Reflections on Being Charge Nurse

It’s been about two months since I started in the permanent charge nurse Clinical Care Leader position, and I have to tell you, it ain’t what I expected. I’m not complaining. But this might be the hardest, most challenging job I ever had, and that includes the hot summer I worked in the kitchen of a Greek restaurant whose owner pinched my bum. Some reflections:

1. You can’t be everyone’s friend. A cliché that’s actually, really true. The people you thought were on your side start to look at you sidewise,and the people who didn’t much care one way or the other really begin to hate you. Let’s face it: sometimes you make decisions that piss people off.

2. You can’t please everyone. Corollary to the above. No matter what you do, or how carefully you consider each decision, there will be someone, somewhere second-guessing you, and then bitching loudly about how they would have done things differently.

3. The faint of heart, thinned skin and unconfident need not apply. Probably true of emerg nurses in general, but more so for charge nurses. Having the hide and temperament of a rutting rhinoceros is a definite prerequisite. After being called racist and being told to eff-off in the span of a week, I feel like I need body armour.

4. Cool not hot. When the place is falling down, two VSA’s* have arrived on the doorstep simultaneously while an indrawing, tripoding† three year-old is at the Triage desk, Plastics is having a tantrum because there’s no more 4.0 Plain Gut left in the department, and Weanus is walking towards you with look on his face that would frighten children, a charge nurse running around screaming like the Four Horsemen of the Apocalypse have just galloped through the ambulance is not helpful. Keep it cool, because

5. All disasters pass. When the place is falling down, the effect is temporary. Really. Beds upstairs will appear, Weanus will go off muttering, the VSAs will die or survive — in short, all crises are temporary, by definition.

Except when they’re not.

6. I work with some amazing nurses and some distinctly nasty personalities. Some times they are the same people. I used to think this was a contradiction. Now I am not so sure.

7. Sick calls are highest Friday nights and Monday mornings. Except on statutory holidays, when for some reason we are always fully staffed. Don’t think I don’t notice.

8. Physicians start treating you with respect. I have specialists, who in my ten years at Acme Regional, have never once spoken to me directly, suddenly asking about my summer holiday plans and buying me coffee. It’s weird and creepy, but also a pretty sad commentary on perceptions of power in large hospitals.

9. Your colleagues have no idea what you do. I mean, they could probably describe it generally, but somehow think it mostly involves sitting around and directing traffic. The short list of what I do? Let’s see: bed allocation and patient flow in the ED, staffing, staff assignments and scheduling, supply ordering, allocation of beds for admitted patient on the floor, dealing with angry/complaining/grieving patients/nurses/physicians, being the liaison with other floors and departments on a day-to-day basis, helping to carry out new policies and procedures and ensuring compliance, mentoring and role-modelling, attending various committee meetings important to the emergency department. . .

Maybe I should develop a list of core competencies.


* See Glossary

† I.e. in respiratory distress.

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  1. #1 by Boris on Friday 11 June 2010 - 1659

    I’ve enjoyed reading your posts this afternoon, and have plugged you over at TGB.

    Well done.

  2. #2 by torontoemerg on Saturday 12 June 2010 - 1027

    Thanks Boris for the shout out and the compliment: I really appreciate it.

  3. #3 by @rdjfraser on Thursday 17 June 2010 - 1523

    I love you blog and so glad you use it to vent. Gets me excited to get back to the real world of nursing, which is making me think about where to start. Obviously not with being charge nurse, but I was wondering if you had any thoughts.

    As always thanks for sharing

  4. #4 by thenonconformer on Monday 28 June 2010 - 0355

    In Canada Nurses as well are clearly too often undeniably too mismanaged and pretentious services and pretentious management is generally the way things are still done: for the last few decades too now. While clearly the patients in Hospitals, nursing homes, tend to be sick often now still even seven days a week, 24 hours a day, the nursing staff clearly as a whole are not adequate 24 hours a day, seven days a week. Now in a typical medical facilities there tends to be at least 3 types of classes of Nurses and related services being provided. The main day shift of Nurses tend to be the generally the one the best, offering the best, first class services. But even here there tends to be a mixture of both very high caliber workers and also some very bad ones too. The second shift of after noon and evening shift, services tend to be the one next composed of second class nurses, those who do generally themselves do offer a less substantial services. And next the late night and weekend nurses tend to be composed mostly of third class nurses, the undeniable worst, poorer Nurses, workers services being offered. The Nursing supervisors themselves tend to place the unwanted, the least desirable nurse for the late night and weekend shifts.

    Often you’ll hear nothing but gripes and complains about their bosses, their superiors, their parents and the government, nothing about blaming themselves or looking towards constructive solutions to their so-called problems.

    I AM AN UNBELIEVABLE BELIEVER IN “SEEING IS BELIEVING”, WHAT I WITNESS MYSELF, SEE IS THE REALITY, AND SO IS MY FATHER. WHAT YOU SEE IS WHAT YOU GET, AND HOW THEY DO TREAT ME IS GENERALLY HOW THEY OFTEN STILL DO TREAT THE OTHERS TOO. What I too often have seen too many selfish, self centered Nurses do still is mostly to put their own desires, goals, such as coffee breaks, laziness, more money ahead of the patients’ good welfare. Sad. My very senior father has an incurable, painful disease and he needs proper pain management in Hospitals, old age homes and rather often he still does not get it.

    California’s nursing disciplinary system is disgraceful. The state currently does not have a standardized method of monitoring suspensions or firings of registered nurses. The major nursing unions in California, opposed a bill for, primarily, a mandatory reporting clause that requires all employers to notify regulators about any Nurses firings for serious violations, such as gross negligence or physically harming a patient. California’s Board of Registered Nursing recently discovered that 3,500 registered nurses have been disciplined in other states.

  5. #5 by Anonymous on Wednesday 30 October 2013 - 2109

    I am a permanent charge nurse- sorry- Patient Care Coordinator for an inpatient rehabilitation unit. I’ve only been doing this gig for 2 months and I can definitely relate to your findings. I never realized how hard and demanding this job could be. I never took in to account that all of my relationships with my coworkers would change. I love my job but it’s not what I expected it to be. Your perspectives, though not completely parallel with the rehab specialty, are often my own perspectives of my position. It’s nice to know that others feel the same.

    • #6 by Anonymous on Friday 01 April 2016 - 1333

      I have been a charge nurse for the last two years and I agree with you in the fact of can’t be every one friend
      I enjoyed reading your post

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