CHARGE NURSES

How to be a Great Leader – The Nurse Leader Handbook by

Quint Studer
Lesson 1 – What is a leader?
Definitions of Leadership
 Leadership is the opportunity to give, not just to get; to inspire an
organization rather than control it, to create value rather than extract it. True
Leadership is about having the purpose and passion to make a positive impact
both in and out of the workplace. – Yale School of Management, 2009
 If your actions inspire others to dream more, learn more, do more and
become more, you are a leader. – John Quincy Adams
 Leadership is a process of giving purpose (meaningful direction) to collective
effort, and causing willing effort to be expended to achieve purpose. – Jacobs
& Jacques, 1990
 Leadership is the art of getting someone else to do something you want done
because he wants to do it. – Dwight Eisenhower
 Leadership and learning are indispensable to each other. – John F Kennedy
 Men make history and not the other way around. In periods where there is no
leadership, society stands still. Progress occurs when courageous, skillful
leaders seize the opportunity to change things for the better. – Harry Truman
 It is better to lead from behind and to put others in front, especially when you
celebrate victory wen nice things occur. You take the front line when there is
danger. Then people will appreciate your leadership. Nelson Mandela
Leadership is….

 A process of getting things done through people

Collaboration, Inspiration, & Recognition
 All about credibility
You must talk the talk and walk the walk
 Responsibility
The buck stops with you
 Doing or being willing to do what you ask of others
 Giving people hope and building belief in the future
“Leaders are purveyors of hope.” – Napoleon
 Is a challenge!
If leadership was easy, everyone would be a good
leader!
Leadership is not….
 An exact science.
There is no set of rules to follow, so it is always an adventure.
 Waiting for someone else to lead.
Leadership requires taking initiative and challenging people to
better themselves.
 Telling others what to do.
“The difference between a boss and a leader: a boss says,
‘Go!’ – a leader says, ‘Lets go!’ (Kelly, 1995)
 Something you are born with.
Leadership is a skill that can be learned and improved on.
 A position or title.
You can lead from anywhere in an organization.
 Just about getting the job done.
How you get the job done is also important. Anyone can yell and
scream, it takes a leader to motivate.
Skills & Qualities of Leadership
 Visionary
Ability to paint a vivid picture of where to go. Able to communicate direction. Proactive look into the future
(*looking beyond today)
 Integrity
A person of integrity is the same on the outside as on the inside.
 Accountability
Taking responsibility for action or non-action.
 Magnanimity
Giving credit where it is due. Ensures that credit for successes are spread as widely as possible. Conversely, a
good leader takes personal responsibility for failures.
 Fairness
Dealing with others consistently and justly.
 Dedication
Spending time and energy necessary to accomplish the task.
 Creativity
Able to think “outside of the box”; Asking “what if?”
 Professionalism
Personal & Professional accountability. Active membership in profession. (Clinical ladder, certifications, advancing
education.)
 Humility
Recognize that they are no better or worse that other members of the team. A humble leader is not self-effacing
but rather tries to elevate everyone.
 Assertiveness
Is not the same as aggressiveness. Rather, it is the ability to clearly state what one expects so that there will be no
misunderstandings
So How do I Become a Better
Leader?

 Clarify your own goals and values

 Research Leaders of the past
 Read…a lot!
 Attend training seminars
 Get experience
 Find a Mentor
 Ask questions, find out what the Director would expect
of you as their representative.
Charge Nurses Role
 Changing patterns of care delivery require that charge
nurses should be:
 Accountable
 Responsive
 Flexible
 Able to understand the concepts and principles of
leadership
 Able to build strong teams and gain the trust of the staff
they lead
 Note: The role can be expanded to include several
responsibilities specific to needs of the department
Charge Nurse Roles

 Unit leader in professional behavior as well as Clinical

skills
 Clinical expert
 Physician liaison
 Administrative liaison
 Clinical care coordinator
 Patient care advocate
 Unit resource manager
Leadership vs. Management
Leadership
 Centered on change
 Challenges current
“norms”
 Doing the right thing
 Lights the fire within
people
 Facilitates effective verbal
communication
 Innovative
 Possibility-thinking
 Uses Persuasion Power
Management
 Order / consistency
centered
 Focused on controlling
complex processes
 More about “doing things
right”- following the rules
 Lights a fire under people
 Written communication
 Promotes standardization
 Focused problem-solving
 Uses Position Power
Charge Nurse Responsibilities
 Assist with unit scheduling and staffing
 Coordinate unit admissions and discharges (resource
management
 Coordinate flexible staffing solutions according to patient
acuity and unit needs
 Facilitate multidisciplinary communication
 Facilitate conflict resolution using AIDET
 Patient or family issues
 Staff issues
 Inter-departmental issues
Professionalism- Common Standards of
Behavior align our behavior with our values and
provides clear expectations about how we are to
conduct ourselves
 Safety: We will demonstrate that safety is an uncompromisable core value and the foundation of our
promise to each other, our patients and the communities we serve.
 Privacy: We will always maintain customer privacy and confidentiality. It is the personal responsibility
of every staff member to protect the privacy and confidentiality of every customer encountered.
 Attitude: We are committed to providing the highest quality of service and meeting our customers'
needs with the utmost care, compassion and courtesy.
 Communication: We must be committed to listening attentively to our customers in order to fully
understand their needs.
 Customer Waiting: We will always keep patients informed regarding the time in which service will be
provided and make them comfortable while they are waiting.
 Responsiveness: We will respond in a way that demonstrates the care, courtesy and respect our
customers deserve.
 Service Recovery: We will not be defensive if a customer complains; their perception is their reality.
 Appearance: We need to take pride in our personal appearance, our facility and its surroundings.
 Commitment to Coworkers: We are linked to one another by a common purpose: serving our
patients and our community. Coworkers, our physicians and volunteers are our team members. They
deserve our respect and support.
 Sense of Ownership: We will take pride in what we do and how we do our job. We will feel
responsible and be in control of the job that needs to be done.
Employee expectations and
Professional Behavior of Charge
Nurses
 Identification Badge and identifying selves when
answering phone
 Personal Appearance including jewelry, fingernails, hair
and tattoos. Standardized uniform is required
 Community Cares Customer Service including AIDET in
person and while on phone
 Personal Telephone Calls and Electronic Devices
 Absenteeism and Tardiness - huddles start at 0645 for
all staff that Charge nurses lead…
 Smoking and Tobacco ,Alcohol and Drug-Free
Environment
 ALC Compliance training completion
Staffing

 Coordinate the core staffing

 Adjust staffing needs of the unit
 Census
 Acuity
 Promote staff competence /
ability to meet patient needs
 Facilitate orientation and continuing education
Resource Management

 Census + Admissions – Discharges = “Full Unit”

 Allocate resources appropriately to meet patient needs
 All about having the RIGHT resources (including staff) in
the RIGHT place at the RIGHT time
 Supplies
 Staff must have the resources to do the job
 Proper organization increases productivity
Effective Communication

 Actively Listen
 Be keenly aware of non-verbal communication
 Use “open” body language
 Remember to “send the mail to right address”
 Learn to recognize when you or your staff are becoming
stressed
 Practice emotional awareness
 Feelings motivate communication more than thoughts
Conflict Resolution

 Dealing with conflict is important -failing to do so can

lead to low morale, absences, attrition, poor patient
care delivery and an unsafe patient care environment
 Evaluate the situation-get everyone involved in the
conflict together to discuss the problem
 Communicate your feelings assertively, NOT
aggressively. Express them without blaming
 Actively seek compromise
 Agree to disagree
Team Building

 Behaviors that gain trust, foster cooperation, and

promote job satisfaction:
 Fairness
 Consistency
 Support
 Recognizing individuals’ efforts
 Routine follow-up with staff during the shift
Quality
Improvement
PDCA process
Plan – what needs improvement
“5 Whys” drill down to real issue

Do - Monitor, Measure and prioritize

and implement the new process
Check – Analyze the change
Act – the hardwiring of the process
Examples: PICC line monitoring, Fall
mats, High Risk Drugs labeling,
Correct weights for NICU babies
Patient Safety
To Err is Human: Building A Safer
Health System -1999
Patient Safety and Quality: An
Evidence-Based Handbook for Nurses
– Agency for Healthcare Research
and Quality – 2008
Stand Up for Patient Safety – NPSF
High Reliability and Safety
Community Cares Model
• Change of Shift safety Huddle
• Bedside report
• Charge Nurse Rounding
HCAHPS- Hospital Consumer Assessment of
Healthcare Providers and Systems and Charge Nurses

 Communication with nurses- While rounding ID yourself as charge

Validate bedside change of shift rounding
 Communication with doctors
 Responsiveness of hospital staff – Call Bells, Hourly rounding
 Pain management – Charge nurse rounding check white boards for
Pain score
 Communication about medicines
 Discharge information- Pink Envelopes
 Cleanliness- Check CNA assignments and call EVS as needed
 Quietness
 Overall rating- A happy staff leads to better outcomes and the
Charge nurse sets the tone for the shift.
 Would recommend- Manage up staff instead of “They are at lunch or
they are busy”
References
 American Association of Colleges of Nursing/ CNL White Paper.
Retrieved January 1, 2012
 Blake, Nancy, RN, CCRN, NEA-BC,” Practical steps for implementing
healthy work environments.” Advanced Critical Care. January- March
2012. Volume 23, Number 1, pg 14-17
 Nurses First. Taking Charge: What Every Charge Nurse Needs to
know. Vol2, Issue 4. July-August 2009
 Hinshaw, A.D (2008) Navigating the perfect storm: Balancing a
culture of safety with workforce challenges. Nursing Research,
57(1S), S4-10.
 Michael Buckley, MD, John Laursen, and Victoria Otarola,
Strengthening Physician-Nurse Partnerships to Improve Quality and
Patient Safety. PEJ November- December 2009
 Mary Krugman, PhD , R.N, Vivienne Smith, BSN, RN, Charge Nurse
Leadership Development and Evaluation. JONA. Vol.33, No. 5 . May
2003
 Inspired Nurse- Bluni, Rich 2009