Charge Nurse Guide to Success

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The following course content

Introduction   

The charge nurse (CN) role is one of utmost importance in the inpatient healthcare setting. More often than not, the role of CN is thrust upon high-performing staff nurses whether they want the responsibility or not.  

As a new leader, you may or may not receive formal CN training from your organization. If you are just starting your journey as a CN or if you are contemplating stepping into a CN position, this course will bring light to the role and discuss effective leadership strategies that you can use to succeed as a CN. 

Charge Nurse Role 

Traditionally, the CN role has been ill-defined across most healthcare systems. Organizations must properly delineate what the role encompasses. The “fly-by-the-seat-of-your-pants” approach can no longer be accepted, the CN role is far too important. Specific job descriptions, postings, and compensation are becoming commonplace as the CN role has evolved (7).  

Let’s discuss the general responsibilities and required skills 

General Responsibilities 

The CN has many different responsibilities. They oversee the quality and safety of the unit. In many organizations, they are responsible for the unit’s day-to-day operations. The CN makes the daily patient assignment based on acuity. They assign new admissions and facilitate patient discharges. CNs coordinate the care of all the patients on the unit.  

Often, the CN will be called in to handle a difficult situation and use their service recovery skills. They also make sure that there is adequate staffing in the unit and will call people in or send them home as needed. Not to mention, in these post-COVID times of severe staffing shortages, the CN may also have to take on a full patient assignment while performing all the CN-associated responsibilities (1). 

Required Skills 

Communication is the most important skill for the CN to possess. Communication is the backbone of nursing – lack of communication or miscommunication is the number one dissatisfier among staff and patients alike. Honing your communication skills is essential. This encompasses both verbal and non-verbal communication as well as active listening (3). 

Being able to manage teams is another required skill. Dealing with people and their different personalities can be challenging. Discerning situations and understanding when to coach and when to recognize staff is a big part of team management. Growing team management skills along with promoting teamwork and collaboration will go a long way in your CN development (3). 

Strong leadership skills are also required to succeed as a CN. Not only must the CN already possess a desire to lead, but they must also be willing to further develop these skills and learn new skills that will enhance their leadership abilities (3). 

Service recovery skills are required in the healthcare setting. Issues will arise involving staff, physicians, visitors, and patients. Knowing how to employ service recovery and resolve issues in a quick, efficient manner will be a huge asset in the CN role. Staff will often come to the first line of leadership with service recovery issues. Knowing how to take care of these situations at the CN level is paramount. If an issue is escalated and must be brought to another level, it becomes more difficult to recover the service. The quicker the issue can be resolved with the fewer people involved, the more effective the service recovery will be (3).  

Promoting service excellence by modeling desired attitudes and behaviors is another needed skill. Behaviors and attitudes tend to roll downhill. The CN is a role of influence. If the CN acts and talks in a certain way, the staff underneath them will tend to follow suit (3). 

Effective Leadership 

Just because a nurse is amazing at the bedside, it does not mean that they will be effective in the CN role. Possessing and developing effective leadership skills is greatly needed in the CN. Staff nurses will follow a strong leader. Many organizations offer leadership training.  

As a new CN, you would be well served to seek out these opportunities. The evidence shows that CNs who have gone through leadership training are more effective than those who have not. These CNs have shown to remain in their roles or progress to manager/director positions (3). 

Though there are many different styles of leadership, there are two main classifications, relational and task-oriented.  

Relationship Leadership 

Relational leadership focuses on building, maintaining, and managing relationships with everyone in the circle of influence. This form of leadership has proven to be transformational and authentic. When nursing leadership employs a relational method of leadership, it has been shown that nurses have increased job satisfaction and a more positive view of the leaders.  

The CN who uses relational leadership is much more able to get their nurses “on their side” and promote the shared vision of the unit and hospital. This form of leadership was also associated with praise and recognition. Further, when leaders use a relational method of leadership, workplace bullying decreases, and nurse’s intent to stay increases.  

Task-Oriented Leadership 

Task-oriented leadership focuses on the daily nursing tasks and their completion. The mechanics of the individual tasks become the entire focus. The literature indicates that task-oriented leadership brings the opposite results to relational leadership.  

Nurses under this type of leadership reported decreased job satisfaction, decreased intent to stay, and absent praise and recognition. This indicates that it is important to build lasting relationships with your staff. Success comes through those relationships (5). 

Teamwork 

The CN must be able to not only function within a team but be able to step up and lead. They have to promote an atmosphere where individuals coalesce into a thriving team. The CN needs to focus on the team to accomplish the overall goal of the unit/facility. When the CN has a clear focus of purpose and can not only communicate but direct their team, the desired outcome becomes more probable (4). 

Trust is necessary when it comes to teamwork. For a team to function, they must know that they can count on all the other members of the team. The CN needs to cultivate an environment of trust. They do this by first showing themselves to be trustworthy. Doing what they say, modeling desired attitudes and behaviors, and treating all team members with the same courtesy and respect will go a long way toward developing trust (4). 

Providing feedback to the team is another role that the CN takes within the team framework. The CN often acts as both a coach and cheerleader. They use coaching to deter unwanted behaviors and to elicit those behaviors that are desired. Coaching to correct versus coaching to reaffirm/recruit.  

When the team is functioning as wanted, progressing towards the goal, or just demonstrating success (no matter how small), the CN cheers them on. Public recognition of desired behaviors strengthens the team and provides a model for the behavior (4). 

An effective team is able to anticipate one another’s needs and actions. Once a team has been together for a while and they have built trust among each other, they begin to fall into a rhythm. Within this rhythm, out of familiarity, they begin to anticipate other team members’ needs. This is a natural progression of the team as they function at a high level (4). 

Effective teams also back one another up. When a team member is overwhelmed, the rest of the team is able to recognize this and come to their aid. They do not want to see one of their own drown and will step in to help. As the leader, the CN should be able to coordinate the efforts to help the team members in need (4). 

Also, effective teams are able to adapt on the fly. When an initiative is not working, they can recognize the shortfall and adjust their strategy. Collectively, they decide to readjust their way of thinking and move on to something that may work better. They are always evaluating and reevaluating if a particular strategy is working or not and endeavoring to improve (4). 

Communication Strategies 

As a CN, communication is paramount. The CN communication model is not just aimed at their nursing team, the CN must also be able to effectively communicate with physicians, ancillary departments, hospital administration, stakeholders, and patients and their families.  

Let’s discuss some effective communication strategies: 

Awareness 

Before the CN can improve their communication skills, they should have an awareness of what their communication style is. A communication style can determine how effectively the message being communicated will be received. Having an awareness of how they communicate will make it easier to improve communication and adapt other styles of communication as needed. Being aware of the environment and who the CN is speaking with will also help the entire communication process (3). 

Active Listening 

When having a conversation, many listen for a place to interject their point of view. They stop paying attention to the conversation and focus on the point that they want to make. Active listening is different. It is a difficult skill that requires practice. The focus is totally placed on the speaker while the listener brings their own thoughts into captivity. Summarizing what was said and asking follow-up questions indicates that the listening was intently listening. Body language during a conversation can also promote active listening. Facing the speaker, leaning in, having good posture and uncrossed arms will show the speaker that you are listening (2). 

Pauses 

Effective use of pauses is another communication strategy. It is another skill that takes practice to get comfortable using. At first, using pauses may seem awkward and counter-intuitive, however, pauses allow for reflection. During an emotionally-charged conversation (which the CN may tend to have) pauses are especially useful to digest what was both said and felt. The pause can also help control the tempo of the conversation (2). 

Summarization 

An extension of active listening, summarizing what was said lets the speaker know both that you heard and are interested in what was said. It lets the speaker know how you understood what was said and gives the speaker an opportunity to correct any misconceptions and further clarify their point (2). 

Conflict Resolution 

The CN will be called upon to resolve conflicts between various different individuals. In the hospital setting where emotions are running high, it is not unusual for conflicts to arise. The CN should be able to defuse the situation. It is important for the CN to be aware of the full context of the conflict. Understanding who is involved, what prompted the conflict, and any other variables will help the CN through conflict resolution (6). 

There are different methods that the CN might use to resolve conflicts. 

Accommodating 

This style is all about emphasizing what the parties have in common thereby decreasing the importance of their differences. With this style, there is a push to satisfy the interests of the other party (6). 

Avoiding 

In this style of conflict resolution, the CN has very low interest in themselves or any other party in the conflict. It is all about avoiding conflict altogether. The CN avoids all responsibility by overlooking the problem by not even listening or talking about the conflict (6). 

Collaboration 

This style requires an examination of differences and the exchange of information between the parties. It forces the parties to collaborate; to come together and work out the issue (6). 

Competing 

In the competing style of conflict resolution, the CN puts their interests above the other parties. They will use behaviors and words that will place the other parties in trouble (6). 

Compromising 

In this style, the CN will place an equal interest in all the parties involved including themselves. In this style, all parties share the final decision. Each party may give something up or have to sacrifice something to agree on the end decision (6). 

No matter the style of conflict resolution that the CN uses, the CN needs to be well-versed in how to conduct themselves. Remember that the words coming out of your mouth only account for a fraction of the message that you communicate.  

Non-verbal communication such as facial expressions, body language, and posture all send messages to those you are speaking with. In conflict resolution, these non-verbal cues can help or hinder the CN’s ability to have a positive outcome (2). 

Quality and Performance Improvement 

On top of all the other hats that the CN wears, they also drive patient safety, quality, and performance improvement (PI). They play a direct role in moving the metrics in the realms of quality and patient safety by helping to develop and implement PI initiatives. The CN must also sell the PI initiatives to the frontline staff in such a way that they take ownership and put the initiatives into daily practice.  

The charge nurse identifies the successes and barriers as the PI initiatives progress and shares the best practices with the team. More often than not, one of the biggest barriers to implementing any new initiative is staff buy-in. The CN must use their influence to get this critical buy-in. The type of leadership style that they project will directly impact whether the staff will get behind and drive the initiative (4, 7) 

Conclusion

The CN role is an integral part of any nursing unit. Leadership training for the CN is of utmost importance. Many skills and strategies required to be an effective CN need to be taught and practiced for the CN to become an expert in these skills.  

The CN needs to be seen as a leader in their organization and given the resources needed to perform the CN’s duties. As a new CN, it is strongly suggested that you seek out these learning opportunities. If none are available at your facility, seek out a mentor CN.  

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