Editor's note: This is Part 2 in a three part series discussing the importance of charge nurses' knowledge and understanding of their leadership role in their organization.
By Lisette M. Cintron, RN, MSN, CHCQM, CNL, clinical nurse educator
The Middle: Icebreakers
The workshop should open with an icebreaker activity called "Fear in the Bucket." This activity entails reading the following statement: "As a charge nurse I am most afraid of…"
Each charge nurse must finish the sentence by writing on a piece of paper and placing their statements into a bucket located at the center of the table.
After all charge nurses have submitted their entries, the buckets get switched with the other tables. The charge nurses then read each other's statements and discuss the reality of what fears are being experienced by their peers.
The goal of the icebreaker is to have everyone be aware of the fact that they are not alone.
By the end of the workshop, many of their fears—if not all—will either be resolved or lessened to where they can feel more at ease in their role and with the decisions they have to make on any given day.
Along with being an icebreaker, this activity brings about a lot of dialogue and at times laughter amongst the participants.
Once the icebreaker is complete, the discussion on the role of charge nurses ensues. The question then asked is what do you believe to be important attributes or traits a charge nurse should have. The answers that follow should fall in conjunction with what is in the literature.
According to the literature, charge nurses should be:
Charge nurses must also have:
- A positive attitude
- The need to control
- An image
- The ability to learn from mistakes -Humor (Connelly, 2003)
The workshop's leaders discuss and define each characteristic by giving examples to help the participants better understand each attribute and trait they should hold themselves.
From there, the discussion should flow into asking nurses how they feel as a charge nurse. Do they feel overwhelmed or that they should be a psychic, and know what is going to happen before it does.
The charge nurses should know that although these are some examples of how they can feel, the expectations are not the same.
Charge nurses need to understand that they are human and the expectation is to ensure the flow of the daily unit operations is in conjunction with meeting the organization's objectives, while ensuring the quality of care is being rendered in a cost effective manner.
It is important to make sure the charge nurses are aware that their role encompasses being the:
- Coordinator of nursing services
- Evaluator of staff performance
- Resource to the staff, patients, visitors, and physicians
- Role model
- Supporter to staff so that the expectations set will be met with guidance and direction
- Clinical expert
- Key role in ensuring the deliverance of excellent quality care
It is also important for charge nurses to understand their actions set the pace and what they set as an example will soon become the rule.
Another role a charge nurse can take on is being a leader. This is a big part of their role because they need to exhibit communication and problem-solving skills while instigating change by encouraging, motivating, and inspiring at the point of care.
As Connelly, et al, 2003, postulates as a leader you need to be visible, identifiable, accessible, approachable, and authoritative to not only your staff but your customers as well.
The charge nurse is the conduit for information provided from management to staff and from staff to management (Nurses First, 2003.)
An important area to stress throughout the workshop is charge nurses not only need to be aware and understand what their RAA is, but that they know the differences between each.
The charge nurses should comment on what they think the difference between RAA and the information given to them from the literature search.
Having the charge nurses comprehend and put the words to action will assist them in better understanding their role. Miller and Manthey, 1994, define responsibility as taking ownership (Creative Healthcare Management, 2003). It is the obligation to answer for one's actions; ensuring a task is accomplished; it is about getting the job done.
According to Miller and Manthey, 1994, (Creative Healthcare Management, 2003), accountability is about reflecting on actions and decisions, evaluating the effectiveness and then directing future efforts. According to Hardy, 2008, it is 'not just about getting the job done, but how it gets done.'
Authority, as defined by Miller and Manthey, 1994, (Creative Healthcare Management, 2003), is about the right to act in areas where one is given and accepts responsibility. While Hardy, 2008, postulates it is the power that is vested in an individual or organization to accomplish a given task or responsibility.
After going over the difference and asking for examples from each charge nurse, have them divide into groups of four to five, giving them a form to work on. For about 15 minutes, the charge nurses will meet and add additional information they gained from hearing other presentation topics.
The forms distributed cover areas on the management of patient flow, quality/risk, delegation, etc., and each has specific duties associated i.e. prioritization of flow, discharge planning, clinical outcomes, core measures, etc.
It is important for charge nurses to know the purpose of completing the forms so they will comment on what they think their RAA should be in each area.
At the conclusion of the workshop, the information gathered from these forms will be taken back to leadership so that they can have their RAA decided on and available to them in a tangible format. This will be a resource for them to look back on when they are unsure of what their RAA is in a given situation.
The charge nurses are thrilled to know that their input will be utilized by the leadership team in deciding what their RAA as a charge nurse will be.
The workshop continues delving deeper into the responsibility of a charge nurse. Some of these responsibilities include:
- Ensuring safe and effective clinical practices are occurring
- Enhancing the patient's experience by performing patient rounds and building relationships
- Managing the people and patient flow
- Contributing to the delivery of the organization's objectives
- Acting as a change agent by being the catalyst for change using evidence-based, thereby, leading development and ensuring clinically effective practice
- Being a role model to staff members by creating an atmosphere that empowers them to contribute to the delivery of high quality care.
When speaking on the topic of accountability, remember to discuss in detail what will be expected of each charge nurse when it comes to accountability. Remind them that as charge nurses they will be accountable for/to:
- All customers, eg: staff, patients, families, visitors, physicians, as well as the organization
- Communicating deviations in safe and effective practice
- Supporting and demonstrating the organization's missions and values
- Being the change agent
- Setting the expectations
Most importantly, the charge nurse will be accountable for being the role model by practicing what they preach.
Authority is the last topic discussed because it is a difficult topic. Authority generally creates many questions and concerns, and requires additional time for dialogue.
There is very little literature on the topic of a charge nurse's authority is because it varies given the organization's objectives, policies, and procedures. However, what a charge nurse has the authority to ensure is a common theme among organizations.
Charge nurses have the authority to ensure:
- Assignments are completed and covered based on a patient's needs
- A schedule is completed and any gaps are dealt with
- Tasks are delegated effectively and the care is supervised
- Decision-making in the areas where they are both responsible and accountable for, eg: guidance to those with less experience, requesting additional staff when census rises
- Staff accountability, especially if patient safety or the performance of patient care duties is compromised, adherence to regulatory or organization requirements are not being followed.
Once RAA is covered, charge nurses are more at ease knowing there is something more concrete for them to utilize in their every day role as a charge nurse.
Click here to read Part 1 of the series.