Great Charge Nurse = Great Shift, Better Patient Care
You should never underestimate the importance of a charge nurse. A great charge nurse can make your shift run smoothly, while a not-so-great one can make work much more difficult. Charge nurses influence team culture and performance, provide staff mentorship, and ultimately affect the quality of care that our patients receive. But what makes a great charge nurse? I’m sure we can think of stories that would influence how we might answer this question. It’s more than having strong clinical skills and checking the boxes of operational tasks; it’s how they do the work that can make them amazing leaders.
The key to becoming a great charge nurse is to develop interpersonal skills with a focus on self-awareness and control over one’s actions. The challenge is that these interpersonal skills are more difficult to learn than task-based skills, because your response to a situation is not one-size-fits-all. Many factors during an event influence your response.
In my years of experience in leading charge nurses, I’ve learned that it’s common for novice-to-experienced charge nurses to feel intimidated, overwhelmed or unsure of their skills or decision-making abilities. The literature supports this situation, saying that charge nurses often feel unprepared to handle the demands of the job. That’s a big problem, considering the importance of the role. The good news is that these soft skills of leadership and self-confidence can be developed through training and practice.
Education Increases Leadership Confidence
Nursing leaders at our organization recognized the opportunity to focus on the leadership development of our charge nurses. We held a charge nurse orientation class that provided a high-level overview of the role, but no other follow-up classes. There were also general organizational development classes, but they were rarely attended. These classes were not taught by nurses and not specific to the job role of the charge nurse, but they needed to be, which Delamater and Hall (2018) found to be meaningful when developing nurse leaders. Leadership development for charge nurses was nurse manager-dependent, leading to insufficient educational offerings and various degrees of charge nurse leadership skills. We decided to create an evidence-based leadership development program geared specifically to our charge nurses.
We held the first round of a series of leadership development classes in summer 2022. Attendees participated in four in-person, 90-minute classes. We debated if we should offer virtual class attendance, but the benefits of the relationships that can be formed in person outweighed the risks of low attendance. At the time, there was no charge nurse-specific competency recommendation, so class topics were selected based on previous publications about change nurse leadership development and our organization’s leadership competencies. Since then, the American Organization for Nursing Leadership has broadened their nurse leadership competencies to include all leaders. The class topics included diversity, equity and inclusion (DEI); leadership style; communication; and influencing others.
Participating charge nurses received an email after each class with optional learning resources pertaining to the class’s topic. We recognized that people have different preferences for how they like to learn, and generational differences can influence learning styles. The email had resources such as literature, videos, podcasts, blogs, journaling activities and websites. The options promoted inclusivity to meet these preferences. We also offered participants the opportunity to be paid for up to two hours per week during the weeks between classes, so they could dive into the extra learning if they wanted to. There was no penalty if they decided to not review the content.
Results of Our Journey
Our charge nurse participants described increased confidence in their leadership skills after taking the course. All of the charge nurses responded that they used something they learned in class in the months following the course. They loved learning from each other’s experiences and from a nurse leader who understood the challenges of their jobs. The charge nurses also liked the options provided in the emailed resources. Some charge nurses enjoyed listening to one of the podcasts while on a treadmill or going for a hike. Others read the literature during downtime on shift or at home in pajamas with a cup of coffee.
We offered the second Charge Nurse Leadership Development Series in fall 2023. The course topics are the same, and the optional educational information and other resources have been updated with publications from the past year.
Where You Can Start to Develop Your Charge Nurses
A structured leadership course is beneficial, but it is not the only way to learn. There are many resources and strategies to support your charge nurses’ leadership development:
- Schedule monthly 1:1 meetings with your charge nurses. Use the time to build your relationship, provide tailored leadership teaching, give and request honest feedback, and check in on goals. Use the time as a forum to discuss personal opportunities for the charge nurse and to request their ideas for how the work unit and team culture could improve. Engage them in finding solutions to the opportunities they identify.
- Support the growth of authentic leadership skills. One idea is to lead an exercise for your charge nurses to identify their leadership values. Confirm that they value honesty, integrity and equality, and ask for others. How do their personal values align with your organization’s values? How do they communicate their values to their team and show them in their actions? Help them embrace what makes them different and leverage their lived experiences.
- Identify their strengths and areas of opportunities. One way to assess this is to use the American Organization for Nursing Leadership’s Nurse Leader Core Competencies. Instruct your charge nurse to assess the strength of their skills associated with each competency, and you do the same as their supervisor. Where do your answers align, and where are the gaps? Prioritize your teaching on the lower-rated items.
- Build a culture with frequent feedback, and view negative feedback through a lens of opportunity. One way to standardize feedback is to teach your charge nurse to embrace a growth mindset, a philosophy that we can improve our skills through dedicated work, including seeking feedback. Provide honest and direct, formal and informal feedback to your charge nurses on a regular basis. Formal feedback can be given at your 1:1 sessions. If you don’t have feedback built into your standard session agenda, be sure to advise them prior to meeting that you intend to provide feedback. Informal feedback can involve sharing your observations while on your work unit. Be sure your setting is appropriate (and private), and tell them what you saw, stating the positive or negative effects of their actions.
- Build a structure for charge nurses to collect and provide feedback within the team. Teach them how to plan for a feedback session, including the appropriate physical setting for a feedback discussion, their body language and word choice. Use role play, and be sure to develop their skills in being able to check their emotions when receiving feedback.
- Ask your charge nurses to provide you with feedback. Don’t say, “I’m always open to your feedback.” Instead, formally build this into your 1:1 meetings and informally ask, “Is there anything you think I should have done differently” during regular duties (tough conversations with staff or patients, leading meetings, etc.). The more receptive you are when you are presented with feedback, the more you’ll receive it! Acknowledge that you understand it can be difficult to give feedback to your leadership, but you are always trying to do better by embracing a growth mindset.
- Check your body language and tone of voice. Listen carefully to what they are telling you. Don’t get hung up on a word or part of the message; instead try to see the bigger picture in what they are saying. It is OK to ask questions to gain a better understanding, but be sure to avoid being defensive.
- One way you could do this is by framing your question with, “Your feedback is important to me, and I want to make sure I understand so I know how to respond. Can you give me a little more information?” Thank them for the feedback. Be sure to interact with them as you usually would; avoid behaving in a way that could feel like retaliation. You are role modeling the “right” way to receive feedback.
- Treat yourself with grace and kindness. If you don’t agree with what they said, accept it as information and try to understand why they feel that way. If you handled the situation poorly, it’s never too late to own your behavior. Reach out to them and say something like, “I’ve been thinking a lot about what you said and how I reacted …” Be sure to follow up with them after you made changes in response to their feedback to see if your efforts helped.
- Structure ways to challenge your charge nurses, and encourage them to find ways to challenge themselves. One way is to set a goal to engage in a small improvement project once per quarter. Discuss the idea in team meetings or in 1:1 sessions. Support them in creating tangible plans.
- If charge nurses on the unit struggle with effective communication, ask them to start a communication journal. After each shift, they can reflect on an interaction and how their communication made the situation better or worse. What would they have done differently? Review the journal entries with them at your monthly 1:1 meetings.
- Coach charge nurses on the unit to fit learning into their lifestyle to encourage them to stick with it. Help them make a plan, and it’s OK to start small. Do they commute to work? They could try a leadership podcast such as an AACN Leadership Podcast or a Ted Podcast. Encourage them to share new learnings with the team.
- Help charge nurses on the unit find a leadership mentor. Ask what qualities or life experiences would be desirable in a mentor and facilitate an introduction. Ask the mentor to meet with your charge nurse and talk about how the mentor developed a helpful skill set.
- Model continual learning by creating a leadership book club or journal club with your team.
- Do you need more training before you can teach your team? Brush up your skills through continuing education, such as AACN’s Fundamental Skills for Nurse Managers.
Prioritize Leadership Development
If charge nurse leadership development is not a focus at your workplace, I strongly encourage you to advocate for it. Given that 800,000 nurses are planning to leave the profession in the coming years, we do not have time to ignore ineffective leadership. Nurse leaders contribute to healthy work environments and nurses’ professional quality of life. Probably the most important introduction to a leadership role is being a charge nurse. It is imperative that they start off right in their first leadership role. Most of us already know how difficult the role can be. Based on our experience in developing a charge nurse leadership development program, we can make it easier to transition to this role with the best support.
How will you support your charge nurses as they start their leadership journey?