My hospital has recently started implementing some changes, and one of the things that they did was take away having free charge nurses on each unit (i.e. a charge with no patient assignment), and have started requiring that they take a full patient assignment on top of handling charge duties. As you can imagine things have not been going so well since this change. I'm just curious- is this a thing that exists in other places? Every place I've ever worked has had a free charge, except in emergency situations such as extreme short staffing when the charge would take a smaller assignment. If you guys could weigh in with your unit type/specialty, number of beds, and whether your charge is free I would appreciate it! Trying to gauge how realistic it is that all of our staff is so upset with this change.
400+ bed hospital, level I trauma center, teaching center. I'm a float nurse but do charge often. Ideally, I'm free on any unit that has at least 24 beds but often I'm not because let's face it, if I'm there, the unit is already short staffed. I personally like the challenge for the most part.
Every unit has a different budget and matrix so it's kinda hard to answer your questions. Some units lately have chosen to have a lower patient ratio and the charge take "lighter" patients...a 4:1 ratio. Doesn't matter if the floor is medical, surgical, cardiac, observation, etc. Normal ratio tends to be 5:1 but if we're really busting at the seams and staffing is tight throughout the house then we can go to a 6:1 ratio.
To me it's not the end of the world but it does really depend on how heavy the patients are mixed with how new and independent the nursing staff are if that makes sense.
Last edit by AJJKRN on Jul 9
: Reason: Typos
We have a free charge 99% of the time at my current hospital. Occasionally, the charge has to pick up one or two of the easiest patients. At the first hospital I worked at, the charge had seven patients instead of eight ...and no LVN to cover if they were lucky.
Charge nurses at my hospital take a full or reduced patient load. Small hospital. Ive also worked at a tertiary medical center where all except the dayshift charge took a full patient load when the doctors still wrote orders.
This may not be helpful since our unit is so different.
PACU - upto 10 beds, most patients require 1:1 care as they are not holding their own airways when they first arrive and some come still intubated. Once holding their airway, it's very possible on busy days to end up with a second pt that may or may not be holding their own airway. Charge nurse takes patients.
I'm on a Tele unit, our charge takes a full load. We are 1:5. They do assign them the easier patients though but I would never do it for the little pay increase they get.
When I started in ICU, charge had an assignment. We usually picked the lightest assignment for charge. The unit was small-only 8 beds and only experienced nurses were hired. Charge nurse helped with problem solving, bed placement, communication with the house supervisor, but that was about all.
The unit doubled in size and now the charge does not have an assignment, but does more work involving staffing (that used to be done by the house supervisor back when charge had a patient assignment). There is plenty to keep the charge nurse busy, and I hope we keep the charge nurse free in the long term future.
I am in oncology at a trauma level 1 & magnet hospital. Our charge nurses on days don't carry patients. The charge nurses on nights have anywhere from 0-2 patients, depending on census.
I am on a Gen/Surg floor in a 900+ Magnet hospital. Our ratio is 1:4 on days, occasionally 1:5. they try not to give anyone more than 1 patient that rates as high acuity. We used to be a standard 1:5 but we had an "intervention" nurse that did things like discharge paperwork, PRN pain med dosing or watching your pts while you might be in a room for an extended dressing change or something. Our charge has no patients. On nights, ratio seems to be 1:5 or 1:6. Charge may take an epidural if there is one.
The surgical unit I worked on varied. On day shift the charge nurse didn't take a load; on evenings the regular charge nurse typically didn't get a load but when I did relief charge on weekends I often had to pick up a patient load. I tried to arrange staffing to stay "free" so I could perform my charge duties properly, but often I was doing yeoman duty. On nights the charge nurse had a full patient load of 5-7 which I though sucked. This was also the "new grad" shift so who was going to be available to mentor them? They also had no ancillary staff. I thought they had a very raw deal.
Telemetry 28 bed unit at a Magnet Hospital. If staffing allows the Charge RN is free from patient assignment. If staffing is not sufficient, then the Charge RN has 2-4 patients. On a different note; does the Charge RN get paid more for charge? My current employer does not pay "extra" for beginning in charge. My prior employers have payed more to the RN in charge. As a result of administration not paying for the charge duties , I have refused to take charge. My stand is that if administration does not recognize and respect the extra work and responsibilities of a Charge RN, then I will not be a Charge RN. What are your thoughts?
Level 1 trauma center with Comprehensive stroke center designation, 600+beds. ICU (med surg + "neuro section") 2:1 ratio usually. charge has assignment usually 1 post
Op heart or 2 like the rest of us. Charge does not get charge pay. I wish we had charge RNs with no assignment.
In the Med-Surg unit I worked the charge would not have an assignment 99% of the time. If we were short, the charge nurse might have to take 1-2 patients, but it was always the easiest patients. In the ED I work the charge never has an assignment and is primarily responsible for patient flow and staff management. It would be ridiculous to have the ED charge take patients.
EDIT: In the Med-Surg units of the hospital in which I work ED, the charge nurses have a full patient load, which I think is absolutely ridiculous. I hope they at least get a charge differential (as we do in the ED).
Must Read Topics