Ready to be in charge?

[GadgetRN71, ASN, RN]

I accepted a job at a level one trauma center OR-I'm on a closed team. We do our own sceduling and call and I will be the charge nurse on my shift which is 3-11pm. I've been a nurse almost a year and a half but am new to the whole trauma thing. Any advice from the more experienced nurses on the whole leadership issue? I have one of those baby faces and am easygoing-I'm aware that to some docs, this could be seen as weakness. I really like this job so I don't want it to blow up in my face. I'm tougher than I seem but I don't want to get in over my head. I'm supposed to have a couple of weeks working with a more experienced nurse but if it isn't enough, would I be seen as weak if I asked for a couple more? Thanks.

[mikethern]

If this is the first time you will be working in this hospital, the advantage is that nurses will respect your authority more than if they already knew you. The disadvantage is that you don't have circulating experience in this particular operating room, so you won't know their specific routines.

If you HAVE worked there before, you will probably lose some friends because nurses don't like to take orders from someone who used to be their peer.

Overall, being charge nurse can be a lonely job because a lot of people won't like you. Also, it's tough when people try to take advantage of you by leaving work early without you knowing and other stuff like that.

I was a charge nurse for a couple years. I will never do it again.

On the bright side, you probably won't do patient care anymore, so you don't have to worry about getting injured or catching a disease.

Here are some tips. Always take care of your staff. Always make sure they get their breaks. Always make sure they get relieved on time. Nothing sucks more than being ready to go home after a rough day but no one relieves you. That's a sure way to become hated as a charge nurse.

Also, since you are in a trauma center, ALWAYS make sure you have a circulator and scrub person doing nothing in case a trauma comes rolling into the O.R. unannounced. If this happens, and all your staff is busy with elective cases, you are SCREWED. More than a few times, I have seen resident surgeons bring in a dying patient without notice and expect the O.R. to be ready for them.

Don't let your staff take advantage of you, but don't disrespect them either. Remember that there is a nursing shortage, so your goal is to make your nurses WANT to work at your hospital. Try to make them happy. Nothing is more stupid than a charge nurse being an asshole to his or her staff. It's basically begging for your staff to quit.

Now's here an idea that I made up. Create a questionaire to be filled out by all of your staff. Ask them to rate their competency is each service from a scale from 1 to 10. For example, vascular? 8. ortho? 4. urology? 7. etc. It's very useful to know what cases each staff member can do. Then, on a slow shift, you can have staff who are not busy double scrub or double circulate on a case they do not know how to do. Your goal should to have all staff trained to do any case.

Also, on the questionnaire, ask staff what they do not like about this operating room. If it is a reasonable complaint, try to fix it to make them happy.

[GadgetRN71, ASN, RN]

Thanks Mike, I will be doing patient care though! It will be myself and a tech after about 6-7 pm(8pm when we have a 12 hour person) so anything that comes rolling through those doors I will be circulating. Thankfully, it's just one specialty because we're a closed team. I think I will be asking for another few weeks of orientation, though. Just learning the quirks and personalities of people and balancing what cases can go when...

[mikethern]

we're a closed team.

What is a closed team?

[GadgetRN71, ASN, RN]

At my hospital, 2 services (open heart and ortho) are considered closed teams. Namely, that people that are on these teams just work in their respective specialties. You take call for your own specialty and the scheduling is specific to your specialty as well.

[mikethern]

Being in charge and circulating at the same time sucks. What happens if you are doing a case and an emergency rolls in before you have time to call the call team?

[TracyB,RN, RN]

Easy... no call team, no other surgery until the back-up arrives. Most cases aren't that flippin emergent that it can't wait 30 minutes...

One more reason why all your duties should be completed as much as possible at the start of the shift.

[mikethern]

Easy... no call team, no other surgery until the back-up arrives. Most cases aren't that flippin emergent that it can't wait 30 minutes...

I guess you haven't worked in a level one trauma center. CABG bring-backs don't wait for the operating room to be ready. Neither do some other types of cases.

[GadgetRN71, ASN, RN]

Luckily, I do orthopedics, no CABGs for me!

[ewattsjt]

Hope everything works out for you, WitchyRN! Keep us updated.