The Charge Nurse as Team Leader - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN,

“Finding good players is easy. Getting them to play as a team is another story”. Casey Stengel

Many nurses today are reluctant to take charge nurse roles. Charge nurses are unsung heroes in today’s health-care environment. Their nursing leadership is right at the point of care and critical to better patient outcomes. Yet, we know that many nurses assume charge nurse roles without the skills that they need to effectively lead teams.

The Charge Nurse Role in Today’s Health Care Environment

“I am just not sure that I am ready to take charge. 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?”

This is a concern that many nurses have before they begin the charge nurse role. Charge nurses are expected to lead staff on their team, 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 can be very challenging. With 12 hour tours, there is often little continuity in the membership of the team. Yet despite the challenges, embracing the role of charge nurse can provide enormous professional satisfaction and a tremendous leadership growth experience. Yet to be effective, charge nurses need support and development from their managers and directors.

Role Responsibilities

In a 2010 article in the American Journal of Nursing, Jean Flynn and her colleagues Patricia Prufeta and Linda Minghillo-Lipari provide a competency checklist for charge nurses to help you in your personal development Charge Nurse Critical Competencies. Charge nurses have accountability to the organization, staff and patients for the care that is delivered. Organizations depend on charge nurses to be the gate keepers for safe and efficient care, which meets regulatory requirements and ensures an economic return.

Charge nurses conduct real time assessments of unit productivity during various points throughout the shift. They often determine how staff resources will be distributed on their shift, or the upcoming shift in response to changing institutional and patient needs. Charge nurses must also be familiar with the institutions policies and procedures in order to navigate through what is often a very complex system.

Charge nurses interact with physicians related to patient care issues, interfacing with support departments and facilities management to ensure patients have the needed supplies, medications and an environment conducive to healing. You also also have direct patient and family contact, often with difficult patient or family dynamics and complex care management challenges. As the health-care environment is changing, charge nurses now often take on additional duties such as oversight of core measures performance and hourly rounding.

Charge nurses set expectations for staff and provide support so that staff can carry out those expectations. They are expected to hold staff accountable for performance of their professional patient care duties, adherence to regulatory requirements, and documentation of this essential information. The charge nurse serves as the conduit for information provided from staff to management and from management to staff. Charge nurses assist with the orientation, training and professional development of staff. They play a key role in the competency assessment process and make sure that the team works together effectively.

Key Ingredients for Effective Teamwork

If you have worked on a highly effective and smooth running team, it is an experience you are not likely to forget. Effective teams have the following 10 key characteristics:

Clear Goals that everyone on the team works towards
Clarity about the role and contributions of each team member
Open and clear communication
Effective decision making
Engaged team members in the work of the team
Appreciation of diversity – generational, cultural and diversity in thinking
Effective management of conflicts
Trust among team members
Cooperative relationships
Participative leadership

You can see from this list, that charge nurses need to understand their own position description and that of all of their team members. Understanding the level of competency of staff is also important. The knowledge and skills of a new graduate will be very different from more experience staff. Team members will have different attitudes, beliefs and values so developing common ground such as we are here for the patient and everyone on this team helps one another is important.

Why Things Go Wrong On Teams

The most common behaviors that create obstacles to effective team work include blaming others, turf protection, mistrust and an inability to directly confront issues. In the absence of complete trust, people are more likely to withhold their ideas, observations and questions. Professionals are also more likely to leave teams with trust issues. It is not surprising that in our health care system, ineffective teamwork is now recognized as a potential patient safety issue.

Charge nurses need to help the team to develop the ability to collaborate effectively, build relationships and trust, innovate and achieve results at a consistently high level. Being sensitive to their needs is very important. Staff members need to feel valued and essential to unit function. Many times nurses go without needed breaks. If nurses are not supported in caring for self, this leads to low staff morale. The charge nurses can assist with seeing that these breaks are taken and heavy workloads are redistributed. An additional stressor is when staff nurses precept orientees or novice nurses. When making assignments, the orientation for new staff must be adjusted for and supported.

The charge nurse role in today’s environment can be compared to air traffic controllers in the aviation industry. On today’s busy and often chaotic patient care units, patients, staff and interdisciplinary team members rely heavily on charge nurses for their guidance and direction. Rising to meet this leadership challenge can provide enormous professional satisfaction and a tremendous leadership growth experience when their is support from their leaders.

Read to Lead

Federwisch, A. (June 12^th, 2008). Who’s in charge? Retrieved July 6^th, 2009 from http://news.nurse.com/apps/pbcs.dll/article?AID=2008106160049

Flynn, J.P., Prufeta, P. & Minghillo-Lipari, L. (2010). An evidence-based approach to taking charge. American Journal of Nursing, (9) 110, 58-63.

Sherman, R.O. & Eggenberger, T. (2009). Taking Charge: What Every Charge Nurse Needs to Know Nurses First, 2(4), 6-10.

Sherman, R.O., Schwarzkopf, R. & Kiger, A. (2011). Charge nurse perspectives on frontline leadership in acute care environments. International Scholarly Research Network: ISRN Nursing, 11(Article ID. 164052), doi:10.5402/2011/164052. Click Here for Article