Transitioning into Charge Role

[dontbetachy90, BSN, RN]

Hello, all! I am looking to hear some of your real life accounts regarding either your own transition to a charge nurse/clinical leader position, or your experiences WITH your charge nurses/clinical leaders. What have been your biggest struggles, how did you recruit resources to work through them, and what have you found helped you shape your role as a leader the most? What are you still working on? For others, what makes a great charge nurse, what makes a not-so-great charge nurse, and overall what are your expectations for your charge nurse?

I recently accepted a position as clinical leader on my 24 bed cardiac step down/progressive care unit, and I am struggling in my transition more than I'd anticipated.

We are very "green" on my unit; I have 3 years' experience, the most experienced RN (10 years) has been on medical leave and is weeks from returning, the second most experienced RN (10 years) is a great nurse but not the strongest team player/mentor/leader. Other than that, we have a nurse that has been there a year and a half, and the rest are between fresh-few-weeks off orientation and 6 months experience, tops. They are, for the most part, easy to work with and have so much potential, but they are still new, and our patients are relatively high-acuity. We run a tight ship and as we've lost a lot of seasoned nurses and gained a lot of new hires, we are starting to struggle as a unit and more mistakes are being made, things being missed, etc.

There are nights when I am scheduled with 3 brand, BRAND new nurses, 2 floats that are not familiar with the unit, and 1 other nurse (sometimes they rock, sometimes they don't, nature of the beast!) I also may add that like most places, we are struggling with fully staffing our clerk and CNA positions. I often absorb the unit clerk role on my shift as charge, making it difficult to complete my own tasks, let alone lead my team, ensure all patient's are safe and well cared for and that things are getting addressed, round with patients, perform mandatory audits... you know the rest.

With the team being so fresh I understand they have many questions and needs and normally I am more than willing to, even EXCITED to teach, orient, and hold the hands of our newbies, but I am feeling very overwhelmed 75% of the time in my role, and sometimes I feel I'm coming down with "impostor syndrome." I am struggling to find balance between assisting staff when it's needed and simply babysitting staff; I want to foster independence in my team, encourage them to utilize other resources rather than come to me for every hangnail and hiccough. Also, I want to be as effective as possible in my role, rather than letting my headaches show as I fear I sometimes may.

Any thoughts, advice, real life accounts would be so, so appreciated!

[Been there,done that, ASN, RN]

I have been, there done that. I would never have taken on the additional role of unit clerk.

It is NOT your role to" teach, orient, and hold the hands of our newbies". Review your job description. You are there to assure the smooth functioning of the unit. It sounds like a tough one.

[nursej22, MSN, RN]

I would speak to your manager about your concerns and list out your absolutely must do tasks, should get done soon tasks, and fluff. If he/she expects you to be the unit clerk, then something else needs to go away. Ask him or her to order food for the unit on especially rough shifts. Consider potlucks, too. Everybody has to eat, and can bring a team together.

As for day to day, you have to prioritize and delegate. Know each person's strengths and use them when you can. I was always mediocre at IV starts, but I knew my superstars, and most of the time they were flattered to be asked.

A mid-shift huddle can be useful, to find out who is sinking and who has time to help another. Of course, there are always those who will suck the life out of you if they can, so set limits and stick to them.

Use teachable moments, like an abnormal rhythm or a rarely seen condition, to share amongst your newbies.

Make sure everyone gets their breaks!

If there is a topic that many are struggling with, check with your manager or educator to arrange an inservice.

If some one is says they are drowning and need help, ask them what is the one thing you can do right now for them. Often times that is all they need.

And this may sound corny, but a little appreciation goes a long way. A sincere thank you is priceless.

[Crush]

Listen. And I like the "corny" one above of appreciation/respect.

My favorite nurse manager was the one who saw we were drowning and came out of her office wearing scrubs. She got on the floor and started helping out. While she was not able to help out the whole shift, it was enough to let us know she really cared. She made sure if we did something right or got a praise card from a patient to let us know and thank us. Staff meetings started off with what was going right on the unit and she ended meeting with a positive uplifting quote.