NR 447 Week 7 Night Charge Nurse Interview Paper Example

The Hour She Would Take Back: An Interview With a Night Charge Nurse on an Orthopedic and Neurology Unit

Student Name

College of Nursing, Chamberlain University

NR 447: Collaborative Leadership in Healthcare

Instructor Name

Month Day, Year

The Hour She Would Take Back: An Interview With a Night Charge Nurse on an Orthopedic and Neurology Unit

The Interviewee and the Approach

I interviewed a night charge nurse with fourteen years of experience, nine of them in charge, on a 36-bed orthopedic and neurology unit in a community hospital. The conversation lasted about fifty minutes, in person, after her shift. I prepared eight questions but used only four, because the most useful answers came from asking her about one specific night rather than about leadership in general. The findings below are arranged by theme rather than in the order they came up, and her words are quoted only where the wording itself matters.

How the Questions Changed

My first two questions were the ones most students would ask: what makes a good charge nurse, and how do you handle conflict on your team? Her answers were thoughtful and could have come from a textbook: be fair, be visible, listen first. Neither answer told me anything about how she actually works. The interview changed when I asked a third question from my list, tell me about a night that got away from you, and she paused for several seconds before answering. From then on I dropped the rest of my prepared questions and followed that night, asking what time things happened, what she was doing when the new nurse came to the desk and what she would do differently. The contrast between the first ten minutes and the rest of the conversation is itself a finding: general questions invited her to describe the leader she wants to be, and the specific question invited her to describe the leader she was on one night.

The Night She Would Take Back

When I asked her to describe a night that got away from her, she did not hesitate. Two years ago, at about 0230, a patient on her unit who had had a spinal fusion that afternoon became hard to wake. His nurse, a new graduate, came to the desk and said he seemed sleepy. The charge nurse told her to check his pain medication and recheck him in thirty minutes. "I heard sleepy and thought opioids," she said. "I didn't go look." At the recheck he was unresponsive, and the rapid response team found that he had a large epidural hematoma. He had emergency surgery and recovered with some lasting weakness.

What she said next was the most important thing in the interview: "The new grad did everything right. She came to me. I was the one who didn't get up." She said she was charting on an admission at the time and that it felt reasonable to let a nurse handle her own patient. Looking back, she believes the problem was that she heard the new nurse's words through her own expectation rather than asking what the nurse was actually seeing.

Where She Agrees With the Reading

Much of what she described matches this week's material on the charge nurse role. Eggenberger (2012) describes charge nurses as holding the frontline, carrying responsibility for the whole unit's safety while also absorbing tasks and problems themselves. The charge nurse described that exact tension: she was holding the unit by charting an admission so her nurses would not have to, and in doing so she was not available to see the patient who needed her. She also described the pull toward protecting new nurses from being overloaded, which led her to take tasks from them rather than to go and look at what they were seeing.

Where She Disagrees With the Reading

The most interesting part of the interview was where she disagreed with what I had read. The course material on delegation and supervision emphasizes that the registered nurse should give clear directions and follow up. When I described that, she said: "That's written for day shift." Her point was that at night, the charge nurse is often the most experienced nurse in the building outside the intensive care unit, with no manager, no educator and a house supervisor covering several floors. In that setting, she said, supervision is not a follow-up after delegation. It is physically going to see any patient a new nurse is worried about, every time, regardless of what the charge nurse is doing. "If a new grad walks to my desk, I stand up," she said. "That's the rule now."

I think she is partly right and partly overstating it. The reading does not say that supervision is only verbal follow-up; the national delegation guidelines describe supervision as including direct observation when the situation calls for it (National Council of State Boards of Nursing & American Nurses Association, 2016). But she is right that the material assumes a level of support that night shift often does not have, and that on nights the charge nurse's own eyes are often the only second assessment available. Her rule is a response to that gap, and it is more demanding than anything in the reading.

An Answer I Did Not Like

One answer bothered me. When I asked how she handles nurses who call her to the bedside too often, she said she sometimes lets them work it out, "because they have to learn." That seemed to contradict her rule about always standing up. When I asked about it, she said the difference is what the nurse says: a nurse who asks where the supplies are is different from a nurse who says a patient seems wrong. I understand the distinction, but it relies on the charge nurse correctly hearing which kind of request she is getting, and that is exactly what failed on the night of the hematoma. I did not challenge her further in the interview, but I think this is the unresolved part of her practice. Benner (1984) describes expert nurses as recognizing patterns intuitively, and her rule seems to depend on intuition that she has already told me failed her once.

What I Take From It

I take one practice from this interview. When I am in charge and a nurse, especially a new one, tells me a patient seems off, I will go and look before I suggest a cause. The charge nurse's story showed me how easily a word like sleepy can be heard through an expectation, and how that expectation can come from what the charge nurse is doing at the desk rather than from the patient. It also showed me that the reading on delegation is written with more support in the building than many night shifts have. The finding of this interview is that on nights, the charge nurse's job includes being the second pair of eyes in person, and that this has to be protected even when it means leaving an admission half charted.

References

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Eggenberger, T. (2012). Exploring the charge nurse role: Holding the frontline. Journal of Nursing Administration, 42(11), 502-506. https://doi.org/10.1097/NNA.0b013e3182714495

National Council of State Boards of Nursing & American Nurses Association. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3