1. Cox, Sharon MSN, BSN

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Q I was excited to become the nurse manager on my unit, having enjoyed being a charge nurse for 3 years. But 6 months in, I'm rethinking my decision. I just put out fires every day, my former friends aren't sure how to relate to me, and my health and home life are suffering with the 24/7 demands of the role. Where do I start to get this turned around?

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Clearly, your honeymoon is over and the real learning curve has begun. Think of this turnaround process as changing your mindset, building relationships, and establishing boundaries. Attending to these three steps will take you out of your comfort zone, so remember that being uncomfortable can be a good thing; often, that's where your growth is.


Having moved from an expert charge nurse to a novice manager, it's natural to feel overwhelmed. You've taken on a role that challenges you, and failing to manage these feelings can lead you into a "downward spiral" of reactivity, self-doubt, victim thinking, and even isolation. It's essential that you shift to a more proactive mindset or "upward spiral" to have the energy for a management role. To shift from reactive to proactive thinking, always begin with taking ownership of how you may be contributing to the situation. For example, are you trying to be all things to all people, ignoring your intuitive sense, having difficulty asking for help, or setting unrealistic expectations?


Brainstorm with someone who knows you well on options for changing self-sabotaging behaviors. Think about what you need to be more effective and develop a plan that reflects how you want to proceed. By focusing on things you can influence and problem solving situations, you'll feel the energy that always comes with being proactive. This change in energy lets you know that you've made the all-important shift away from reactivity.


Along with working on your inner game, develop team agreements in key relationships, such as your director, staff members with whom you work, and department directors closely aligned with your unit. These agreements should be in response to the question, "What do I need from you and what do you need from me for us to work well together?"1 Revisit these agreements every 3 to 4 months and delete or add to them as needed.


Ask for routine 1:1 meetings with your director every 2 weeks to problem solve and negotiate for what you need. Ask peers with expertise in areas that you find difficult for mentoring to expedite your learning. Develop a peer partner relationship so that you don't have to rely on previous friendships. The transition from close friend to manager needs to be intentional; the advice from others who've lived through it can be invaluable. We all need a good friend at work who has our back and offers honest feedback, so choose wisely and nurture this relationship.


In addition to taking ownership for personal changes and building a network of healthy relationships, you must set boundaries. Remember "you get what you tolerate," so decide what's important to you and determine limits. For example, work with your peers to create a system for sharing on-call time, develop a decision tree for staff members to use before they call you, commit to answering e-mails only during work hours, or make your exercise routine nonnegotiable.


Lastly, always give yourself a year before making any role changes, taking good notes along the way. And don't forget the workplace serenity prayer: Grant me the serenity to prioritize the things I can't delegate, the courage to say no when I need to, and the wisdom to know when to go home!




1. Cohen S, Cox S. Essential Skills for Nurse Managers. Danvers, MA: HCPro; 2015:33-34. [Context Link]