How important is it for a Charge Nurse to be able to run a code?

[Anna Flaxis, BSN, RN]

Another thread here today got me thinking. On a scale of 0 to 10, with 0 being totally unimportant and 10 being absolutely essential, how important is it for a charge nurse to be able to run a code? Are there other leadership qualities that are more important?

The reason I ask is that I was recently at my ACLS refresher. One of the charge nurses from a 40 bed inpatient telemetry unit was in my group. This nurse should not have passed the ACLS refresher, IMO. He or she struggled every step of the way, and had it been a real code, I would have feared for this patient.

Now, I'm not saying that *I* could run a code seamlessly. There is a huge difference between a classroom environment and the real deal. But, I am not a charge nurse.

What say you?

[PMFB-RN, RN]

I would rate it as "0". Not important at all. It's not a charge nurses roll to run codes, at least not in any of the hospitals I have ever worked in.

They should know the initial steps to preform until the code team arrives, though, like how to call the code and to start CPR, fetch the crash cart. After the code team arrives the charge nurses roll should be to be available to fetch things or make phone calls, or maybe take part in the code as directed by the code team leader, usually this means CPR or recording. Otherwise they should stay out of the way.

ACLS used to be hard and people used to fail it all the time. Now they want everybody to have it, even med-surg nurses and it has been dumbed down to to the point of being meaningless.

[Anna Flaxis, BSN, RN]

They should know the initial steps to preform until the code team arrives, though, like how to call the code and to start CPR, fetch the crash cart.

This person failed to even do this. This is a telemetry unit, and the person did not recognize the lethal arrhythmia, to start CPR, to grab a crash cart, or to give the first dose of epi (at my facility, the floor is supposed to be capable of getting that far, because of the time it takes for the code team to arrive).

Otherwise, I see your point.

[brownbook]

I agree with PMFB. I'm just concerned that if the charge nurse struggled so much with the making it easier (or dumbing down) of ACLS, what other important, critical, medical-nursing concepts do they just not get?

But even with that I would rate people skills higher than technical competence in a charge nurse.

[heron, ASN, RN]

It may depend on the facility. Many long term acute care facilities don't have docs around 24/7. One such facility in my city most definitely expects charge nurses to run a code until EMS can get on site ... getting iv access, ventilation, checking the rhythm and defibrillating when indicated are all part of a code and, as we all know, things can get very confused when a pt codes ... a clear leader giving direction is a necessity.

[BUNightingale]

This is a tough one. Resusitation is one of my passions in nursing so my gut instinct is to say that charge nurses should be "experts" but I know this is not usually the case. I think they should be experts at CPR at least. CPR includes AED training so a lethal arrhythmia could at least be shocked prior to our arrival. My building is tall and maze-like depending on the floor you are on so our code team can take vital minutes to arrive. I would be happy to see the patient on the monitor, CPR in progress and the crash cart at the bedside.

[PMFB-RN, RN]

It may depend on the facility. Many long term acute care facilities don't have docs around 24/7. One such facility in my city most definitely expects charge nurses to run a code until EMS can get on site ... getting iv access, ventilation, checking the rhythm and defibrillating when indicated are all part of a code and, as we all know, things can get very confused when a pt codes ... a clear leader giving direction is a necessity.

*** Do they have tele units in long term acute care? I have never working in one and have no idea. In the hospital where I work a physician, either the senior resident, or the ER physician is the code team leader with the rapid response RN designated as the alternate code team leader. Where I currently work about 1/4 of the time no physician arrives until the code is well underway and the rapid response RN runs the code. There have been time when neither a physician or the rapid response RN arrives, usually when there are two codes at once, and one of the ICU RNs who is on the code team will run the code.

We do not even allow charge nurses, or any nurse other than the coding patients primary nurse to even be in the room unless they get drafted by the code team leader (unusual).

[ninjago]

Back when I worked in SNF, all that was required of us, Charge Nurse was a CPR- AHA. So when patient coded, we did CPR. But made sure 911 was called and on their way. Even though I and a few of the nurses were ACLS certified, we never get to do it because most often, EMS had already arrived.

In hospital, however, we (nurses working that shift) are each assigned a task in case there is a code. Charge Nurse is always the team lead before the doctor arrives. The admin staff are always there to help, too.

I work as Charge Nurse in another facility so I have to know it and be ready. So for me, it is very important 10/10.

[RNChristy]

I would have to say that the charge nurse should be able to at least run a code (10/10). I have been the charge nurse/Clinical Coordinator on a 40-bed Telemetry floor and had codes called and I was able to coordinate my staff to begin before the ICU/ER code team was available. We would have the crash cart there, patient on backboard, monitor, IV, and meds started if the ER doc wasn't there yet. Of course, I was ACLS certified already, too. When I went to ICU/CCU, we were the code team along with the ER Doctor and unfortunately there were many times when we would respond and that CPR had not even been started and the crash cart was not even in the room yet. If the charge nurses were properly prepared, this would not happen. I do believe every facility is probably different, but I believe the charge nurse should be able to at least get the code started, if not able to run the code.

Christy, RN

[caroladybelle, BSN, RN]

A true story:

Back when I didn't know tele, I was floated to a tele unit. I was bathing a dementia pt who suddenly went limp. I checked him, and then called a code.

After several minutes with no one coming, I called again. Several minutes went by, without even the monitor nurse coming down while I was doing CPR. I managed to get the attention of an aide to get the charge - she ambles back to tell me that the charge cancelled the code team..... Because the pt had a rhythm, and that the float doesn't know tele, the pt is fine.

PEA anyone. No pulse and pupils fixed and dilated. After basically have to talk the charge down to physically see the pt, we called it again and very ticked off team coded him.

[Batman25]

I'd put it at a 10/10. It sounds like in your case the person should have failed. If they put people through that struggle that defeats the whole purpose.

[crb613, BSN, RN]

I guess I am a little different but I do think a charge nurse needs to be able to run a code. I work at a smaller rural hospital, and we dont have a code team.

I think a charge nurse should be a nurses nurse....experienced,able to handle virtually any thing that comes up....skills + brains. We have a couple like this, and I am always so happy when they are there for backup if needed. On the other hand we have some that couldn't find their backside....makes for a long night.