Being "In Charge"

by Clint Maun, CSP

Like no other time in history, health care organizations are relying on critical leadership skills to accomplish success on a daily basis. This is particularly important in the nursing departments, because they have the largest number of employees. Nurse leaders must develop understandings about how nursing relates to every other person and department throughout the organization.

Given today's demanding health care environment, charge nurses, unit managers, nursing coordinators and supervisors must assume leadership roles. Allowing charge nurses to be tattle tales, snitches, or ombudsman involved only in nursing related interventions ignores the inter-disciplinary nature of today's health care profession. Health care organizations need for these individuals to be involved in "in-charge" activities before lasting success can occur.

This translates to the CEO, and/or Administrator, Director of Nursing and any other members of the management team ensuring these "in-charge" individuals are:

1. Setting the appropriate tone at the start of the shift.
   
2. Involved in hiring processes and decisions.
   
3. Actively included in budget and quality of care implementations (this is where issues of quality and quantity of work are blended together).
4. Participating in successful coaching interventions for individuals they supervise including both positive and negative feedback opportunities.
5. Developing a sense of "CAN-DO!" in their team's daily performance.
   
6. Involved in detailed discussions with other department's management teams concerning the effective delivery of care and the impact their departments have on each other, as well as the patient/residents.
   
7. Providing leadership when family and patient/resident concerns are voiced.
   
8. Overseeing appropriate documentation for the care delivered on their unit thereby assuring regulatory compliance and reimbursement success.
   

The CEO, Director of Nursing, Administrator and other management teams must train, develop and continually coach the charge nurses around issues raised involving the above mentioned responsibilities. Many charge nurses want to be "in charge," but the organization's hierarchical structure is designed to keep them from assuming leadership roles.

A common situation is the Director of Nursing not wanting to relinquish control or share leadership responsibilities with the charge nurses. Sometimes, charge nurses want the extra pay associated with being "in charge," but don't want the charge nurse duties and responsibilities that go with being "in charge." At other times, there are charge nurses who only perform direct patient cares and just want to "get along nice" with their co-workers, rather than deal with leadership direction and decision responsibilities.

Successful health care organizations are moving toward leadership models more in line with the rigors and demands being thrust upon their nurse managers. We suggest that any organization's the first step is beginning discussions with small groups (10-12 people max). These groups will include the CEO (where appropriate), Administrator, and Director of Nursing along with the organization's charge nurses.

Information gathered at these meetings help determine what should be done to help nurse managers become successful leaders. When this sort of nurse leadership development is needed, we have found that small group discussions and micro-training sessions are more successful than large scale training classes.

Maun-Lemke has developed a leadership audiotape and videotape series called "In-Charge" that helps organizations find a point of reference for where to begin. There are many other reference tools available. What is important however, given today's nursing shortage environment, is that health care organizations get busy with this important leadership activity as soon as possible.