Malaya is the charge nurse on an inpatient oncology unit. She is loved by the patients but hated by her colleagues. She takes 4-5 smoke breaks during her 12-hour shift; each 20 minutes long. Because she is the most experienced nurse on the unit, the newer nurses feel unsafe during her absence since they are dealing with blood transfusions and chemotherapy. If she doesn’t like you, watch out because she will make your life miserable by giving you the worst assignments, won’t relay accurate information obtained from physician rounds (the charge nurse rounds with physicians), and will somehow find a reason to get you in trouble. No one dares to bring this up because if she finds out, she’ll retaliate (she’s done it before). Everyone’s afraid to speak up for fear of what she’ll do.
I hear stories like this one over and over again.
We put people into a charge position typically because they are really competent at their job. But being competent doesn’t make you a good charge nurse. In fact, the charge role can allow a competent unprofessional nurse the opportunity to wreak havoc on your department.
The reality is…
- Charge nurses are NOT formal leaders but are expected to act as leaders
- It’s rare that organization’s offer ongoing professional development for the charge role beyond the initial class
- The charge nurse can destroy the team because they hover under the radar
The charge position is a power position. If given to the wrong person AND if they are not developed and watched, they can become the queen or king bullies on the unit.
Yet another example…
A colleague recommended me to one of her clients who was dealing with Brenda, a toxic charge nurse, in her ICU.
Brenda was extremely competent, had been there for over a decade, and was LOVED by the physicians. Brenda made assignments based on whether or not she liked you, would befriend new nurses and then set them up for failure, would undermine everything Kim, the manager, did, and would basically change her schedule if she didn’t like it, etc.
The staff described her as beastly on a good day. During a focus group meeting, Brenda actually stood and arrogantly said, “Kim thinks she’s in charge. I’M THE ONE WHO’S IN CHARGE HERE!”
Any attempt Kim made to discipline Brenda was met with harsh criticism by the physician team. So Kim did nothing until her turnover rate reached 50% in her department. Then she asked for help.
And yet another…
I recently discovered the depth of bullying by some of the charge nurses. On one unit, if the charge nurse liked you, she gave you the easier patients. If she didn’t, you got the most complicated, worst patients. Some nurses figured this out. If they knew she was working, they would call when they knew she was making assignments; play dumb, “Oh. I didn’t know you were working today…” and then offer to “stop by Starbucks” to bring her favorite coffee. They resorted to bribing her just to get an easier assignment.
The manager had no idea this was going on.
5 Strategies Leaders Can Adopt When the Charge Nurse is the Bully
If you’re the leader in a department and suspect or know that your charge nurse is a part of the problem, follow these strategies:
So often we make assumptions that if we put someone in the charge role that they’re “good to go” and that we don’t need to worry about them. How wrong that is!!!
Pay attention. Check the assignments after the charge nurse makes them. Are they fair?
Watch for any negative body language – not just from your charge nurse; pay attention to how others react towards her. Do your new employees appear afraid when around her? Are they trying to “butter her up” so that they don’t become her next target?
The key is to start paying attention.
2. Engage in honest conversations
Chances are, nobody has actually told this nurse that she’s toxic!! Don’t assume she knows. She may have received so many accolades for her performance that she doesn’t even realize there’s a problem.
You can’t fix something if you don’t know it’s broken. Tell her.
Schedule a meeting with her. Tell her that you want to talk to her about something that is uncomfortable for you to say and may be uncomfortable for her to hear. Tell her that you need to be honest with her about her behavior. That although she is clinically competent, the way she treats people is not okay.
In your conversations, use key statements such as:
– It’s not okay the way you’ve been treating your coworkers.
– You are incredibly competent, and I also need you to step up and act in a professional manner.
– This is a professional environment yet you have not been treating your coworkers professionally.
To read more about toxic nurses, click here.
3. Provide leadership training
Although education and training don’t solve problems, by providing ongoing leadership development for your charge nurses, you are better able to influence their behavior and teach them the essential skills needed to step up as leaders, even though they’re informal leaders. Providing an initial charge nurse class isn’t enough!
4. Start a documentation trail
Start documenting as soon as you sense a problem. To be in charge, most organizations have an additional job description or at least written expectations for their charge role.
Demonstrates collaborative and respectful behaviors
Attends 80% of staff meetings
Gives honest feedback to staff, keeps the individual’s confidences
Make sure you’re documenting how your charge nurse is violating the expectations. Be sure to include dates, times, locations, any witnesses; describe any incidents and the impact. Also include any verbatim comments, “She’s [the manager] not in charge. I am!” Because the charge nurses are usually so competent, you will need to build a compelling case if you choose to therapeutically extract them.
Document, document, document.
5. Remove his/her power
During a coaching call with one of the leaders in my online academy, she wanted to talk about how to handle a charge nurse who never attends staff meetings (it’s a requirement), doesn’t do her mandatory audits, undermines her authority, and is a toxic force in her department. My advice? I recommended that she remove her power – take her out of the role immediately.
When small acts of incivility or disruptive behaviors go unchallenged or ignored, these people gain a sense of power. This power leads to more and more acts of aggression to the point where they feel untouchable.
If your charge nurse is the problem, it doesn’t matter how clinically competent he or she is. Take him/her out of the role. Period.
Never, never, never allow someone who isn’t a professional role model to stay in a power position. People with power are more likely to abuse those without it.
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Make no mistake about it. The charge role is a power role. Make sure you have the right people in that role because if you don’t, you’re putting everyone else at risk.
If you need help to address disruptive behaviors in your department, stop trying to figure it out on your own. Call us instead!!
The team at the Healthy Workforce Institute is ready to help you cultivate and sustain a healthy and professional workforce culture. Check out ways other organizations get the help they need by clicking here.
Be kind. Take care. Stay connected.