New to LTC- new charge nurse, advise please, how can I be a good charge nurse?

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Hi all,

I have never posted on a site like this but I need some help from some nurses that are familiar with this kind of nursing and can help me understand how to be a good charge nurse.

A little about me, I am from the Emergency Department, I have always worked in critical care and although I do love it, the schedule wasn't fitting into the rest of my life. I got this awesome job working for the nursing facility, and at first it was just an RN position and then they offered me the charge nurse position on the evening shift, which means I am all by myself with one other RN (most of the time, I'm told), to run the facility. The challenge was very exciting to me, I am always drawn to that. But now I am getting a little nervous and kinda down wondering how I am going to do this?

I really need to know what makes a good charge nurse? I have been in "charge" before but on a much smaller scale, this is a very large facility 250+ beds.

As one can imagine I am having a lot of anxiety, I want to do right by the patients the facility , and the staff. I have been there for a week, havent even started the charge training (had core training and whatnot of course) and already I am feeling the challenge, trying to be likable, but taken seriously, its hard, and I'm the youngest RN there, which makes it a bit harder.

Any advise would be greatly appreciated.

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250 LTC beds with two nurses?? That is a lot.

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Two RN's there are still many LPNs on staff on the off shifts.

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I work in LTC with a rehab unit, Assit living and elderly rentals. Their goal is to be 1/2 RN & 1/2 Lpn . The RNs quit when they get enough experience for the hospitals. They frown on LPNs working in Rehab, but will allow one to fill in for an absent RN. My advice to you, treat everyone with respect. The co I work for lost nurses that had been the 6 to 9 years bc of the policy change. If you are the Charge Nurse, act like one. Don't push ur responsibility onto other nurses. Stand up for the nurses under you.

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Wow, your situation is similar to one of our RN supervisors at our facility, except we only have one RN super on the second shift at a time. She was an ER RN for years and now works the 12 hour shifts on the weekends and fills in the one day off during the week for our full time RN super. Ironically our full time super is VERY young. She is 22 or 23ish (sorry can't remember exactly) Both have still "made it work" for the most part in spite of their backgrounds.

Age of a supervisor quickly become irrelevant when their actions speak louder than their numeric age. Given you already worked as an ER RN probably already puts you in an easier position than she started off in.

It will be a challenge for you to transition from ER nurse to LTC nurse so you will need to be patient with yourself and not burn any bridges you absolutely do not have to. Sometimes us LPN's have to help this particular RN super remember what environment we are in because the "rules" are different. You are likely "hardwired" from your previous job to just automatically do certain things that will now get you in a lot of trouble if you do them "on the fly" in a nursing home. Like making sure you know what the persons code status is BEFORE you start CPR. Getting a Dr order BEFORE you start an IV line etc.

Indeed I must agree that it is wise to treat others the way you want to be treated. Show them respect and be willing to hear them out before you make decisions and it will serve you well. ANY nurse that thinks they can "fly solo" and has not need to confer with other nurses or try to work as a team with the other nurse's in a nursing home/rehab setting is just asking for trouble. Including the RN supers. It makes no difference what letters are behind your name when crap is hitting the fan in this type environment. If you cannot work as a team everyone is going to suffer. If you cannot learn to respect each other and pool your experiences and knowledge, again everyone is going to suffer.

It is highly likely that the facility you are in is no different than any other LTC/ rehab unit. Good chance the patient ratios are to high. LPN's are already scrambling to just try to keep up with all the issues on their own floor, get all their meds out on time, get all the treatments done for the day do all the charting on all of these issues keep all their dementia patients safe, deal with their own aids etc.

Be willing to jump in and help crank out the mountain of paperwork when an issue comes up and someone has to be sent out or an admission comes in or incidents happen etc.Be willing to jump in and start taking off orders when the fax machine goes nuts. Do not take the stance "that is their job". Don't make them feel like you cannot be called on for help. You will certainly not be earning any respect that way and ultimately you are the one in trouble when your LPN's fail. You are going to be sitting in the DON's office right along with them if they are not getting done on time and costing the company money in overtime or if they miss a piece of paperwork because they were overwhelmed etc. Team work always teamwork in this environment.

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I am an RN who has been in LTC for many years. I started as a CNA at the age of 16. Being a good supervisor can be a challenge. The key is gaining respect of those that u are supervising. Never expect them to do something u wont do yourself is my motto. Be firm from day one. You arent there to make friends and let them know that. You dont have to be a "b--tch" but make sure they know your in charge. U will learn to have a sixth sense when someones not doing what they should be. Correct people though educate them why. CNAs have very little formal education and are trained to do tasks. Teach them why we reposition and toilet people. Most do care about their residents but dont understand the whole picture. I always say people want to do a good job though lack the knowledge to do that. Show them wounds caused by lack of hygiene, nutriton and positioning and explain how fragile elderly skin is and why. I rarely resort to a write up unless I have given this education and it keeps occuring out of lack of care and laziness. Get to know the residents and the little cues they give before they end up in a full blown crisis. Gain respect by helping when they are looking frazzled and overwhelmed. A good leader cares about people they are leading. Sometimes listening to them in private for a few short minutes about something that isnt too good in their home life helps them put their troubles aside to provide excellent care to the residents. Be their work family though set boundaries of what they tolerate. Yes u are going to be very busy yourself but managing time to know whats going on with the staff and residents allows u to approach each one in a respectable fashion. Good communication with them and your supervisors is essential. Let them know immediately what they expect and adhere to that. Been an RN in LTC many years and wouldnt trade it for anything

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