Taking Charge: Lessons in Leadership

I recently took a promotion to become full time Charge Nurse on my Med-Surg floor. While I was excited for the opportunity to take on a leadership role, I also felt a fair amount of anxiety about how I would be received. First of all I am young (and look even younger, to boot!), leading people sometimes 10+ years my senior both in age and nursing experience. Second, I am a relatively new addition to this floor, and I realized that many people could feel that I hadn't fully "paid my dues"yet. In spite of these things, I recognized that this new role would further facilitate my passion to support and educate nurses,  and I decided to jump in with both feet!

I've given a lot of thought to what it takes to be a great Charge Nurse. Some things are given: you know how to do and teach the skills your floor nurses use, etc. There are, however, many intangible aspects of leadership that have a great impact on your success. I've still got a long way to go to fill these big shoes, but I thought I would share some of the things I've learned so far.

1.) Respect is earned. I can't make anyone respect me or my role, but I can be a person who deserves respect. I subscribe to a servant leadership style. Med-Surg nursing in back-breaking, dirty work. When you are on the floor, it sometimes feels like you are in the absolute trenches of your profession. People are often quick to resent those "away from the bedside" who "don't know what its like". My favorite charge nurses are the first ones to answer the call lights, clean incontinent patients or take a patient to avoid overloading the floor. I strive to be that charge nurse. One answered call light says, "I'm in your corner" better than any number of conversations.

2.) My nurses are my first priority.  Charge nurses are responsible for the overall flow and quality of the care received on the floor. That means that I am in near constant contact with Bed Management, Social Services, and the House Supervisor to help keep things running smoothly. It also means that I'm rounding on patients and doing quality audits for management on a daily basis. For me, however, the most important part of my job is serving as a resource for my nurses. I judge the success of my day by the number of my nurses that get out on time.

3.) Know when to say "No".  Unlike being on the floor, Charge Nurse duties have a relatively flexible time frame, and, at our hospital, we don't take patients. That means that I can usually re-arrange my to-do list to help other nurses, and nurses know that I am their 'go-to'. However, there are eight nurses, and only one Charge so I can get stretched pretty thin on any given day or hour. I've had to learn when to say, "I can't now, but let me find you someone who can". If you juggle more than you can handle, you will inevitably drop one or all of your items. Better to take on a little less, be reliable and consistent, than to take on too much and drop the ball.

4.) Gripes go up. No floor is perfect, which means there will always be gripes about one thing or another. There will always be personality conflicts. It doesn't help unit morale in the slightest, however, to have a visible person complaining all the time. For better or for worse, it can and will impact the floor. I always made an effort disengage from work gossip or drama, but now it is essential to my role. I I try to take any concerns I have have to go to the appropriate person, up the chain of command, or keep them to myself. I learned this one the hard way.

5.) Be Sincere. People make mistakes, and in charge, yours will impact your coworkers. Apologize quickly and genuinely. Actively listen to people. Approach people honestly and you will be well received.

6.) Support your new nurses. Whether they are new grads or just new to your specialty, you have to give a little extra love to those with less experience. There is no "entry-level" nursing position, so the learning curve is steep and overwhelming for many people. Today's new grads are the nursing leaders of tomorrow. I would not be where I am if it were not for my 'mama-bear' nurses who took me under their wings while I was still mastering nursing skills and judgement. I believe that if nurses feel supported and heard, floors will have higher staff retention. The higher the retention, the more opportunity for quality team building and mutual support among staff members.

What Burnout and Burnt Food Have In Common

Working in this field comes with a price. Increased workload, high turnover, and increased patient acuity: these are only some of the issues that plague the nursing field today, and they have very real repercussions. Translation: hospitals are short staffed, and consequently their nurses are overworked. Many studies correlate understaffing with decreased patient satisfaction and increased nurse burnout. According to one 2010 Survey, the average turnover rate for RNs practicing at the bedside is 13.8%, and that number is even higher for Med/Surg RNs like me at 16.9%. The majority of these nurses leave their jobs within one year of accepting the offer. 

Burnout [burn-out]: a state of emotional exhaustion, overextension, and decreased sense of personal accomplishment associated with increased psychological distress, physical illness and alcohol and drug abuse.

Voluntary Turnover. With 8.2% unemployment nationally. This tells me that many who love nursing are finding the hospital environment unsustainable. Although the nursing workforce is growing, studies suggest that by the year 2020 there will still be a shortage of approximately 800,000 nurses. That means that the correlation between understaffing, patient satisfaction and nurse burnout is far from over.  We, as nurses, must therefore learn to cope with the strains of our profession if we are to have any longevity in our chosen career.

I advocate a simple principle: guard both the quantity and quality of your free time.  

1.)  Quantity.   A nursing professor once advised me to not work overtime during my first year out of school. It was some of the best advice I ever received. The pressure to work overtime is immense in short-staffed hospitals, and the money is good. Resist the temptation. To this day, I can count on one hand the number of overtime shifts I have worked. If we are to believe what the statistics and examples above imply, working just 36-40 hours a week is hardly sustainable for many nurses, let alone 50-60. Know your limits. To be able to provide the quality care we pledge ourselves to when we become nurses, we must also provide quality care to ourselves. That means leaving the hospital and nurturing other parts of our lives.

2.)  Quality.    As nurses, we are constantly giving of ourselves to other people. We can only give as much as we have stored. A wise person once told me that the most excellent ministry comes from our spiritual overflow. Sustainable nursing must also come from personal overflow. I don’t mean to get to philosophical here, so stay with me. We need to find activities, hobbies, etc. that give back to us, that refill our empty storehouses to the point of overflowing. It’s the classic work hard, play hard principle with a twist.

Homemade Lemon Squares

For me, that replenishing time happens in the kitchen. I hole myself away to try out delicious recipes I dog-eared months ago. Do they always turn out? No. But there is something so innately satisfying about using simple ingredients to attempt culinary magic. Cooking feeds the creative side of my brain that gets neglected during the week. There is this je-ne-sais-quoi that is simply celebratory about the kitchen, connecting you back to the holidays and special occasions that have long since past. Even the food itself, raw and earthy, is therapeutic. The fresh scents and bright colors are a welcome break from the recycled air and stale hospital light.

A while back I hit a wall. Although I rarely have a lack free time, the quality of my spare time took a serious plunge. I wasn't living inspired, and the old hobbies had lost their luster. Coincidentally, I was frequently coming home from work exhausted and frustrated. I realized that I was trying to put my work, however vocational it may be, in a place it was never meant to be. I needed to revitalize my spare time. My husband bought me a DSLR camera for my birthday with instructions simply to try it. I had often ogled at photography over the years, a pastime that reached nearly obsessive levels while we were planning our recent wedding. With his encouragement, I dipped my toe in the water of a new hobby, and with much success found my inspiration again. It even revitalized old familiar friends, like my tiny kitchen, with new life. With my creative needs furnished, work found its proper place in the rest of my life. It became enjoyable again, as it was able to meet much more reasonable expectations.

Maple Walnut Scones with Vanilla Orange Glaze

If you are a nurse or a caregiver in any capacity, you must take care of yourself or you will quickly burn out. The quality of your alone time is equally as important as the time itself. What are you doing to nurture yourself today?