10 Tips for a New Charge Nurse
A charge nurse is so important in keeping a hospital department running smoothly. Whether in the ER, ICU, or inpatient floor, the charge nurse is essential to the team.
Being a charge nurse often comes with years of experience — but sometimes it comes with less than one year. Many units have high turnover, and you can find yourself in charge with a year of experience or less. (Believe me — I was one of them!) It's nerve-wracking, but it's absolutely possible to do a great job. Here are some charge nurse tips to help you become a resource your team can rely on.
What Is the Role of a Charge Nurse?
A charge nurse is the "nurse in charge" on the unit — the leader of the team, at least for the shift. They're usually one of the most experienced and knowledgeable nurses on the floor. The job differs by unit, but it usually involves:
In the emergency department, a major role of the charge nurse is throughput — keeping the department moving by getting patients admitted, discharged, or transferred out, and making space for new patients coming in. On a busy night you may even need to take your own patients or function as a triage nurse when short-staffed (which, let's be real, is basically the norm).
Tip 1: Know the Policies
A major job of a charge nurse is to know the policies inside and out — essentially the rules of flow for your specific department, aka "how it all works."
This includes policies on the admission, discharge, and transfer process; medication administration, transfusions, and more. These are specific to each facility and department, and you'll naturally learn them over time on the floor. In the meantime, each facility should have an intranet (online database) or printed resource where you can look policies up, print them, and save them as needed.
Tip 2: Know Your Backup
It's ideal to have a charge nurse with years of experience, but that's not always possible. Nursing turnover is real, especially on night shift, and you may find yourself in charge with as little as one year of experience or less.
With a year of experience or less, you simply cannot be expected to know everything — every policy, every situation. That can be terrifying, but there are resources available when you don't know the answer. Even though you're the charge nurse, there should be a "higher-up" you can reach:
A Real Example
I moonlight as a night-shift hospitalist. A charge nurse on a med-surg unit with less than a year of experience reached out, concerned that a patient's heart rate was dropping into the 30s during sleep. The patient was asymptomatic and had been bradycardic in the 50s while awake. I reassured her this was okay — even expected — in this specific patient, and to notify us immediately if he developed any symptoms or abnormal rhythm. When you don't know, reach out.
Tip 3: Get Good at Throughput
A charge nurse's primary responsibility is to keep the department moving. This is crucial in the ER but matters on any floor. Patients need IVs started, labs drawn, transport to imaging and back, medications given, call bells answered, and discharge instructions. Admitted patients need report called and transport upstairs.
Delays in throughput are common, especially in the ER, and may be due to:
A charge nurse can minimize many of these by being proactive: transporting patients, cleaning stretchers, making phone calls, helping nurses, and reminding providers to reevaluate and disposition their patients. That's how you become an expert at throughput.
Tip 4: Help Out
The nurses in your department are busy and overworked — you can say that again. Being chronically understaffed is all too common, which means nurses fall behind on assessments, procedures, medications, and charting. That impacts throughput, patient satisfaction, and worst of all, patient outcomes.
As the charge nurse, you need to help your nurses wherever they need it — placing IVs, transporting to radiology or the floors, obtaining EKGs, triaging, and giving ordered medications. It makes you a good team player and keeps the whole department running.
Tip 5: Lead by Example
As a charge nurse, it's your job to lead by example. You may not hold a formal manager title, but being selected as charge for a shift means you are the team leader, at least for that shift.
Don't do one thing and expect another from your nurses. Help out whenever you can, maintain good rapport with patients, providers, and ancillary staff, and conduct yourself with professionalism and integrity.
Tip 6: Stay Calm in Crisis
Staying calm during emergencies is important for any nurse, but especially a charge nurse. It's your job to put out fires left and right and make sure the nurses on your unit handle emergencies appropriately.
Emergencies happen in the hospital all the time — it's the name of the game. And it's not just life and death that tests you: families may be yelling because they're frustrated, and patients will literally be trying to die on you. Staying calm is easier said than done, but one thing that helps is knowing your stuff.
If you know the policies and what to do in specific emergencies like cardiac arrhythmias or codes, you'll be more prepared — and that preparation gives you a sense of calm when emergencies inevitably arise. There is nothing more stressful than uncertainty.
Tip 7: Be a Good Team Player
Being a good team player matters for any nurse, but especially a charge nurse. Be a hard worker willing to help others — don't expect them to return the favor, but a good team player eventually will.
As the person "in charge," it's important to not play favorites. Don't give your "besties" easier assignments or fewer admissions; the nurses will resent you, so be as fair as you can. Always have your team's back. Understand situations from their point of view and give them the benefit of the doubt — nurses aren't perfect and do make mistakes, so support them however you can rather than throwing them under the bus. These traits matter in any leadership position.
Tip 8: Stay Organized
Staying organized is huge for nurses, and charge nurses have an even bigger need — you're not just managing your own patients, you're managing the entire floor. Knowing who has what assignment, which patients they have, and what needs to be done is essential. In stressful environments it's easy to know you have a lot to do but not know where to start.
Get there early if you need to, make lists, and prioritize. Chart in real time to avoid the charting backlog that weighs you down and adds stress.
Also check out: How to Stay Organized as a New Nurse.
Tip 9: Be Great at IVs & Procedures
As the charge nurse, you will be used as a resource. Nurses will come to you when they can't place an IV, when a procedure is giving them trouble, or when they've never done it before.
It's a great idea to be excellent at IVs — they're a common need on any unit, but especially in the ER. Placing lines and drawing bloodwork is essential for throughput and good patient care, so it's a valuable skill to have in your scrub pocket. Practice, practice, practice, and learn all the tips and tricks.
Related: 10 IV Insertion Tips for Nurses and How to Start an IV.
Tip 10: Be Good at Rhythms & Codes
Probably the most stressful part of being a charge nurse is the pressure of knowing what to do during emergencies — intubations, code blues, and emergent cardiac arrhythmias. Knowing your cardiac ECG rhythms is so important, yet many nurses struggle with it. As the charge nurse you need to be an expert, because your nurses will come to you for advice or interpretation.
You should know each drawer of the code cart, the code cart meds and how to reconstitute them, and how to use the defibrillator. That includes:
You should also be familiar with the basics of how to recognize a STEMI. If your rhythm interpretation and arrhythmia knowledge could use some work, building that skill set is one of the best investments you can make as a charge nurse.
