Charge Nurse

[2bTraumaRN2008]

Just a "general" questions for you all...

Do you have charge positions at your facility? If so, how many on days/nights?

How many beds is your unit?

What is your turn around like?

Just wanting to know because I think my facitly needs 2 day shift charges, we used to have 2, but one became manager and they never refilled the position.

I am on a 40 bed med/surg unit with 15-20 discharges and admissions a day. As soon as one leaves, another is rolling in.

The charge will help with admits/discharges when possible, but if we have to do it, it can be very overwhelming with a 1:6 ratio...trying to admit/discharge someone, while someone else is calling out for help or 3 call lights are going off, etc.....

I'm trying to convince mgmt that we need our 2 charges back, one for each wing (20 patients) on each. This made for smoother transitions for the incoming/outgoing pts, and pt satisfaction was higher because we had the charge to help out, and was more readily available since they only had 20 pts to oversee vs. 40.

Just looking for advice to take back to mgmt to see if we can get our second charge nurse back.

Thanks in advance for your input :)

[HouTx, BSN, MSN, EdD]

Sorry to be the bearer of bad news, but multiple charge nurses are rapidly becoming extinct. In fact, in order to deal with increasing productivity requirements, many organizations are now requiring charge nurses to take a patient assignment rather than being free-floating. These productivity standards are mandated by the top.... and managers must comply or lose their jobs.

I am interpreting this scenario as a typical "failure to keep the lights on" example of bad management. A clinical manager cannot simply eliminate resources without coming up with a way to continue necessary services and functions.... it always produces the same type of bad outcomes.

Staff have very little chance of reversing staffing decisions that have been made by higher-ups. Instead, you should be asking the manager to pitch in (like he/should have done in the first place!!!). When the charge nurse is in need of assistance for simultaneous admits/discharges, etc - the manager needs to step in and take care of one of them.

Best of luck to you!!!

[classicdame, MSN, EdD]

It is harder to justify costs when someone does not have direct patient care duties. I do agree that a charge nurse is valuable, but ours also have patients, though less of a load.

[Elladora]

I work in a psych unit, so my situation is probably a little different. We call our charge nurse a Nurse Lead. There is one per shift for anywhere from 80-90 clients. Turnaround time for us averages 6 months. We have some people that stay a month of two and some that have been there 25+ years.

Good luck to you!

[2bTraumaRN2008]

Hmm, very interesting...None of our charges take pt. assignments, except at night...that person may take one or two pts. until the 2300 nurse comes in, then the assignment is changed, and this is very RARE that they take pts.

They are now looking at creating a "floating admit/dc nurse" who simply does this, and of course helps others in need as warranted. This of course will free up the charges for other duties, but I see the charge as being more valuable since our census is always high, and our acuities are through the roof!!

No mention of eliminating charge positions in general, they post jobs for them in other units ( which is few and far between), but they have been available. I would think if they were going to due away with the positon, they wouldn't fill them as ppl. leave.

[turnforthenurse, MSN, NP]

Our dayshift charge is our manager, but since she is on maternity leave, there is another nurse who has assumed the role in her absence. Our manager (and also this nurse) do not take patients. They mainly round with the doctors in the morning on all patients. They also help with admits/discharges, help answer call lights, etc. There have been a few days where the "charge" RN has been absent so one of the regular staff RNs will assume the role of charge, but they have to take a full patient load, which is supposed to be 1:4 but lately has been 1:5 because we are short on nurses. And they still have to round with the doctors in the morning. We occasionally also have a nurse who will work solely as the admit/dc nurse during the day, but that is once in awhile, it seems.

Night charge is one of the staff RNs...we switch off to try to make it as fair as possible. We take a full patient load (1:4-5) but we do not have doctors to round with. I round with the doctor on my patients if they happen to come by and see them (which is rare, unless the patient is a new admit) but that's about it. We check the crash carts. Make assignments for both the night shift and day shift (goes faster because day shift already knows their assignments and we can start report right away!). We assign beds. If patients have a complaint and wish to speak to the charge nurse, then that is our duty as well.

[NicuGal, MSN, RN]

We have one permanent charge person on each shift. They work 4-5 days a week. They usually don't carry a patient load. Some days when we have 50 kids and the lid is blowing off everything, 2 charge nurses would be good, but not gonna happen.

[anotherone, BSN, RN]

days rarely gets pts. evenings 75% of time does and nights always do.always a full load too . it is charge of the shift. usually the person with the most experience gets to do it. some shifts that means 20years other shifts 9 months........ try to give charge easier pts but sometimes there isnt an easier assignment. and charge gets stuck dealing with staffing , a full load, and helping others. almost everyone hates being charge

[K+MgSO4, BSN]

I am charge on the AM or evening shift. I don't take patients. But I take 6 patients overnight. In the last 7 days we have flipped 51 pts on a 25 bed ward.

I assist with discharges and admissions. Trouble shoot issue the nurses have eg cannot get bloods canula caths done organise post op meals after 5 pm. This is a mission at our hospital!!

Update our handover sheet and computer system. Deal with the bed manager etc. August has been horrific. It's winter and we usually slow down but we have gone nutty this month. We usually average 70 discharges a month but by day 7 we have 51 I cannot see it slowing down.

We are fighting for a discharge liasion nurse who can take some of the pressure off the nurses and me. At least I am a member of ANF. One of the strongest unions in Australia.

I am sitting with a bottle of wine and a pizza post working 6 days!

[Jenni811, RN]

Im on a med/surg floor. We are 35 beds with 1 charge nurse that does not take any patients unless there is one EASY EASY patient who will not be discharged since discharges take a while. Like an observation patient or something. We used to have 1 charge nurse with a "secondary charge nurse" that has like 2 patients, or just is hands on the floor. They got rid of that position and brought in 2 Clinical nurse leaders and a Clinical nurse specialist on each floor. Apparently they are supposed to help out on the floor, so we were all for having them.

It has been anything but, all they do is make MORE work for us instead of helping us to complete it. Those positions have just been a complete joke.