Charge nurse responsibility

  1. I need help......I am occasionally in charge on 3-11 in level 2 16 bed Ed .Ideal staffing is 6-7 Rn , a sec and a tech. We have 4 new staff members all have taken a critical care nurse internship, all are ffrom nursiing home backgrounds with an average of 10 years, now all off orientation and working staff. so about 6 months in the hospital now. One night I was in charge myself and my staff consited of the 4 newbies. I prayed all night the we didnt get any critical pts.and we didnt. I dont feel that this is appropiate staffiing. I wrote lettersand spoke to director of nursing, unit director, risk managment, and I had the support of the medical director of the ed docs who happened to be one of our docs that night. Ihave worked in this hospital for 21 years , last 12 in ed, I have never done anything like this or have ever been so scared to be in that situation., I now have refused tio be in charge unless I have at least 3 other experienced nurses to cover triage, trauma and critical areas. I will not be placed in that situation again, I will quit and they know that,. Ihave been getting different answers to my question, how responsible am I for the inexperienced nurses , when I am in charge. Am I crazy, or does anyone else agree that a nurse with less than 6 mo experience should be responsible for triaging 60-70 pts a shiftor a trauma room? I fel like we are living on a prayer untill something happens........the other night(not in charge) one of the newbies runniing nitro , piggy backed wide open on a chest pain! pt ended up ok, diid all usual reporting of a med error, nurse manager said , we are working on part 2 of their orientation.! Help me! I used to love my job, but I am scared they are gioing to kill someone
    •  
  2. 5 Comments

  3. by   cmggriff
    ikimiwi,
    There is a book in print titled "Law Every Nurse Should Know".
    It contains a lot of very valuable info regarding just such situations. My understanding of the problem is that the "Charge"
    RN is responsible for all that happens in the ER during that shift. You are the Supervisor of those other nurses. If a newbie mistriages a patient you can be held responsible for not putting someone more qualified in the position. If you have no one better qualified, then you have taken an unsafe assignment. In short, it sucks to be you in charge of the newbies.
    BTW, what do you get paid extra to be "Charge"? Gary
  4. by   mcl4
    Originally posted by cmggriff
    ikimiwi,
    There is a book in print titled "Law Every Nurse Should Know".
    It contains a lot of very valuable info regarding just such situations. My understanding of the problem is that the "Charge"
    RN is responsible for all that happens in the ER during that shift. You are the Supervisor of those other nurses. If a newbie mistriages a patient you can be held responsible for not putting someone more qualified in the position. If you have no one better qualified, then you have taken an unsafe assignment. In short, it sucks to be you in charge of the newbies.
    BTW, what do you get paid extra to be "Charge"? Gary


    What would the nurses do then in this situation. Refuse to be in charge?

    I've seen charge position change somewhat today. We are all responsible to follow policy and procedures. If one doesn't, then this person is held accountable. Yet, I see the problem if a patient sues, everyone under the sun is part of the litigation which most likely would include the charge nurse.
  5. by   RoaminHankRN
    I feel for you...
    As an ex charge rn in the ER, it is not uncommon to run into these situations.
    Couple of ideas...

    1. DOCUMENT DOCUMENT... Can't stress how important it is to do this. For med errors, patient care complaints, staff concerns, what have you.. management needs documented cases about your "newbies" not doing things correctly. Will it change anything.. that is another story. But should something come down legally... you have documentation.. keep copies too.

    2. Talk to the people who you have trouble with. As a charge nurse you also have the responsibility and the opportunity to help these RN's. See if there is an area they have trouble with. Offer tips that you have amassed in your 12 years ER experience. Offer yourself as a resource..

    If all else fails, stop taking the occasional charge nurse.. and stay staff..
    But you are right, when it gets busy or you have a major trauma.. that's when it is frustrating. Get the house supervisor involved to help out if possible.. Let the newbies get involved and if possible, try to observe and help them out ( I know the rest of the department is usally in chaos by then)
    oh and remember Document!!!

    Good Luck
    Hank
  6. by   psnurse
    This is that old double edged sword. They don't have the experience to make you comfortable giving them major trauma, but if you don't give them major trauma, chest pains, ect., they won't get the experience for all of you to be comfortable.

    New ED nurses shouldn't cover triage. I have never been anywhere that they let you triage without 6 months experience minimum in that particular facility. Maybe, that would be a place to start?? They need hands on before their instincts start to kick in.

    I was in charge of ED when we had about 6 new grads come off orientation. It seemed they were all on my shift and all on my weekend. This is what I did and all but one of them did just fine. The other one had to go somewhere else, but she recognized that herself.

    I put all the experienced people in the minor treatment areas. Generally, these patients can wait if something comes up. Then I put all the newbies in the trauma and chest pain rooms. This meant their patient ratio was less even if their patients were sicker. Then I assigned them all a resource person, myself included in the resource list.

    The resource people weren't supposed to do the tasks, simply provide direction and oversee in a general sort of way.

    Then I told the resourse people, "Look, if you agree with it or not, these new people work here now. If you want some help, then maybe we should make them the best nurses they can be." Everyone stepped up to the plate and we developed some great teamwork. Very few incidents, very few med errors.

    This approach might not work for you, but it worked great for us.
  7. by   RNKitty
    PSNurse:

    What a great job of mentoring!!!! Kudo's to you to turn a possible negative into a great positive.

close