Need advice/tips on being a good charge nurse

etaoinshrdluRN · Jan 12, 2011

You can be pleasant to CNAs without bending over backwards to be their friends. I would recommend maintaining a distance for a good long while, in fact. For me the problem was not disrespect (usually, anyhow, until I had had a chance to "prove myself") The problem was highly manipulative CNAs. I got a lot of he said/she said, lots of lobbying for getting to go home early, not have this or that assignment, etc. All of it couched in friendliness, just in case I was a soft touch.

The way to resist that is by being ever mindful of the "supervisor, not friend" model, and treating them all with firm respect. Good charge nurses seem to be able to fake the authoritative manner until they make it, when they're first hired.

I do think that a polite detachment from CNAs will be good for you. You need not be stern, and if you're destined to be friends with any of them, it'll follow, eventually. LTC CNAs (of which I was one, for 5 years) seem to be less professional in their behavior than hospital CNAs, and why give them any opening? Hopefully you're working at a facility where the work culture is good.

On nocs, you'll find that CNAs love a charge who answers lights, and I recommend doing this. However, don't read too much into the lavish praise you'll receive for doing this, and don't let your work suffer, either. Unfortunately, nocs attract a certain number of people who want to sit around and noodle on Facebook rather than do their chores, so you may need to get medieval on them, as well.

Hope I don't horrify you with this. The LTC place I worked was a nightmare of childish CNAs.

UpinawayRN · Jan 12, 2011

Not an answer...but to share my first experience on orientation day 5, I tried to tactfully resolve a conflict between CNAs and was told, "Why don't you get up and do it yourself!!" This while I was franctically trying to learn the paperwork of the place. I was stunned. Yeahh....that job didn't work out so much...I should have read some conflict resolution nursing references before starting..hadn't been in that position before and wasn't yet confident enough to tough it out. :eek:

Nursein215 · Jan 12, 2011

Good Morning,

I have dealt with this situation as a nursing student during my last clinical rotation. I am 23 yrs old but look way younger (from what i have been told) so alot of CNA's dont like to take orders from me. I got frustrated so i told myself that i wouldnt let it get to me because at the end of the day its your license and your job thats on the line. Be friendly but stern, because if you try to be their friend the respect goes out the window. Everybody should know their place. But every job is different. so good luck and stay true to yourself.

Revvy1337 · Jan 12, 2011

Be kind, courteous, and polite. Know it all people do exist but some cnas do know plenty about their residents which you won't for awhile. They are your eyes and ears. One thing that drives me crazy is staff acting like they don't hear alarms.

scherie88 · Jan 12, 2011

I am nervous since I have never been in a managment or supervisor position..but I am going to try my hardest...I just hate that feeling of not having confidence..I will keep a "polite detachment" which seemed like good advice..I have had only two jobs in the past 16yrs..cna then a nurse..both places I worked seem like there was always the cna's who were more difficult than others.

Revvy1337 · Jan 12, 2011

Cnas are more tough than bikers hehe.. I am a cna still.

handyrn · Jan 12, 2011

Just my opinion here. You said you were a CNA for 16 years? You know how invaluable CNAs are then. They are the direct caregivers at a nursing home. My technique has always been to give them the credit they deserve and it's always helped me to get respect. While working in a nursing home, I always help answer lights. Being new, I would always ask a CNA to help me with cares, telling them that they know the resident better than I and could they help me with whatever the resident needs? I praise, praise, praise for technique and being able to please the residents. When they see that I am happy with them and thanking them for taking good care of the resident and thanking them for helping me learn the resident, they are more willing to accept me and help me make sure that our shift runs well. This has worked for me. It's the "do unto others" mentality. You were a CNA, what nurses did you respect and why? Treat your CNAs like you would like to be treated as a CNA. There's my two cents.

JenniferSews · Jan 13, 2011

I pretty much agree with Handyrn.

I have found some simple tactics that work in my short time. First- ask directly. If a call light is going on and on and on while the CNA's are truly busy, I try to answer it myself. If I can't help the patient (like they are a 2 person assist and it's just me,) I find a CNA and ask for help. If that CNA is unwilling, I tell them to FIND the CNA responsible or do help me themselves. I have found that putting the responsibility on the cna to either help or find their coworker has really helped over time with accountability. If I run off to find the responsible CNA, everyone learns quickly that is the answer every time I need help. Otherwise they learn it's faster just to help me than make excuses. Instead of "I don't know" or "X is at lunch." I can then follow up with "who is covering, because this call light needs to be answered." It took an amazingly short amount of time before I never had to ask. Maybe we just have good CNA's but a little accountability and a lot of thank you and appreciation and working side by side when they were swamped went a loooooong way. Now that they know I am paying attention and willing to help when I can, there is a lot more team effort. I still thank my cna's daily for helping out someone that isn't technically their assignment. But I am not their friend, I am their boss. But I have been working at knowing each CNA's individual strengths and weaknesses to help with the learning process. I know a lot about them and their work, but not much way too much about their personal life.

I think for a lot of places it's just overcoming your fear of subordinates and delegation. At the end of the day, everyone should know what their job is, and can't complain too much when you request that they do their job.

backatit2 · Jan 13, 2011

Just my opinion here. You said you were a CNA for 16 years? You know how invaluable CNAs are then. They are the direct caregivers at a nursing home. My technique has always been to give them the credit they deserve and it's always helped me to get respect. While working in a nursing home, I always help answer lights. Being new, I would always ask a CNA to help me with cares, telling them that they know the resident better than I and could they help me with whatever the resident needs? I praise, praise, praise for technique and being able to please the residents. When they see that I am happy with them and thanking them for taking good care of the resident and thanking them for helping me learn the resident, they are more willing to accept me and help me make sure that our shift runs well. This has worked for me. It's the "do unto others" mentality. You were a CNA, what nurses did you respect and why? Treat your CNAs like you would like to be treated as a CNA. There's my two cents.

that's where the answer is.

carolmaccas66, BSN, RN · Jan 13, 2011

I work as Charge Nurse in some LTCs and most of the CNAs are really good. But you have to remember some have worked there for a long, long time and it's hard to supervise for me as an agency nurse, if I'm only doing one shift. I find some CNAs very hard in their attitude, slack in the fact that they don't actually THINK about what they are doing sometimes (VERY annoying!), then you have to talk to them, and they don't consider the legal ramifications of some of theirs and my actions as a RN.

It's best if you go in there and ask them to HELP YOU as you are the new kid on the block. Tell them, though ur supervising, you want to work with everyone. That should set the scene so to speak. And be prepared to help them with the hard graft of LTC work.

Learning to be authoritative takes time and comes better with age I think. You may find some CNAs are older than you and resent 'being told' what to do. I always say something like 'I understand you've been here a long time, but I am in charge of this shift and I need your help to care for everybody. If you want to go to university and get your RN license, go for it'. Then I repeat my request of what I want done. If they don't do what I ask, I talk to them, then report them. I've also had CNAs who were resentful having to do pad changes/rounds, and I could not help out because I had more important things to do like organising staff for the morning or rosters. CNAs don't really distinguish the role difference unfortunately, so sometimes it's hard trying to explain this all to them.

You need to look at your time management as well. I mean if ur busy doing meds and a ton of other duties, you cannot possibly manage, say 65 residents on your own. You have to delegate duties, and if people don't like that well tough. The work has to get done.

But if you work with them and ask them to do things, please if that's OK, that usually works.

Let us know how you get on.

backatit2 · Jan 14, 2011

I work as Charge Nurse in some LTCs and most of the CNAs are really good. But you have to remember some have worked there for a long, long time and it's hard to supervise for me as an agency nurse, if I'm only doing one shift. I find some CNAs very hard in their attitude, slack in the fact that they don't actually THINK about what they are doing sometimes (VERY annoying!), then you have to talk to them, and they don't consider the legal ramifications of some of theirs and my actions as a RN.
It's best if you go in there and ask them to HELP YOU as you are the new kid on the block. Tell them, though ur supervising, you want to work with everyone. That should set the scene so to speak. And be prepared to help them with the hard graft of LTC work.
Learning to be authoritative takes time and comes better with age I think. You may find some CNAs are older than you and resent 'being told' what to do. I always say something like 'I understand you've been here a long time, but I am in charge of this shift and I need your help to care for everybody. If you want to go to university and get your RN license, go for it'. Then I repeat my request of what I want done. If they don't do what I ask, I talk to them, then report them. I've also had CNAs who were resentful having to do pad changes/rounds, and I could not help out because I had more important things to do like organising staff for the morning or rosters. CNAs don't really distinguish the role difference unfortunately, so sometimes it's hard trying to explain this all to them.
You need to look at your time management as well. I mean if ur busy doing meds and a ton of other duties, you cannot possibly manage, say 65 residents on your own. You have to delegate duties, and if people don't like that well tough. The work has to get done.
But if you work with them and ask them to do things, please if that's OK, that usually works.
Let us know how you get on.

if it gets to the point where you have to say that, you've done something wrong! making a snide remark like that is a good way to find yourself ALONE with 65 residents "you cannot possibly manage" real fast!