Charge Nurses Are Also “Chief Retention Officers”

Organizational loyalty is cemented through relationships with supervisors and managers, but don’t overlook the importance of the Charge RN role to nurse loyalty and retention.  Turnover studies show that more often than leaving an employer, staff leave their first-level supervisor.

Charge Nurses play a role in onboarding, coaching, patient experience and safety, and nurse retention.  Develop your Charge RNs to be unit leaders, by teaching critical thinking, delegation, effective communication, conflict management, leading through change, and other qualities for successful leadership.

How can a Charge Nurse help your organization with nurse retention?

Being a Leader Who Fills In Gaps

It’s obvious that nurses on the team are busy, overworked, and possibly stressed. Your team may be understaffed at times, or during this Covid/Delta-era, understaffed most of the time. This means nurses on the team or unit could be behind on charting, procedures, assessments, or administering medicines. This may slow down throughput, and it could impact patient satisfaction or even outcomes.

A Charge RN can be the first line of defense to keep the unit productive and nurses happy. She may need to fill in in placing IVs, triage patients, get EKGs, or order medications. The Charge is a leader who fills in gaps of care or administration, quarterbacking and motivating the team, whether it’s normal times or Covid-times. This type of leader keeps team morale on an even-keel which helps with nurse retention. On the flip side, an unprepared Charge Nurse can have the opposite effect.

Helping Nurses Manage Stress and Keep Calm

Of course you want all nurses to be calm in emergency situations, but in the Charge role this is especially important. Charge Nurses put out fires during the shift and oversee that other nurses handle stressful situations properly. A Charge Nurse who knows her stuff and understands key policies can take the air out of a stressful situation.

The Charge Nurse can also help alleviate nurse stress by keeping the shift organized. Charge RNs should make prioritized lists and help chart in real-time to avoid backlog which can also cause stress.

Being a Communication Line Between Management and Nurses; Identifying Problems Early and Intervene

Charge Nurses should foster nurse communication and gather input for the organization. They may have the best intel on how the team is perceiving and reacting to what is going on.  Help your Charge RNs understand how to use “chain of command” when escalation is needed (and not needed).

Continuous, open communication, however, makes nurses and all of us feel valued.  Charge RNs can help identify workplace incivility early. These incidents can lead to low team morale, low productivity, and increase absenteeism. Conflict is unavoidable and problematic, so nurses with strong conflict resolution skills are better able to deal with challenges quickly and reduce potential errors stemming from it. A Charge RN can also identify staff who are struggling and help with early interventions.

Be a Model of Positivity and Professionalism

Encourage Charge Nurses to lead by example, and always look for ways to help the team succeed. Encourage your team to practice positivity and professionalism by showing initiative and by thriving under direction. Let Charge RNs know that serving as a good example and demonstrating a strong work ethic, flexibility, and positive attitude will help pave the way to future leadership positions. It isn’t just about “soft skills” of leadership either, because these are skills which will impact issues like organizational financial goals, patient outcomes, and patient experience.

You may not be thinking about how Charge RNs can be a key part of your nurse retention efforts. Nurse Managers can’t do it all alone.  Reward Charge Nurses with professional development and watch the change in team dynamics! 

To assist health systems who would like to sample the power of charge nurse development, or are strapped for instructors in these staffing-challenged times, Catalyst Learning is teaching public NCharge® “Nurses Learning to Lead” classes in Oct-Dec. Learn more about our upcoming virtual, instructor-led course. Courses carry 3.5 ANCC contact hours.

“Be the Boss No One Wants to Leave,” Webinar by Rose O. Sherman, 9/28/21, sponsored by Catalyst Learning Company

“Letters: Embracing retention at all levels,” Lippincott Nursing Center/Nursing Management magazine, Kathy G. Newton RN, Florence Stewart RN/BSN, Sabra Henry RN/BSN

“Strategies for Nurse Retention,” Elite Learning, Lorraine Mercado

“Recognizing and Overcoming Toxic Nurse Leadership,” RN Journal, George A. Zangaro PhD/RN, Kelly Yager MS/RN, Joseph Proulx, EdD/RN  

“Improving the Charge Nurse ‘s Leadership Role: A Collaborative Learning Forum,” Walden Education, Felicia Katherine Pryby, 2016

How Can I Be The Boss No Nurse Wants To Leave

This article is a summary of a digital workshop given by Rose O. Sherman and Catalyst Learning Company on 9/1/2021. Ms. Sherman’s presentation was titled “Become the Boss No One Wants to Leave: Nurse Recruitment in Turbulent Times.” Catalyst Learning sponsored the event in recognition of the heroic role that nurses played in the U.S. in 2020 and 2021.

Across the U.S., nurse leadership is struggling with unprecedented staffing shortages and high turnover. COVID-19 has been a ‘Quake Experience,’ a massive life change with aftershocks that will likely last for years. Nurses have experienced an impact both personally and professionally, leading to stress, burnout, exhaustion, hopelessness, and some disengagement. Nurses and other health staff may be reconsidering their professional lives, asking questions like “am I really supposed to go back to work like nothing happened?” “What is my economic worth, and am I respected?”  “Is acute care the right setting for me? Have I found the right work-life balance?”

In the midst of this nursing workforce landscape, nurses are leaving the hospitals and systems they work for. While burnout, stress, inadequate staffing and better pay may get more attention and headlines, a major reason that nurses leave organizations is lack of good leadership. A lack of leadership doesn’t just mean the nursing VP. All levels of leadership, including the Charge Nurse, play a key role in retention. Nurses look for stability, trust, compassion and hope from their leaders. Younger nurses especially have different work demands than their more experienced peers, with needs evolving from paycheck to purpose, from wanting a boss to wanting a coach, and they look more for frequent feedback than annual reviews.

So given this new reality, how can I be the boss that no one wants to leave?

Focus on a Healthy Work Environment, plus Focus on Unit and Team Culture

Unit culture is an invisible architecture that new staff sense quickly. To have a healthy work environment, Nurse Managers and Charge Nurses set the tone. Make sure these frontline leaders encourage nurses to ask questions, make nurses feel appreciated, and listen to staff concerns. Nurse leaders who inspire staff generally have a strong bias toward taking action to correct situations, are vulnerable and compassionate toward staff, and manage conflict and diversity of ideas well.

Teach frontline nurse leaders to have zero tolerance for disrespect and abuse. A Charge Nurse who sees and ignores incivility or bullying has just normalized the behavior. Staff then either become part of the hostile workplace or leave entirely.

What is something nurse leaders can do quickly to help with culture issues? Consider bringing back an old ritual, or even start a new one. During COVID madness, many teams lost the rituals that connected nurses to the team and created a psychological safety net for the unit.

One last thought to help with work environment is to create a culture of recognition. Give symbolic gestures to show that leaders appreciate nurses. Begin shifts with “thank you for being here,” nominate your staff for awards, write thank you notes, and attend events where staff are being recognized. If your managers and Charge RNs see you doing this, they will likely follow your lead.

Do what you can do to encourage group cohesion and stronger work teams, remember that a toxic culture will destroy the best plans. Focus on work culture will help make leaders that staff do not want to leave.

Develop Charge Nurses to be Unit Cohesion Leaders

Organizational loyalty is cemented through relationships with supervisors, managers, Charge Nurses and team members. Many nurses don’t leave a health system, they leave their first-level supervisor. Develop your Charge RNs to be unit leaders, by teaching critical thinking, delegation, effective communication, conflict management, leading through change, and other qualities for successful leadership. Charge Nurses are the first-level supervisors who play a role in retention, onboarding, coaching, plus of course patient experience and safety.

Be Flexible to Meet the Needs of Your Staff – Be a Coach for Younger Nurses

Older nurses are retiring fast, and even Gen X makes up barely a quarter of the nursing workforce. Gen Y and Gen Z make up 60% of the nursing workforce now. As a leader, don’t wait for these Millennials to grow up and become Baby Boom or Gen X nurses. It is not going to happen. Be flexible in your leadership style to meet needs of younger staff. Be as accommodating as possible with work schedules for example. Also be flexible in your leadership style by trying to think more like a coach than a boss. Younger nurses think more about purpose than prior generations, so show young staff how their role contributes to the mission of the organization.

Lifetime employment is not the goal of most nurse staff today. Staff are more likely to see their jobs as “tours of duty” on a professional career ladder. To show support for Millennial and Gen Z nurses, support nurses’ career goals and do not give any perception that you may hold associates back from moving to the next level. Ask your nurse staff questions to aid their career development with questions like: “what goals do you have,” “what types of professional roles have you considered,” “what obstacles are you encountering,”  and “what new skills do you want to achieve.” Consider using a Career Development GROW® Model Coaching Template with nurses to show you value their career trajectory.

Communication is Key, Especially During Turbulent Times

In complicated times, transparent communication and visibility is key. When leaders don’t communicate, staff will fill in gaps with misinformation. Nurse leaders should practice effective communication during practice and policy changes, consider diverse communication styles among different staff, and choose the right words and tone for communication. If leaders do not communicate effectively it can lead to gossip, mistrust, perceptions of staff favoritism, and staff can become defensive.

The correct communication tone and style can be difficult even during ‘normal’ times, but it is even more critical when staffing is short. When there are staffing issues, make sure leaders are transparent about the challenges the team is facing. Make sure leaders are transparent about recruiting tactics that have been tried, ask for staffing ideas from the team, and acknowledge that nurse leaders do not have all the answers. It may be a difficult message, but staff will appreciate honesty, and may even be able to help.

STAY Interviews and Strategic Off-Boarding

STAY Interviews are a way to help with avoidable turnover. Aim to do at least 2 each year per nurse, the first one within 90 days of hiring. After this interview, note the actions that you will take and the actions the nurse/staff member will take. After this interview, use a stoplight method to assess risk of turnover, with green being likely to stay 1+ years, yellow to likely stay 6-12 months, and red a high risk for immediate loss. Ask questions like “what do you look forward to each day,” “what are you learning or do you want to learn,” or “how can I make your job better or want to stay?” Even if you are likely to lose an employee in their current role, you may find other internal roles that may be better professional fits. STAY interviews can help with internal mobility which reduces recruitment costs, and keeps high-potential staff in the organization.

If and when nurses do leave, stay upbeat and positive. Thank them for their contributions, and remember that other staff will watch how you manage resignations. When valued staff resign, think about how to create loyal alumni who will recommend your organization, and leave the door open for boomerang employees.

Catalyst Learning produces the curriculum NCharge™: “Nurses Learning to Lead” for Charge Nurses, which is available for on-site or virtual instruction.

Helping Charge Nurses to Lead During Unstable Times

The role of the first-level supervisory nurse is critical for quality patient care and overall work quality for nursing staff. The role is also very complicated, especially given that nurses often assume the role based on clinical skills, with limited formal leadership development. Solving problems, understanding staff members scope of practice, and dealing with staff needs is a lot to take on, even when times are not turbulent. And in 2021 we know many nurse teams are dealing with staffing issues and turnover. Many teams are staffed with 50% new graduates, more temp travel nurses, burned out nurses, and high acuity patients. These factors, along with turnover of nurses and senior leadership plus new IT processes, add up to many nursing work teams dealing with a continued challenging time.

So how can nurse directors and leadership help charge nurses, as they lead through a turbulent time?

Be transparent about the key issues

Charge nurses do not expect their managers or directors to have all the answers to problems that arise, but they do want the truth. If you are transparent that there is instability and that the team is going through rocky times, that transparency can be a building block for trust. It can also help solve the issues. When staff members have all the information on a topic, they may devise reasonable suggestions or alternatives to solve or improve a problem. Through transparency, nurse teams can mature more quickly.  A lack of transparency can have long-term detrimental effects and lead to less trust or more turnover.

Offer support from more experienced nurses

Young nurses are not looking for authoritarian leadership; they want coaching to help them learn and grow as professionals. Retaining nurses requires adapting to this generation, so make sure the right experienced nurse is providing the coaching. The right coach/mentor can help a young nurse see how their contributions are valued. Mentors can encourage continuous learning, help young nurses to build networks/join professional organizations, and even help teach young nurses about emotional intelligence. For example, University Medical Center (Texas Tech University) offers senior nurse mentors to new nurse leaders. This helps nurses to think about professional development, clarify skills needed for the new role, and understand the goals of the health system. There is nothing in a textbook that can replace real-life experience of a seasoned nurse who has navigated a full career.

Identify struggling staff and plan for early intervention

Be on the lookout for nurses who are struggling with exhaustion, anxiety, or just the reality of how difficult the nursing profession can be. Help show them time management tricks or talk about where the nurse is struggling. If a nurse has a hard time speaking with physicians for example, help them practice those scenarios.

But if a nurse isn’t pulling his or her weight, or causes unnecessary team stress, find a plan to fix the issue. A charge nurse has enough on their plate, so especially during turbulent times, take as much of the team conflict or struggling staff issues off the table as possible.

Remove common leadership barriers charge nurses face

Even when not enduring turbulent times, there are personal and organizational barriers that can hinder success of frontline nurse leaders. Removing as many of these barriers as possible will setup your charge nurses for success. Personal barriers a new leader could face are an inability to see the big picture, a lack of self-confidence, or not delegating work. Remember that your charge nurses may have never led a team before, so talk through these personal barriers.

Leadership barriers could be organizational. These barriers could include staffing issues, a lack of ancillary or clerical support, or a lack of standard operating procedure. It’s impossible for a charge nurse to effectively complete tasks if he or she doesn’t know what the expectations are. If possible, it would be beneficial for charge nurses to meet with administrative leadership to quickly draft a common list of responsibilities. See our related article, 9 Leadership Barriers that a Charge Nurse Faces.

Offer leadership development to prepare nurses for the charge nurse role

Many nurses in a charge RN role have never led a team before and are serving in it because they have the clinical skills. Going from a nurse peer to a nurse leader can cause stress, as it is hard to delegate work to a friend.  So prepare your new nurse leaders with training that can give the insights, interpersonal skills and business knowledge they need to manage a team. Charge nurse leadership development can help a nurse transition from peer to leader, lead quality initiatives, be confident in communications, and help with conflict management.

HCA, the largest private health system in the U.S., made a strategic decision to systematically prepare future nursing leaders for success.  It developed its Charge Nurse Leadership Certificate program and saw that effective development of frontline leaders can improve retention and the delivery of patient care.

Being a charge nurse during turbulent times is very hard. Whether it is staffing, high acuity patients, or employee stress, the role is harder than ever. And we know that the charge nurse role is a first step into nursing leadership, so it is essential that we encourage these new leaders.  It is a win-win-win for leaders to provide stability, transparency, and inspiration.

“3 Common New Nurse Struggles,”

“Transparency in Nursing Leadership and Healthcare,” Duquesne University School of Nursing, Rose Sherman, April 14, 2020

“Tips on How to Effectively Communicate to Doctors for New Nurses,”

“Mentoring Nurses Toward Success,” Minority Nurse Magazine

“For Nurses – Mentoring,” University Medical Center – Texas Tech website

“Helping Charge Nurses Create Stability When Staffing Is Turbulent,” Emerging RN Leader, Rose O. Sherman, May 6, 2021