a while maybe she is running around like a chicken with her head cut off and needs some support.  Even if you can't offer your help because you are busy yourself, you may be able to delegate to someone else who has the ability to help.

The best nursing units look after each other and provide support when needed.  It will also help you to know which patients are a heavier assignment so you can pass it along to the next charge nurse and make assignments accordingly.

6.  Don't Ask of Anyone what you Wouldn't Do Yourself

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This goes back to fairness and making balanced assignments.  If you notice that you are giving a nurse another fresh post-op and she all ready has two, maybe consider reassigning or switching around assignments to keep the workload safe and balanced.

This can be difficult because nursing units are unpredictable at times, but it's worth considering when you see that someone is getting particularly pummeled during a shift.

7.  Stay Ahead of the Game and Be Prepared:
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Staying ahead of the game is having situational and global awareness.  Ask the staff to keep you updated with any patient issues that may develop into an emergency or unsafe situation.  Maybe you have a nurse who suddenly has a combative patient that may need a sitter, or a post-op patient who's vitals are becoming unstable.

There are many times when a situation can take a turn for the worse on a nursing unit, if you are kept up to date with what's going on in other patient rooms, you will be much better able to deal with an emergency or difficult situation.

In addition to staying updated on patient status, I always believe in being prepared with a plan should the ED send you a new admission, a patient acuity changes, or someone's discharge has been postponed.

Having mental preparedness and having a tentative plan before you need one will give you the readiness to delegate when needed.

8. Be Approachable and Patient:

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As charge nurse, you are expected to be a resource to your staff and provide support when needed for difficult or complicated assignments.  Sometimes nurses will come to you with family problems, illness, or interpersonal issues among co-workers.

When you are willing to listen to the staff in a non-threatening way they will feel comfortable coming to you with concerns or problems that are affecting them.

This is crucial to becoming an effective charge nurse.  For example, if a new nurse feels intimidated by you she may withhold asking for help if she is struggling with an assignment.  This could potentially cause an adverse patient event.

Above all else, be kind and patient with the staff.  Everyone has their own reality and struggles, but if you are patient and a good listener you will be a valuable resource to your co-workers.

You Got This!
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You were chosen to take on the role of charge nurse, they believe you can do it and so should you!  Don't sell yourself short and trust your instincts.  If all else fails, learn from your mistakes and enlist the help of your mentors!

If it doesn't challenge you it doesn't change you, take on the challenge and be a valuable resource for your co-nurses, GO GET 'EM!

Are you new to the charge role and have a challenge you've faced in that role?  Post your story below in the comment section or like my page on facebook, Thanks for reading!

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