Supporting our Team Leaders and Charge Nurses

By Rose O. Sherman, EdD, RN, FAAN

A colleague who reads this blog recently sent me an article about why Team Leaders Make a Difference that captured the work of leadership expert – Marcus Buckingham. This article makes so many important points about our informal leaders who are the glue that hold our units and departments together. In the research that I have done with charge nurses, I have found that as the span of the nurse manager role has expanded – there is increasing dependence on charge nurses and other nursing team leaders. With rising patient acuity, decreased lengths of stay, staffing shortages, pay for performance measures and new technologies, the context of health care environments has significantly changed and these roles have become more complex.

Yet often, these unsung heroes don’t get the recognition that they deserve in organizations and sometimes don’t have the leadership training that they need to be successful. Buckingham points out that great organizations are really the outcome of many outstanding teams. To effectively support team leaders, nurse leaders today need to consider the following questions:

1. Does the team leader have the right qualities for what is needed in the current environment?

When considering nurses for frontline leadership roles, our research has shown that those currently working in the role rated good communication skills as a key quality for success. Communication is challenging in today’s environment with both the diversity in the workforce and the culturally diverse patient populations served. Good communication was viewed as being critical to patient safety. Team leaders have to monitor the consistent use of communication tools that organizations have in place such as team huddles, bedside report and hourly patient rounds. The role of the charge nurse was described as being similar to that of an air traffic controller. They also need to have strong organizational skills and the ability to effectively manage their time and control their own stress levels. Clinical competence in the area assigned was identified as being important to effectively coach and mentor others. The quality of being approachable and non-judgmental was seen as critical. Younger, less experienced staff need to feel safe when seeking help to avoid making errors.

2. What type of ongoing leadership development is needed in these roles?

Every team leader should receive initial training in key competency areas including communication, effective teamwork, coaching and delegating, conflict management, customer service and performance management. Recent research also indicates that managing “bullying” or “horizontal violence” on teams is also a must. Because we are in a rapidly changing healthcare environment, wise organizational leaders recognize that leadership development needs to be ongoing, ideally at least quarterly. Without ongoing communication and development, team leaders in our studies reported difficulty staying current with policies and procedures.

3. How can these roles be made more rewarding?

Nurse leaders report that it can be difficult to recruit nurses to assume frontline team leadership roles. The pay differential is often not significant and leaders can sometimes feel powerless in their roles to change processes in their complex organizations. Although there are challenges in the role, frontline leaders in our research reported many satisfying aspects of their work that could be shared with prospective leaders. Coaching and mentoring younger staff is the highest rated role satisfier along with the personal opportunities and satisfaction that comes with success in a leadership role. Leaders who publicly recognize and value the contributions of their team leaders to the success of the organization build loyalty.

It is often said that healthcare is a team sport because contributions are so interdependent. Buckingham has wisely noted that “we are all in the human nature business, the business of helping people discover what they can become.” An investment of time and resources in our team leaders and charge nurses is not only a wise business decision but can have a huge impact on staff satisfaction, interpersonal relationships and ultimately patient outcomes.

Read to Lead

Schwarzkopf, R., Sherman, R.O. & Kiger, A. (2012). Taking charge: Frontline nurse leader development. Journal of the Continuing Education in Nursing, 43(4),154-160.

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. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236392/