Taking Charge - Are You Ready?

By Rose O. Sherman, EdD, RN, FAAN

“I am just not sure that I am ready to take charge on my unit. I know I have leadership skills but I am a relatively new nurse. Am I really ready to assume all this responsibility? My nurse manager thinks I have excellent leadership potential and is encouraging me to take the plunge. But what if the staff does not respect me in the role and what if I fail?”

In today’s turbulent healthcare environment, nurses with less than one year of experience often find themselves being asked to take charge. It is not unusual to feel the type of anxiety that the nurse above expressed to me when she learned that her manager wanted her to take charge of her unit on the night shift. Charge nurses are expected to lead staff while managing the work systems and processes on their units to insure that the needs of patients are met. It is a skillful balancing act and not all organizations provide the nurses with leadership training before they accept these responsibilities. Yet despite the challenges, embracing the role of charge nurse can provide enormous professional satisfaction and a tremendous leadership growth experience. Important keys to success in becoming an effective charge nurse include understanding the role responsibilities and developing the skills needed to enhance communication, reduce conflict and build team synergy.

The Charge Nurse Role

Before you take charge for the first time, it is important to ask what the role responsibilities are and if a formal position description is available for you to review. The charge nurse role is not uniform across all healthcare settings. The title of charge nurse has been around since the early 1980’s. One definition for charge nurse is a nurse assigned to a particular unit or department that has been designated by a nurse manager or director to coordinate nursing activities on a particular shift. In some settings, charge nurses are called unit facilitators or shift coordinator and the role may be permanent or it can be rotated among staff. Depending upon the position description in your setting, your role could include any or all of the following:

Making Patient Care Assignments and Delegating Care to Other Members of the Team
Ensuring that Staff and Patients receive the Support They Need
Facilitating the Admission and Discharge of Patients to your Unit
Monitoring New Orders written for Patient Care
Overseeing Care given by Licensed Practical Nurses and Patient Care Assistants
Evaluating Staffing and Assessing Unit Productivity throughout the Shift
Monitoring Unit-Based Performance Indicators
Arranging for Supplies/Equipment
Coaching Staff
Communicating with Physicians
Serving as a Liasion to Other Departments
Answering Patient and Family Concerns
Contributing to Staff Evaluations
Serving on Committees and Task Forces

These are challenging responsibilities especially if you are in a setting where you are also expected to take a patient care assignment. Charge nurses have accountability to the organization, staff and patients for care that is delivered. Organizations today depend on charge nurse to be gate keepers for safe and efficient care that meets all regulatory requirements. During the shift, charge nurses have to conduct real time assessments of unit activity. It is not surprising that the role is compared to that of an air traffic controller. Health care settings today are very complex. The charge nurse is expected to serve as a conduit for information provided from staff to management and from management to staff. In order to achieve all these responsibilities, the charge has to be very familiar with the policies and responsibiltiies of the organization.

Are You Ready to be a Charge Nurse?

On today’s busy and often chaotic patient care units, the team relies heavily on the charge nurse for their guidance and direction. It is important to have a very clear understanding of the role and your own capabilties prior the accepting the responsibilties. If your setting does not have a formal charge nurse orientation program, ask to shadow an experienced charge nurse. Rising to meet this leadership challenge can provide enormous professional satisfaction and a tremendous leadership growth experience.

Read to Lead

Sherman, R. & Eggenberger, T. (2009). Taking charge: What every charge nurse needs to know. Nurses First, 2(4), 6-10.

Sherman, R. (November 2011) Teaching Nurses to Delegate

Sherman, R. (October 2011) Charge Nurse Perspectives on Frontline Leadership