Charge Nurse
A natural progression in career advancement within nursing is to move from staff nurse to charge nurse. In some hospitals, the charge nurse assignment is rotated among staff with experience in the department. In other departments, it may be an identified position that is carried out by a select group of individuals. The charge nurse is to a department what the conductor is to an orchestra. The charge nurse directs the daily operations of the depart- ment, making adjustments when needed. Generally, the charge nurse is viewed as the shift manager and handles the administrative as well as operational functioning of the depart- ment during the shift. The charge nurse is usually responsible for human resource issues on shift, ensuring adequate staffing, making work assignments, and dealing with personnel issues as they arise. The charge nurse liaises with pre-hospital staff and other departments
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to ensure patient flow is maintained. A charge nurse is often tasked with the responsibility of completing reports required by the institution or accrediting agencies.
A good charge nurse knows the resources available to handle issues as they arise and knows how to access those resources. Good charge nurses also display exceptional organi- zational skills, have superior communication skills, know how to handle conflict effectively, and can multitask without difficulty.
Common Educational Preparation
Because staff nurses are frequently assigned to the charge nurse role, the educational prepa- ration may be identical. A bachelor’s degree in nursing, however, generally includes leader- ship training beneficial in the charge nurse role. In some institutions, the charge nurse role is considered a stepping stone to other management positions, which almost always require a minimum of a baccalaureate degree in nursing. Therefore, emergency nurses contemplat- ing career advancement should seriously consider education at a bachelor’s degree or higher.
Suggested Career Path
Frequently, charge nurses are assigned from among the staff nurses working each shift, although in some departments, the position may be a permanent designation. Therefore, excelling at the staff nurse role is often used as one of the decisive factors in assigning the charge nurse role. Being a charge nurse, however, requires more than exceptional clinical skills. Leadership, communication, and people skills, as well as a thorough knowledge of the department, are also foundational to being a charge nurse. Taking additional training in these skills will help position you for the charge nurse role. Because intimate knowledge of the workings of the department and the hospital as a whole are also important, consider taking on additional responsibilities, such as volunteering for unit or hospital-wide commit- tees or improvement projects within the department. These activities not only demonstrate commitment to the department but also allow you to stand out when it comes time to assign or select a charge nurse.
Manager
Manager
Although the charge nurse is responsible for the functioning of the unit during the shift on which he or she is working, the manager has 24-hour responsibility for the unit, even when he or she is not physically present. Being the manager of a nursing unit requires a different skill set than being a staff nurse (see Table 2.1).
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Table 2.1
Table 2.1 Differences BetweDifferences Between Staff Nurseen Staff Nurses and Ms and Managersanagers
Staff Nurse Manager
Doer Planner, Designer
One-on-one interactions One-to-many interactions
Reactive personality Proactive personality
Require immediate gratification Accept delayed gratification
Deciders Delegators
Value autonomy Value collaboration
Independent Participative
Patient advocate Organizational advocate
Identify with profession Identify with organization
Source: Mayer, Kaplan, & Kelly, 2014, p. 36.
Although managers should possess the same skills as the charge nurse, the nurse manager must also have knowledge and skills in (Turner, Stone-Griffith, & Kopka, 2014):
■Human resource management (including hiring, termination, evaluations, training, disci-
plinary action, scheduling, payroll, and adjusting staffing to budget and staff satisfaction)
■
Staffing (including scheduling, adjusting staffing to budget and census, payroll)
■Patient care (patient satisfaction, ensuring quality care, patient flow)
■Quality and risk (including core measure, risk audits, EMTALA, dashboards, data collec-
tion, survey readiness, policy development and review, Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS])
■Interpersonal relationships (with physicians, pre-hospital personnel, other departments in
the hospital, staff, peers, nursing students)
■Finance (budgeting, variance reports, supplies, billing, coding) ■Facility (committees, facility initiatives, community meetings)
Common Educational Preparation
The skill set required to be a manager demands the education offered at the baccalaureate level, and most nurse managers would be best served to have a master’s degree in either nursing leadership or business administration. Although the exact educational requirements
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will be established by each institution, the American Nurses Credentialing Center (ANCC) requires nursing leaders to have a bachelor’s degree or higher for Magnet certification (ANCC, 2014). Even though many hospitals have not sought Magnet designation, they have adopted many of the recommendations for Magnet status, including the education rec- ommendations for nursing leaders.
Suggested Career Path
Nurses seeking leadership roles should pursue every opportunity to gain leadership experi- ence. This may involve embracing the charge nurse role when it is available. Staff nurses may also accept additional assignments within the unit or institution to gain a deeper understanding of healthcare from a different perspective than a staff nurse. Sitting on the hospital-wide disaster committee, for example, allows you to meet other key players from around the hospital and learn how each one contributes to the institution. Similarly, seizing the opportunity to be involved with a performance improvement activity at the unit level gives you a broader scope not only of quality improvement but also how multiple factors contribute to outcomes. These types of experiences not only develop leadership competen- cies but may also be viewed during the interview process as an indication of commitment to personal development.
To develop leadership competencies, look outside of the hospital for experiences that devel- op these skills. Assuming leadership at a community level such as the local parent-teacher association, or leadership within a professional organization such as the Emergency Nurses Association, also helps develop skills in leadership and may also help to establish relation- ships that can be beneficial for career advancement into leadership in the future.
Director
Director
In some hospitals, nurse managers report to a nursing director (in other hospitals, the nurse manager performs the role of both the manager and director). A nursing director shares the leadership responsibilities of the unit with the nurse manager but usually takes on most of the administrative duties, leaving managerial duties to the nurse manager. Table 2.2 takes the duties of the nurse manager listed earlier in this chapter and demonstrates how these duties are frequently divided between the nurse manager and a nurse director. It’s not uncommon for a nursing director to be responsible for multiple units and have multiple nurse managers reporting to him or her.
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Table 2.2
Table 2.2 Common Division of Duties Common Division of Duties Between the Nurse ManaBetween the Nurse Manager and the Nurse Directorger and the Nurse Director
Category Tasks Who’s Responsible
Human resource management Termination Evaluations Training Disciplinary action Scheduling Payroll
Adjusting staffing to budget Staff satisfaction
Nurse manager
Quality and risk Core measure Risk audits EMTALA Dashboards Data collection Survey readiness
Policy development and review Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]
Nurse director
Staffing Scheduling
Adjusting staffing to budget and census Payroll Nurse manager Finance Budgeting Variance reports Supplies Billing Coding
Collaborative between the nurse manager and nursing director
Facility Committees
Facility initiatives Community meetings
Collaborative between the nurse manager and nursing director
Patient care Patient satisfaction Ensuring quality care Patient flow
Collaborative between the nurse manager and nursing director
Common Educational Preparation
Although specific educational requirements for a nursing director are unique to each insti- tution, the administrative requirements of this job nearly always necessitate a master’s degree in nursing or business administration. Some nursing directors have doctorate degrees.
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Suggested Career Path
A common career path toward an administrative role such as a nursing director involves gaining experience as a staff nurse, then advancing leadership experience as a charge nurse. Most nursing directors also work as nurse managers prior to becoming a director, although this is not a mandatory prerequisite in most cases. Emergency nurses interested in nursing administration should actively seek leadership experiences and advanced degrees in nursing.