Charge nurse needing suggestions!

Gooselady, BSN, RN · Jan 10, 2015

The difficulties you mention are 'older' than your position, and sound entrenched, like it's been OK to whine and protest your assignment for quite a while. The 'culture' you entered into is already sick. I've been charge and supervisor, and my first job as a charge was similar to this. The staff were all older than me, and much more experienced, knew each other outside work. The last thing their pride would allow them to do is take orders from a nurse their own kids' age. They'd been skating by for years and naturally didn't want any interference.

I quit.

Later on I was charge and in one job a supervisor many more times with positive experiences. I look back on that first job and wonder what exactly was different between then and the more positive experiences? I had matured of course. And, that first staff was impossible to work with. I didn't have the administrative authority or back up to make any changes whatsoever. My hands were tied. Nurses have more responsibility than authority and this gets us into binds like you are in.

Somehow it became 'acceptable' for a grown nurse to demand you answer questions like 'how come I got the first admit?' The questions and complaints you list are beyond ridiculous for them to be making. Beyond unprofessional and immature. And somehow, this has been "OK" thanks to previous management.

I'm pretty appalled and would LIKE to suggest you take your smart, mature and capable self somewhere else. If you want to stay and work with it, get some help -- an EAP, a sympathetic manager who isn't too codependent or afraid of conflict. You'll need all the support you can get. I don't think it's impossible at all, just a lot of work. A lot MORE work than you think or would even want to put into it.

It's not just HOW to answer such bullcrap questions in such a way that the nurse will smile and say Oh, OK .

When I was in charge, I would ASK nurses if they were available to take patients. Even though I knew they were available and really, had no choice. I could trust my nurses that they KNEW that, and by ASKING them, I was extending my respect to them and their workload, rather than dropping a new admission from on high. The nurses I worked with did not need kindergardner refresher courses on how nursing works and what nurses are in a most basic way, called to do.

It is NOT your fault that they are behaving this way, nothing you do causes this, not even you being hired instead of one of them (gee, I wonder why?).

If you can get a person to see you as just another person, no different than they are, they'll relax their defensiveness. And vice versa -- communicate your friendliness and interest in them as individuals. When you give out assignments or tasks, include yourself as one of the 'doers' and make it a point to reiterate how 'we all work together to get the job done'. This might soften up a couple of them.

Maybe someone else has more hope than I do? I'm actually quite the optimist!

No doubt your current managers want you to stay. Enlist their support, get some of the unit history, and request what you NEED from them. Once the staff realize management 'has your back', the atmosphere will improve. In a way, adults get to acting like little kids, pushing and pushing the limits until someone stops them. It will be a lot of work, and it will take it's toll emotionally too, so be sure you are getting your own support and validation. This kind of environment can wear you out and mess with your head . Good luck, I hope something in here made a brainwave for you :)

ICURN3020 · Jan 10, 2015

I have never been in a full time charge position, although I have worked as a charge nurse in my unit on occasion. I have also witnessed what can happen when there is no long-term management. My unit has experienced a revolving door when it comes to leadership and I've seen how it leads to feelings of unease and uncertainty for staff. They sense when their concerns are brushed off by a manager who has one foot out the door and therefore has no real interest in the future of the place. They don't feel supported, they're trying to constantly adjust to changes and the unit tends to lose it's sense of cohesiveness.

You're in a tough spot but I think that with consistency and time, the staff nurses will begin to feel more supported and trusting and that will hopefully spurn them into being a team player.

In the meantime, I would be firm, fair and consistent. I think you will earn their respect by doing so and when they see that you aren't going anywhere and are invested in them and the unit, they'll be more likely to do whatever they can to help out and make the unit the best it can be.

This is just my perspective; it may not be what's going on with your unit.

Good luck!

JustKeepSmiling, ADN, BSN, RN · Jan 10, 2015

Thanks for the responses, though I was interested in hearing how others would handle these questions & remarks.

They stun me sometimes with how rude they are to me. It's a hospital, we get admits, discharges and transfers.

The ones I get the most difficulty from are the older nurses who likely didn't get promoted due to their constant negativity.

The real sucky part in dealing with them is they try to spoil our new hires with their ways. The new hires start off gleaming, especially the new grads excited for their first job, then they see this "culture" and eventually fall prey and begin asking the same questions and complaining how hard the unit is to work on.

We are typically 5:1 or 6:1 with CNAs and we have transporters. There's nothing unusually different on our floor than the rest of the hospital (knowledge from being pulled) and other hospitals I've worked at.

If some of them start with 5 and d/c 1 plus 1 admit they lose it complaining how hard their job is and they want to leave. Then if they don't get around to their admit, night shift loses their mind too.

In prior CN roles, I did immediately after report ask the nurses what were their biggest challenges and what can I do to start the day off right. Usually they just needed someone to give a pain med or help with accuchecks and appreciated this.

When I tried that here, I signed up for instant failure. I had to stop doing this because the nurses were abusing my help and it never helped them anyway. I could do everything they ask and they are still not happy with me or the shift.

I know I'm only 1 person and I alone cannot fix the unit, and the new supervisor is doing great so far.

But when I'm working my shifts I need some pointers for how to stop these nurses in their tracks when they get started questioning and complaining. Its unhealthy for morale. I can't go to the manager every single time someone groans. Something has got to change or I am out of there.

Any further suggestions? Things you've said that worked?

RNJill · Jan 10, 2015

Taking it from a different angle...would it help things to simply have a policy that you take admits based on who comes/is assigned to the rooms that they have? In our hospital and with our system the charge nurse can prioritize which rooms they want patients to be assigned to (ie, they will probably try to steer the early admits toward the rooms of a nurse who hasn't has multiple discharges/admits). But ultimately people know that they will just get admits if their patients are discharged or transfered. There is not the element of "who has time."

There are clearly a lot of other issues going on...and this is not magic bullet..your teamwork and assistance especially toward nurses who get slammed on certain days will be apparent and necessary. But maybe if it was simply policy and procedure you'd hear a little less whining.

Good luck!

tyvin, BSN, RN · Jan 10, 2015

What I tell them, if they ask why they get the first admit or why am I posted here, etc... I tell them it was my decision. I may offer a couple of sentences but not usually because if you do; get ready to babysit. They are welcome to come to me after work and discuss it but 9 times out of 10 they didn't want a particular patient. I always rotate everything except at this one place where they were all tight; they kept in their sections and life was great (very rare).

You can't be their close friend and you can't please everyone. Set ground rules and don't waiver except in emergencies. It's lonely at the top. Be nice, be fair, and you'll win their respect. You must set the example for professional behavior and have mini meetings weekly where they can vent. Jump in and help when you aren't that busy or you notice someone is drowning...that means the nurses and the CNAs :)

As far as the war between noc, days, eve; hey, when you find the answer, let us all know!

jadelpn, LPN, EMT-B · Jan 10, 2015

If prior to the shift you actually schedule what nurse has 1st admit, who has 2nd and so on, then they will know going in what the plan is for the day.

If you do not have an assignment, rather, act as a support, then I would make myself available to help and be clear about it in report "I can do finger sticks" (your CNA's can not?)

Finally, if part of your role is to be in contact with the MD's, and in some facilities it is part of a charge nurse role, and individual nurses do not call MD's, then I would want the "list" as they are checking in with you every couple of hours.

Which leads to--the nurses SHOULD be checking in with you every couple hours so that you know what is going on in the unit, bypass anything that could become and issue, and offer support when needed.

Some days, depending on acuity, 5 or 6 patients seems like 105 or 106 patients--it is those days that are difficult at best.

I have no clue how large your unit is, however, maybe you have an admissions and a discharge nurse who strictly do both for the shift, and lend support otherwise. It could rotate. The admissions nurse calls the MD for any orders on the unit. The discharge nurse assists with meds if needed. When the new admit comes to the unit, the admissions nurse does the initial assessment, hangs fluids, medicates and does the admissions paperwork, then hands off to the nurse "getting the first admit".

I would also assign the CNA's accordingly. They should be assigned the total care patients evenly, the nurse should be aware of the CNA that is assigned to their patient, and plan the day (if you could get vitals and set up the patients, that would be great!) The CNA's should be touching base with the primary nurse every couple of hours as well.

If there is communication that is occurring regularly between everyone on the unit, it can make for a smoother shift. Issues or potential issues are nipped in the bud and dealt with quickly and efficiently.

There is more than one "older" nurse who DOES in fact spend the shift complaining. Doesn't matter the motivation, if they are envious, or just plain cranky. Whatever. I would be direct. "I am not sure how I can divide the patients any fairer than I have. This is the assignment" If it gets to be over the top, then it is up to your manager to address it. It would be interesting to see what THEY would do--and suggestions that THEY have on assignments. You may want to also do that "Nurse Cranky-Pants, I am going to have you make the assignment today"... or even have each nurse decide which patients they are going to take "pick 5, and gooooo". Above all else, humor helps "ok ladies and gents, stop bickering as you are scaring the new nurses. And I swear I will turn this car around....."

Good luck and best wishes going forward!

LadyFree28, BSN, LPN, RN · Jan 10, 2015

Have a sort of a "shift huddle" to set the tone; make assignments of who gets the admissions and leave it at that; promote teamwork, and above all, make sure that the pts needs are getting met.

As a charge nurse, at least in my experience, it is up to me to ensure everything is running smoothly and if a potential issue arises, I'm able to troubleshoot it, as well as cover breaks and make sure that the pts are continuing to receive the care that they need.

vintagemother, BSN, CNA, LVN, RN · Jan 12, 2015

I dunno... I have a new charge who has come in after less than 2 weeks observing, wanting to change things, ie because some nurses aren't doing their written job duties, is now changing everyone's job descriptions. She has never worked in this specialty before.

It's hard for me because I see the problems that will ensue after her changes, but after some introspection, I can see that she is the "charge" and my job is to be flexible. It's hard. I've cried, multiple times.

But, I have to respect her desired goals.

I wonder (I hope) your nurses aren't feeling like I am.

JustKeepSmiling, ADN, BSN, RN · Jan 12, 2015

Charge nurses on my unit do not have management abilities to write people up/have meetings. Its very much so a middle mans job.

I just need to get my shifts under control. At this point I'm ready to leave because after my last few shifts and desparately trying to get a positive vibe going on the unit nothing improves.

The younger nurses come to me for advice then an older nurse chimes in and undermines me.

For example, holding a BB on a pt w/ HR 58. I walked her through the pharm, we looked at the echo & pt had LV dysfunction, has been running sinus brady for days, asymptomatic, no parameter to hold. Then older one says "you should never give under 60." Fine page the MD. MD said give.

Nurse gets admit for pt who missed dialysis, going for urgent tx in approx 1 hr, BP 170/90. Pt asymptomatic sitting up in chair asking for tray. Also told nurse I've known this pt for years and runs high & has med compliance issues. Nurse still freaks out and pages MD, nurse ****** MD didn't order anything for BP, proceed with dialysis as ordered.

Nurse comes to me and tells me pt complaining she can't have her norco. I asked why? She said well the dilaudid is ordered q4 and so is the norco but I already gave her the dilaudid 2 hours ago. Dilaudid ordered severe, norco moderate pain. Nurse refused to give, said only 1 or the other every 4 hours. I had to go calm the pt down and give the norco. The MD was stunned the nurse did that. Pt had metastatic disease.

Nurse starts with 5, discharges 1 early in shift. Around 1400 I give her an ER admit. Tells me "I'm not taking anymore today, this is ridiculous."

CNAs are equally assigned. I ask CNA to go assist pt to bathroom. CNAs both in same room, say they are busy. (Recurrent problem with them ignoring their assignment) nurse said will toilet pt. I go in room to see why both needed and 1 was literally just standing there while the other one supervised the patient on the commode. Pt is a minimal assist.

Nurse tells me pt pulled his port needle out and she can't reaccess it. Won't give blood return. I went to do it and on first stick got good return. Overheard nurse telling another nurse she just didn't feel like doing it.

CNA comes to me and said "I'm sick of the nurses bossing me around, she asked me to get a pt ice, why can't her lazy self do it?" I calmly explained her pt down the hall was having issues and she needed to attend to that. (True, nurse was new trying to please everyone) I asked the CNA to please pass ice as I've also made several passes myself. She tells me "no, I'm sick of passing ice in the morning because night shift is supposed to do it." When she very well knew night shift ran without a CNA that night.

Nephro walks up to me and asks why is his pt on IVF, can't see who ordered it. I look, no order for IVF. I go in room bag of NS running at 30. Ask nurse who ordered it, she said no one. She had "a lot of piggybacks, its no different than flushing." -- that one didn't make doctor or manager very happy. Nurse never comprehended the issue and still complains about it.

These are just examples... I mean theres so many things that go on and details changed to protect patient privacy.

All the leadership tactics and things that have worked so well in the past are failing me. It's like a you can lead the horse to water but can't make them drink it situation. I was just hoping for some seasoned charges to have some tricks for how to turn those situations around. Hopefully with some more time, the changes management is making will help and these negative nancies will either get with the program or move on.

Gooselady, BSN, RN · Jan 12, 2015

I understand you are looking for a fix, to turn this around. I just don't believe, by experience, that it's possible for YOU to, without a lot of management support, 'fix' this. You are coping with some dreadful attitudes, lying, they are LYING to you! and laughing about it in your earshot!

I had a couple of nurses who would accept an admit and say loudly "That's the LAST ONE! I'm not taking another admit!"

Which I ignored because it was rare for one nurse to even GET more than one admit on an 8 hour shift for gosh sakes.

Are you willing to play hard ball? Begin writing them up -- ie, factual objective written statements describing the behavior. "CNA declined my direction to assist a pt to toilet. CNA was located standing in another pts room with another CNA assisting a min asst pt on the commode." "After fixing and obtaining blood flashback on Mediport, I heard pts nurse say "I just didn't feel like doing it". "Renal doc found IV NS @ 30cc running on a patient without an order for IVF. Primary nurse ______ admits there was no order." "CNA ____ stated "I'm sick of passing ice, that's night shift's job".

Just start writing it down and present it to your manager. If you have no authority to even write someone up how in the HELL can they expect you (much less you expecting yourself!) to manage this group of brats?

Seasoned charge nurses would walk right off of this job -- you can't change another person's attitude, it's Psychology 101, it is impossible. You didn't cause it, so ya can't cure it either. As a charge nurse it is FAR beyond your scope and abilities to provide basic behavior management skills. Your job is to help the staff nurses to give the best care to their patients, NOT to parent the staff. That would be management's job, if it's anyone's. I feel for you, your frustration is WELL understood and heard here :) I sense you are asking the impossible of yourself if you hope to 'fix' this mess by using certain words or conducting yourself differently. You sound like an EXCELLENT charge nurse, by the way. I really mean that.

JustKeepSmiling, ADN, BSN, RN · Jan 13, 2015

This is my 3rd nursing job and I really wanted to stick it out and longevity looks good on a resume, especially as a charge nurse on a med/surg floor. Most nurses know that's no cake walk.

I also have a huge nurse conscious and feel like I'd be doing a disservice to the new nurses that are sort of "under my wing" if I leave.

This hospital pays well too. It can't stay toxic forever. I know some of you say this is crazy and leave, but some of the toxic people are leaving/have left and now there's a new manager.

So I have started creating boundaries and clearly stating yes or no and limitedly explaining why. If I'm doing a CN job duty and interrupted by a nurse for something that they can clearly plain as day handle but are just trying to pawn something off on me, I inform them what I'm doing and occasionally have said, sure if you can help me finish this later? And they usually say no that's your job, so I continue on with my business.

I don't want to be ran off by these bully nurses that have gotten their way for so long. I guess I can try the write it down thing, even let them see me doing it and see if that makes them think twice about saying a sarcastic unneccessary remark.

Continue to make suggestions please! I KNOW I'm not the only charge nurse that's dealt with nurse negative nancy!