Cultivate charge nurses at your facility
Training the next generation of leaders
As the baby boomer generation of nurses heads for the door and younger workers begin
to take charge, preparing your staff members for the leadership role of a charge nurse can
appear daunting. However, when you determine what’s involved in developing charge
nurses, this aspect of succession planning can prove exciting and highly beneficial to
your organization.
“For a charge nurse, you want someone who can serve as a resource for their coworkers,”
says Nancy Knecht, RN, staff development specialist in the ICU at Mercy Hospital in
Iowa City, IA. “It’s especially important this day and age to train your nurses to be
leaders.”
Current research has confirmed the importance of such training for this role. “The charge
nurse role is critical because of current staffing issues, the use of agency and/or foreign
nurses, and the need for a proficient nurse to be accountable for issues arising in the
unit,” according to a journal article in MedSurg Nursing.
By setting expectations for the responsibilities and characteristics of a successful charge
nurse, Mercy has created a charge nurse orientation that helps new nurse leaders embrace
their role.
“I decided to take on the charge nurse role because I enjoy a leadership position and want
to share my skills and strengths,” says Karla Ernest, RN, MSN, CRNI, a nursing
veteran of 22 years who joined Mercy two years ago and has been a charge nurse at the
hospital for about a year. “I try to serve as a resource to other nurses in terms of clinical
direction.”
Taking charge at Mercy
In the ICU, Mercy takes careful steps to orient new charge nurses to the position. Many
nurses have received leadership education during school courses, but becoming a clinical
leader requires special training. “Historically, baccalaureate nursing programs have
allotted significant didactic time to the principles of management and leadership,” noted
authors in the journal Nursing Education Perspectives. “Clinical management
experiences, however, vary considerably.”
To ensure that Mercy charge nurses are sufficiently prepared, they first receive
instructional training via a PowerPoint presentation that outlines what’s involved in being
a charge nurse, including covering conflict resolution. Following the presentation, new
charge nurses are assigned experienced charge nurses as preceptors, and they shadow
their preceptors for two to three weeks.
“For a preceptor, we try to get the most experienced charge nurse available,” says
Knecht. “They have a great deal of wisdom and experience to draw from.”
The new charge nurse is prepped about how to handle a variety of scenarios by the
preceptor, such as short staffing or having the right number of nurses but not nurses with
the right skill levels. This helps the charge nurse prepare for handling such situations
themselves.
Before assuming their first position, prospective charge nurses take a written test (which
asks questions such as, “What would you do in a disaster drill?”) and must achieve at
least 80% before beginning their new role.
Once the new charge nurses begin their first shift, they take the lead on the unit while the
existing charge nurse takes care of other nurses and patients, serving as a backup in case
the new charge nurse has any questions.
“Here, they can demonstrate to the charge nurse their leadership skills and their ability to
think on their feet,” says Knecht, which inspires confidence that the new charge nurse is
ready for the role.
The effective charge nurse: A profile
The initial step to take when developing nursing leadership positions, says Knecht, is to
define the role of the charge nurse within your department or organization; success can
only be achieved when new nurses have a clear understanding of their goals and
obligations. For example, determine whether the charge nurse will take on a full patient
load. It should also be clear how the charge nurse should act in terms of delegating work
to staff members and how he or she will be using computer systems and other
technology.
Once the responsibilities of the position have been defined, there are certain attributes
that often make for a successful and happy charge nurse.
“You want someone who can be calm in an emergency situation,” says Knecht. “You
need to make sure he or she can do work while keeping an eye on the entire unit.”
Ernest agrees that this calm nature plays a major role in success. “During a crisis, you set
the tone for everyone else who’s there,” she says.
Good communication skills, adds Knecht, are also crucial, as is the nurse’s ability to
inspire and commend staff members.
“Charge nurses have to be able to give the praise that people need,” she says. “They need
to build them up and say, ‘You can do this.’ ” For this reason, she adds, attitude is
everything. “If you have a charge nurse who’s always depressed or condescending, he or
she is not going to put in as much effort and won’t enjoy the position.”
Keep in mind that charge nurses must have the logistical information that’s necessary to
coordinate care at the facility. “Make sure they know what people serve as what
resources,” says Ernest.
Clinical knowledge, she adds, is also essential. “There should be an overall focus on
education, as well as a large, heavy focus on documentation and teaching them the
correct skills.”
The challenges of developing leaders
There are barriers that often need breaking when fostering new charge nurses, says
Ernest. One of those challenges can come when an experienced nurse is brought in from
outside the organization.
“When you have a nurse coming in from somewhere else, the person has established
habits and patterns of doing things,” Ernest says. “But if you can possibly adopt these
patterns and listen to what they have to say, you can reap the benefits of their
experience.”
Charge nurses may also become nervous that they will not always have backup available
if they need it—or they may hesitate and wait too long to ask for assistance.
“Let them know that they have backup,” says Knecht. “When they’re just out there flying
by the seat of their pants and wait to call for backup, bad things can happen. Then it
becomes a kind of a cleanup. Encourage them not to wait.”
Additionally, sometimes charge nurses need to help staff members look beyond the
basics of a problem and come up with creative solutions, says Knecht.
“You want to have very creative thinkers,” she says. “And the more experience they gain,
the more creative they seem to get.”
References
Connelly, L. and Yoder, L. (2003). “A qualitative study of charge nurse competencies,”
MedSurg Nursing 12 (5): 298–206.
Isaacson, J. and Stacy, A. (2004). “Nursing students in an expanded charge nurse role:
A real clinical management experience,” Nursing Education Perspectives 25 (6): 292–
296.
Source: The Staff Educator, an HCPro, Inc., publication