On any hospital unit, the charge nurse is the go-to person, the one who fields the questions, complaints, reports and physicians' orders, while coordinating staff scheduling and the care of every patient.

Charge nurses used to only work as charge nurses, but that led to too much burnout, according to Christine Kelly, RN, a longtime charge nurse on the hematology/oncology inpatient unit at Children's Hospitals and Clinics of Minnesota's Minneapolis campus. "It's a lot of responsibility, and as our acuity has gotten more acute it can be a heavy load," Kelly explains.

In Charge And At The Bedside

Charge nurses these days split their time between patient care and being in charge. "For consistency, working four days in a row in the role really helps with continuity of care. People know who to go to," explains Kathie Schoenecker, RN, a charge nurse at St. John's Hospital in Maplewood, part of the HealthEast Care System. Schoenecker works on a telemetry unit with up to 33 cardiac patients, where the charge nurses on each shift work a rotating four-week schedule.

"You have to anticipate how many patients are coming in, who's going out, what kind of staff you need, who you have, and you have to make assignments for the next shift," she says. "You want to have enough resources but you don't want to end up with more than you need."

Skills Plus Humanity

Charge nurses must have excellent communication and leadership skills, and a thick skin, Kelly says. "The person I looked up to was somebody who could always do it with a smile on her face," she adds. "You need to be a delegator and be respected by your peers. To be respected, I think you also need to be a good caregiver of your patient, and also of your staff and yourself."

Anyone interested in becoming a charge nurse should ask those in the role what their job is like, shadow them and pursue educational opportunities offered by their employer.

"You have to do conflict resolution, and there are classes about that," Schoenecker says. "Build those skills. You need those every day." Once on the job, charge nurses should check in with co-workers on a regular basis. "Don't be afraid to ask questions when you're in the role," says Kelly. "After your shift is done, talk to people. Ask, `How do you think I could have done this better? What should I have said instead of this?' And get feedback. I think that's key."