Legalities, Pros, Cons of becoming a charge RN in ER

  1. My concern is becoming a charge RN in a city hospital with 1 1/2 years ER experience only. Previous experience was mostly Mother/Baby nursing about 14 years and Med/Surg 2 years. This has been mostly hands-on learning at this facility with a high turn over on the night shift. I work week-ends only at this time and every shift is full speed ahead usually the entire 12 hour shift!!!Most of our experience nurses have moved to days or to another facility with better staffing, pay or benefit packages.
    My decision making has improved, but I feel your charge nurse needs to have more ICU/CCU background. I would like to know the legal ramifications of being charge. Are you responsible leagally for all those that work on your shift?? We have many new nurses coming to this shift and the orientation process is not adequate due to short staffing and busy ER.
    I would appreciate any input that you can offer.
    Thanks,
    Karen,RN
    •  
  2. 22 Comments

  3. by   CmRenstrom
    I understand your concerns, but if they didn't think you were qualified to work charge they wouldn't put you in that position even though it appears there is a need for you to do so.

    Being in charge means that you are responsible to "supervise" or "observe" other caregivers. It doesn't necessarily mean that you are legally responsible for their actions. It also doesn't mean that you should "know everything." At the very least you should be a good resource and know where to help them find the answers if you yourself cannot help or answer them. That may mean knowing which policy manual to look in, or to call the administrative manager on duty if needed. Other departments of course too can be a good resource when in doubt such as calling one of the intensive care units for advice etc.

    Staff are more nervous these days to take on that role, but to tell you the truth I don't think there ever is the perfect time. Everyone feels unsure at first. Many of your senior staff members may remember working charge right out of nursing school.

    As I stated prior, someone must identify good decision making skills in you or you would not have been approached to be a charge nurse. Be confident, stay calm, and a sense of humor never hurts either.

    Good luck!
  4. by   CEN35
    you stated, it should be someone who has some icu/ccu experience? let me say, i have never worked in a unit (as regualr staff....just when they need the extra help).

    they threw me in charge 11 months out of school, into the er. i did it for a year, and then quit doing it.
    not because it was difficult, or tough. i quit because there were too many dinosaurs around, and they would not listen to me. they did their own thing no matter what, and so i quit doing it.

    about a year after i quit doing charge, they asked me if i would do it again. by this time most of the dinosaurs quit and went elsewhere, or changed shifts and it woudn't affect me. so i said yes. two years later i took a manager position.

    i was told a few months ago, when i was there i was to be in charge no matter what. this came up, because i would often come in, and delegate it to somebody else....and just take an assignment.

    why? because taking an assignment without the charge hassles, is way less stressful. guess now it's part of the job description.

    anyways....... you are not legally responsible for everyone in the er. although if your like me, you feel that way most of the time. i try to know, all 17-24 patients in the front part of the er, inside and out (i.e. complaint, labs, ekg's, tests, etc), but that's just me. i want to know who is nothing, and who can go bad in a heartbeat.
    the way things are now days, having 17 rooms, doesn't mean 17 patients. it means that 17 rooms will be filled, and the rest will be in the halls. if i'm not on top of all of them, then i can't conclude which most likely need a room, with/without a monitor, with/without o2 etc. etc.
    i don't claim to be god, allah, budda or some supernurse. the thing is, the docs have an overwhelming amount of confidence in me. we have a lot of new grads that come in to the er. we also have had a lot of new to er people come into work there. unfortunately, there is not only a lack of nurses out there, but alack of seasoned er staff.
    my suggestion......it's difficult enough, to not feel responsible for everybody wheh your in charge. help the people (within reason) that need help, and let those that can handle it on their own do their thing. when you see or feel a patient is headed down the tubes, stick with that patient. help that nurse out. they all don't go bad at once. most of all, don't sign every freakin chart in the place.
    you can't possibly take care of every patient in the er yourself. sign too many charts at one time, and the lawyers will lick their chops.

    just my 2 cents

    me

    p.s. - you'll be fine!!! :d any questions, give me a buzz. this is not meant to sound arrogant, rude or make you worry. it's just how i look at the picture. every artist paints a different picture.
    Last edit by CEN35 on Feb 24, '02
  5. by   KKERRN
    CmRenstron and CEN35:
    Thanks for your reply! I have alot of support from my co-workers and I have always been one to seek out any resource necessary to get the answers needed for the best pt care. I stay calm appearing, but inside feel like I'm swallowing my heart when it gets crazy. I just don't want to put my license on the line for what another nurse may or may not have done.
    We have about 30 beds and do tend to use halls when we have to. I need to be more confident in myself. Our charge nurse seems to always be pulled in so many directions at once. We have EMT's and LPN's that also do a great job, but it takes an RN to medicate, discharge,ect!
    I have worked hard for my RN and don't want to feel my license is on the line for what others may or may not do in a busy ER. I work nights and they seem to just keep us so short staffed after 1am-3am we often only have 4 nurses and many times 3.
    It's great to vent to another ER nurse for opinions. This week end was extremly short staffed and we were full. Sent 3 to cath lab and 2 of those arrived 5 minustes apart. Our teamwork effort was at it's best. This is what makes ER so rewarding as a nurse. I want to always give my best and in the ER sometimes your best doesn't feel like enough. I work with my best friend and she feels being charge is too leagally risky. She refuses to do it as many other nurses do. The dinosaurs, of course, encourage me to do this and several of them are true inspirations for me. Right now it is my decison to train for charge. I feel it would be better to have training ahead of time verses coming in and being thrown in charge without it. Most the training and orientation was just hands on teach yourself to survive...if you know what I mean!?
    Thanks again for responding to my concerns!
    I truly appreciate both of you.
    Karen/KKERRN
  6. by   teeituptom
    Howdy yall
    from deep in the hearty of texas
    Well yall, Ive worked Er for 14 to 15 years now as a charge Rn. And I can certainly appreciate your concerns over the legalities of being in charge. Our Er has 44 beds and even when we use them all, I still end up with patients in the hallways. I think thats the nature of the the beast, called ER.
    As Cen 35 says, he would rather put someone else in charge and take an assignment. I dont blame him atall. After all these years Ive made the rather difficult decision, at least for me< to step down from a charge position. But I can truthfully say it has nothing to do with the ER, as opposed to personal family issues I need to deal with, along with a strong desire to play more golf. And meetings were definitely interfering with that. So for me its a matter of priorities. Ill still work Er, but as staff. And Im looking forward to it.
    Well kkern, all I can offer you is that as far as legalities, you dont suffer from a captain of the ship problem in most states, as far as liability goes. What the main concern is. Do you feel comfortable in your skills to do this job. I will say do not let them force you into it if you are not comfortable with it. When you are in charge, you not only need to posess good delegation skills, but you have to lead by example. You also serve as a resource to every nurse under you. If they cant get that IV, they are going to come to you. If they dont know that medicine, they are going to come to you. If they dont know where to find that supply item, they are going to come to you. If there are patient complaints they are going to pass them onto you. If the floors are a little recalcitrant in accepting admits the nurse are going to come to you. If your supervisor needs some quality assurance done some of it at least gets shared with you. Plus anything else that is a problem is going to be brought to your attention, no matter what it is, big, small, major. insignificant.It all gets brought to you. Trust me on this been there for 14 years , and I have done it all. do I have any regrets about being in charge, hell no. Do I have any regrets about stepping down after all this time, the answer is both yes and no.
    I dont know you or your full situation there. Important considerations include. Knowing your policies and procedures, can you be a resource person. How supportive is your head nurse of the department. Ive been lucky, mine has been wonderfull, she even supports my decision to step down. Do you know all the Federal regulations you need to know. How to transfer to another facility if needed or requested. Is she going to give some time to orient and learn the position, or are you just being thrown in. But the main thing is, Do you want to do this or not. Because if you dont really want to. Like anything else it will just chew you up and spit you out. Can you do it if you want , YES.
    The best I can offer is to look into yourself and decide if you want to do this or not. If you want to I have the greatest respect for you. and Just because your asking in this forum I think you can do it. If you want.
    Best Wishes
    Been there and survived without too many scars.
    Keep it in the short grass yall
    teeituptom
  7. by   KKERRN
    teeituptom,
    Thanks for your input! At this time it is still my choice. I am very good at resources...finding a answer or solution that I feel is most correct. I think my short time in the ER has really improved my thinking process of how and where to find 'em.
    Where would I find the infor on the Federal regulations??? Would my hospital have a manual for them??
    Also, you mentioned that I should know how to transfer to another facility if needed or requested...do you mean myself or our patients??? My concern there is last Sept our head nurse was in a nut shell asked to step down or resign her postion due to her superiors didn't feel she was performing her duties/always acting in the departments best interest with decisions she made!! I do know how to use the COBRA form required by State of Ohio for patient transfers and I do have many options to transfer within our facility or within the area I work. Presently, many area facilities are offering nice sign on bonus/packages for RN's. Our new head nurse is very supportive of the unit, but doesn't always seem to be there for our night shift when it comes to staffing needs.
    I would not be charge every time I worked (at least this is what they relay to me at this moment) and I do feel I could handle it. My skills are good, but I have always lacked what I feel is a strong self confidence in my knowledge background for ER. Everyone ensures me there is always gonna be things that seldom are seen and we can never know everything. I have what I call the common sense or gut feeling to know when to research through questionable orders,situations,ect.
    One of my concerns is that I'm not comfortable with several co-workers that I may be in charge of that just do orders or push meds as ordered without second thought and I don't want to be responsible for their behavior on my license. I worked too hard to risk it!
    Thanks for responding. It's great to talk/e-mail this over outside of my own co-worker's!!
    Karen/KKERRN
  8. by   teeituptom
    well Karen
    I can certainly relate to what you refer to as coworkers, who just push meds as you put it without a concern for anything else. I have a few of them also. Are you responsible for them in a legal sense. No I dont think so, they are liable for their own actions, unfortunately its the patients, who can get hurt by them. But you cant be held liable for their actions. If you see them doing something that concerns you, make sure yo document, document, and document.Cover your rear with documentation.
    When it comes to night shift, I also know the feeling where it seems like were second class citizens of our Er when it comes to staffing needs being met. But having dealt with staffing now for a long time. Filling nights is the hardest. Agency nurses who fill in dont really get much of a differential incentive to work nights. So they hold out for and generally get day slots. The same with prn nurses.
    Talk to your nurse manager, about her support for night shift. Mine has been great over the last decade with her, I could call Amy or Tammy in when we were slammed or to short to cover what needed doing. And if I called there was never a question in their mind that I did indeed need them, and they were there for me, as quickly as possible..
    In regards to transfers I was alluding to cobra guide lines. Personally I find job hopping to not be the answer. Of course Ive been very fortunate here, Ive had a very good job, and Have had a good dept manager, also a good medical director that I could go to with any problems. And none of them have ever put me off at all, if I ever came to them with a problem. So, Like I said, Ive been very fortunate. They have even been supportive of me in my decision to step down from charge position, regretfull yes, but supportive. So Im staying on as staff here.
    Need any advice l
    let me know
    untill then
    Keep it in the short grass partnuh
    Teeituptom
  9. by   debbyed
    From what you write you sound like you'll do fine. Basically I'd just be repeating what CEN35 and Teeituptom have said. From spending some time on this board it usually sounds like CEN35 and I work about the same.

    Our ER has 27 beds and a new one is being built that is 10-12 (HaHa) beds larger. The Charge role is basically to keep moving patients through the system and put out fires. At any given time I can usually tell you what is wrong with each of them, which need to be admitted, which need to be discharged and which are the "Oh ****" patients.

    It sounds like your decision making skills at good and getting better, you just need a little boost in self-confidence. Again I'll repeat you'll be fine and this too shall pass.

    With the new mamage you might suggest that (remember these first few words because they'll open doors for you) FOR THE GOOD OF THE UNIT AND TO INCREASE STAFF MORAL she might want to develop a Charge Nurse Class with orientation.

    Some thing you might do as a project of your own is to start a "Charge Nurse Resource Book" Use a 3 ring binder and when ever you have to search for a policy/procedure that you or another charge nurse may have to find again, copy it and put it in the book. Include Memos that you might have to refer to and anything else that might make the job a little easier for someone else.

    Things that jump to mind are things like Disabilities Policies (like how to contact a deaf interperter) Rape policies Policies on what "redistributed" nurses (floor nurses pulled to ER) can and can't do and so on and so forth.

    If you have questions feel free to E-mail me.
  10. by   KKERRN
    teeituptom and debbye
    I was glad to readyou were alluding to cobra and not changing jobs. I plan on staying at this facility until I retire which could be another 15-20 years!!
    Our new manager has came in to help a few times when we are short and I will always have one of them on call to answer any questions.
    I really like your idea on the charge nurse resource book! I currently carry an address book which fits in my pocket that I use for many things. I keep in-house numbers, ambulances, police, hospitals, nursing homes to call report to, taxi, ect phone numbers. Also, I have tidbit notes about various resources or policy infor, med info...just anything I feel I could need in the future. Our unit has one old book with these numbers, but you can never find it when needed. Several co-workers now have started their own pocket versions too. I always encourage the new staff members to start one.
    Our hospital also has a night supervisor that we call for problems, questions or helping hands. Our supervisors have been there when we call them no matter what the reason.
    Thanks again for your support. I'll put your sugestions to good use.
    Karen/KKERRN
  11. by   massEDgirl
    I have been taking charge for a while on the night shift in our ED. It is mostly the SENIOR nurses that are asked.....although there are alot of senior nurses that can not handle the stress of it and refuse to do it. It can get very CRAZY at times but I am lucky to work with excellent nurses that all help each other. Ones that chose not to work like a team do not last very long.

    My role is mostly making sure the flow of patients keeps moving.... Organize traffic flow of ambulances.....make sure admissions are not held up (HA HA HA)and when the hospital beds are full and we are "boarding " patients I try to help out where needed. Newer nurses often look to you for support.

    It can get scary when you are full ,and have no more room, and you are on the verge of a diversion. I do not think I could do it without a good group of nurses to work with...I hear the "Day Queens" are are hard group to take charge of. That's ok...I'll stick to my nights.
  12. by   KKERRN
    Deb
    Most of our senior members are now on the day shift! Basically, for me to be in charge it means all the seniors on nights are off. We have some new hires coming in now...one has 25 years ER and the other 2 will be new grads.
    Our new head nurse now is trying to set up a mentor program and preceptor program for new hires. When my friend and I started we felt like they just wanted to eat their young, instead of trying to teach them to survive. Even though they was extremely short-staffed...it didn't seem that they were receptive to new team members either. Now that has changed somewhat. My friend and I still remind them how we were treated and that if they want staff to be productive and stay in the ER, that they neeed to be welcomed and shown how to be part of the team!!
    There is only a couple co-workers that I would rather not work with or be in charge of, but I guess you find that no matter where you work.
    Thanks for your feedback!
    Karen/KKERRN
  13. by   KKERRN
    Well, my charge nurse training has begun and I'm scheduled for charge the first weekend in May. My first night I have another charge nurse working 1900-0300 and I work 1900-0700. The main charge nurse on nights will have me do charge for 2 weekends while she takes a zone...real orientation...she will be there to guide me as needed!!
    The head nurse has been very receptive to answer my questions and to make sure I have some training. Usually, there is not any training for this in our ER. I stood my grounds and said I would only accept this positon if I have training and not thrown into it. Then, they thought it was a good idea. I heard so many stories form other charge nurses about being thrown into it.
    I told them I feel I have came along way with the poor orientation experience they gave me and I will not allow that to be the process for taking charge. I want to do this now. I was ambevelient for awhile. I just want to do my best! I'm usually too hard on myself and I know this is going to be a challenge.
    This site has been so helpful in my decison making for this and I again want to thank each of you for sharing and being there for me!!
    Karen/KKERRN
  14. by   traumaRUs
    I wish you the best. I'm one of the night charge nurses in large (62k/visits) level I. Our problem, as with everyone is the acute staffing shortage. We hire new grads, but a lot leave quickly due to the high acuity/census. We have a mentor program, but I'll be honest, we don't do much with it, because we just try to staff every shift, everyday.

    We are probably going to mandatory OT soon. In Illinois, you have to be a trauma nurse specialist in order to care for level I trauma pts and we are losing so many, that soon the charge nurses will be the only TNS's which is scary.

    I wish you luck>!

close