The hierarchal chain of command has taken on many different names over time, yet one thing has never changed-the frontline nurse leader is the most difficult position in the field. It has been called many names from charge nurse, clinical coordinator (CC), head nurse, supervisor and assistant nurse manager (ANM). Although the names are used differently across organizations, one thing remains the same-these are real time positions with huge decision making that impacts patients and staff. I have spent a good 18 years of my nursing career in this position. Initially, the informal nurse leader role takes place as you simply offer the newest nurse help in a situation, guide your support team through a challenging eight-hour shift or handle family conflicts on the unit. Informal recognition turns to formal recognition when you are handed the charge nurse pager or phone and you see your name written under the charge nurse line on your assignment sheet.
I witnessed nurses enter this position based on a variety of rational thought processes. While some enter this position after applying for a posted position, others enter simply because they have the most years of experience or simply offer to do the job for that given shift. Charge nurse for one day, or charge nurse every day, the job is met with many pitfalls. As a hiring manager of over 100 clinical staff, I have the privilege of providing my experiences in order to help those new in the position. I do not intend to reference any literature here, nor recite great management principles. I simply want to share what has worked for me. Here is exactly how I have survived, managed and loved being in the critical charge role for almost 18 years.
My first words of wisdom are very simple. Take a look in the mirror and ask yourself if this is truly what you want to do. Every now and then you must provide a gut check to make sure you are dedicated to the job, respect its demands and are willing to put in the energy. Now that this is out of the way, let me share some situations and ways of thinking that have helped me be successful.
Here is a situation the ANM often faces frequently. The ever-loved creation of the assignment sheet for the next shift. Sitting at the main nursing station, delicately calculating who is arriving for staff, the ANM attempts to create the assignment that will capture all of the patients, allow for admissions, is fair based on acuity and places the unit in a successful position. Coaching the ANM’s on our team, I identified a simple tip that can help improve this process.
Take yourself out of the firing line – Ask your manager/director for a quiet place you can go to work on the assignment. Assess what you need: admissions, discharges, arriving staff, staff remaining, prior assignments and any other factor you can think of. Now, leave the unit and go somewhere quiet where you can focus. Be prepared to have a few ruffled feathers, but keep in mind you cannot please everyone. There are simply too many variables. Entertain requests that make sense for the unit, however, avoid making changes that benefit only one member of the team. This is a nursing unit that must function as a team.
Behave like you want the rest of your team to behave - We call this role modeling behavior and it works. When your team identifies you handling stress in a positive way, they often want to emulate this behavior. Keep your mind clear, focus on the now and remind yourself that every situation will eventually come to an end. Remember to breathe, walk away from frustration when needed, re-set and take a drink of water. These tips are so simple, yet often forgotten.. You are human and can only handle so much at a given time. Learn to process, triage situations, provide feedback to your team and spend time on situations that need it and avoid too much time on situations that do not.
How do you then handle the staff that do not follow your lead, positive role-model behavior and are just always negative and complaining? I am asked this question frequently. The answer is simple: hold them accountable. Lend a listening ear, redirect their behavior, help get them through the situation and then let them know you would like to see them at some point. This sets the tone that you put patients first but need to provide feedback to the staff member. This is the easiest way to start the crucial conversation you will have. This is the hardest part of giving feedback. Now the other person knows you need to talk to them, and often they will approach you to find out what it is you have to tell them.
You want your message to be clear and precise – Tell the individual how you perceived their behavior, attitude and situation. Allow your co-worker an opportunity to talk and ask for advice. Often this will be the case. We then call this coaching. Hopefully, in future situations you will witness the person responding to similar situations in an improved way. If the person does not allow you to provide coaching or argues with your assessment, let them know that this is not appropriate behavior and that you expect a change. Do not take it personally, and know you are doing the right thing. Your team will build respect for you and know you have what it takes to lead them to success.
Always keep your director or manager in the loop - Write an email letting them know you had a conversation and that this is what took place. This will help down the road if the manager or director needs to take further action. I tell all the leaders on our team, “what you permit, you promote.”
Interact with patient’s and family as if they were your own - You learned this in nursing school. It is vital to your survival. Never make excuses, tell patients the unit is busy or tell them that the staff person they are upset with is a great person. Listen, acknowledge and execute a solution. Never make your problems or the unit problems the patient’s problems. Say you are sorry they had this experience, find a way to immediately resolve the situation, provide the feedback to those who need it, move on and keep the ship sailing.
Every day will provide different stressors, experiences, challenges and rewards. Embrace them, learn from them, teach them and keep your team positive. Do not entertain negativity and have courage to refocus your team. You are here to lead a team, care for people and build comradery. I frequently give advice to not allow personal feelings to get in the way, avoid too many friendships and lead consistently. Enjoy what you do, take time out for yourself, vent out frustrations away from your team and recharge your batteries. Enjoy hobbies and simple pleasures and get ready to do it all over again. You, my friend, are a charge nurse!