My Charge Nurse acts like I ask too many questions

  1. I'm a new nurse of 4 months. When my precepting time was over and I was put out in the floor on my own, the nurse manager encouraged me to ask him or my charge nurse questions if I'm ever in doubt. The nurse manager is a great teacher and is always dependable for advice pertaining to patient situations, but my charge nurse is another story. When I approach her with a question or even try to just report a situation such as a patient declining she will walk away from me and act like she doesn't want to be bothered and announce the advice with her back turned to me as she walks away. Now it's to the point where she makes comments like "What's your scary situation now?" when it may not even be a scary situation but just my reporting something like, "Patient ____, has had a declining change in health status, I've called the hospitality and the specialist, would you like to come and assess patient ____ and confirm the findings?" The thing is I've never worked in a hospital setting before becoming a nurse. It was always stressed to us in nursing school that a declining patient should be reported to the charge nurse, so I am just following the protocol I learned. Am I really bothering her too much? Please help me out here. Any advice would be appreciated.
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  2. 16 Comments

  3. by   LovingLife123
    You should be following the protocol of your hospital, not whatever they told you in nursing school. There are no universal protocols.

    Here is what I did when I first started out as a nurse. If I was questioning something or wasn't quite sure if a patient's status was changing, I would grab a coworker and have them see if they saw the same. I would do that before I called the physician. Sometimes, if the physician was right there and I was concerned, I'd just grab them, but 99% of the time it was a fellow coworker. They would steer me in the right direction.

    If nobody was readily available and it was urgent in nature, then I may call charge. Usually it was straight to paging the physician at that point.

    Now, if I thought a patiebt was about to code, then yes, I call charge to let them know. But I don't call them for a changing BP or HR. You will be able to decipher soon what is emergent and what is just a slight change in status that may require some additional medication.
  4. by   caliotter3
    If you have an experienced coworker nearby, like LovingLife said, you can ask them first. That should cut back a lot on the times you go to the charge nurse. That's what I did when I first started out on my first job. We all did that, that is, ask each other. It makes for great teamwork.
  5. by   Cricket183
    It depends. You don't say what kind of unit you work on. I was charge on an oncology unit. I personally would rather a new nurse come to me too often than not often enough, but that's just me. I'm not sure if you've been off orientation for four months or if you've only been a nurse for four months (including your orientation time) but it really takes a good year or more for a new nurse to get their feet under them and get a sense of confidence where everything they learned in school and the reality of real life nursing comes together. That said I would expect that over time a new nurse would gradually be coming to me less and less with questions and start developing critical thinking and trusting their own judgement (maybe using me more as a sounding board rather than a resource.) As a charge I would always expect to be informed of a significant change in patient status though regardless if you were a new nurse or if you had 20 years experience. There's nothing worse as a charge than having a patient go bad and you had no clue anything was wrong because when you rounded on them in the morning they were fine and as you're getting them ready to transfer to ICU, the doctor is grilling you as to what happened and you can't give them any answers and their primary nurse is saying they've been going downhill all day...yes, that has happened! But on the opposite end of the spectrum, I don't need to know every time there is a change in their status either. I hope that helps some.
    Last edit by Cricket183 on Jul 22 : Reason: Can't seem to get it together and communicate my thoughts clearly tonight! Not near enough sleep lately!
  6. by   cleback
    I don't know if it's necessary to report any and all changes of condition to the charge. You may just need to be a but more discerning. If I would consider calling a rapid response or code, then I'd let the charge know. If the patient will likely be very time consuming (severe withdrawal needing q1hr meds), need a procedure done on the floor (bronchoscopy, endoscopy), or anything else that would affect my ability to care for my other patients or eat up resources, then yes--charge.

    If there's a change in conditon that I can still safely handle (new confusion requiring a head ct, bp too high needing a drip, increasing o2 needs), then I'll just update her at the end of the shift. If I want another set of eyes, I may ask another nurse, not always charge.

    When I get floated to the surgical floors, I do the same thing when my patients incisions start bleeding. I always have to pull someone in because I really don't have a good sense of how much is too much blood to lose postoperatively. It all freaks me out a bit. Anyway, I imagine that with more experience it won't be an issue.
  7. by   NightNerd
    I feel like, in the scenario you provided, it may not be necessary to update the charge nurse and request her assessment in the way you depicted. If you need a second set of eyes, or if the patient is declining to the point of a possible rapid or upgrade, then by all means, ask away! But as you learn to trust your own assessment skills more, you'll find that you don't always need a second nurse's opinion. Like others said, the charge nurse should be updated on major stuff, but you will learn which things can be done safely on your own. Still, never let a person's attitude discourage you if it is in the best interest of your patient.

    I am three years in, and I still have to ask questions of my charge nurse. The best feeling has been when she asked ME for an opinion. You will get there! In the meantime, pay the attitude no mind. Check in with other coworkers too, as you can often find mentors outside of management and leadership roles. And, for my part, I think I little light self-deprecation always helps: "Oh my God, Megan, if I haven't already annoyed the hell out of you today, get ready for this!" Insert sigh, smile, and patient care concern here.

    You could always ask her, too. At a point when neither of you is busy, ask for pointers on using her as a resource and what she thinks you may be able to be more independent with. If it's something you aren't comfortable with yet, at least you'll have an open dialogue about your concerns, and she'll know that you are actually doing your job to the best of your ability and are willing to learn from her.
  8. by   gcupid
    I dont know how many times you ask questions throughout the shift in order to give a personal response in regards to if its bothering "the charge" too much. What I can tell you from my experiences is that you can wear your resource out if you keep going to the same person. Find a couple of nurses you trust to help with certain scenarios until you build your critical thinking skills & confidence. At some facilities charge nurses will hide, ignore, or come up with smart ways to dodge you without being held responsible bc every time you bring an issue to a charge nurse, it forces them to address it and can stress them out.

    Also get thicker skin, bc I dont care if i have to ask 50 questions I'm going to do it. As long as I keep my license im happy. So just ignore the annoying responses from the charge bc he/she may just be joking with you.
  9. by   blondy2061h
    One thing that can grate people, myself included, is when people KNOW the answer and know what needs to be done but just lack confidence. I'll come and hold your hand the first time or two but you need to put on your big girl pants and trust your own confidence and skills sometimes. Not if you truly don't know something. But don't let anxiety cripple you.

    Also, make sure you're not asking the same questions repeatedly. Don't ask the charge nurse what the pharmacy's phone number is every night. Make yourself a reference notebook. Learn hour resources. Learn where you can find policies. Look them up instead of asking if you have time. My hospital has a fantastic internal website with links to all kinds of nursing references with policies, IV compatibilities, procedural guides, medication information, and calculators. It also has maps to various places on campus and a directory of all internal phone numbers. Use resources like that! Even small hospitals should have something.
  10. by   caffeinatednurse
    As a general rule, it's a good idea to get the opinion of a coworker before you contact your supervisor...as a nursing supervisor, I can tell you that I'm usually swamped with a million little things that need to be taken care, in addition to having my own people to care for.

    Every nursing supervisor/charge nurse reacts differently to being asked questions. I don't mind answering questions, as long as they're not the same ones. I have, at times, told nurses to trust their instincts and assessment skills because I knew that they were capable of making excellent decisions but I could tell they were unsure of themselves. I've also asked other nurses to assess the patient with that nurse, because I was dealing with something more acute at the time.

    At some point, you will become comfortable with your own assessment skills and will contact your charge to notify them of the big stuff but otherwise handle your own workload without much interference.
    Last edit by caffeinatednurse on Jul 23
  11. by   Prredneck25
    I've only been a nurse for four months, off orientation for 2 1/2 months and I work on a neuro step down unit. Generally I only go to her if I feel like the patient may be in a state of rapid decline. For instance the other day I felt my patient may have been experiencing a revolving stroke. I did my assessment and found new significant deficits, then called the neurologist, called the hospitalist, and then reported to her the situation so that she was aware of the situation at hand just in case this person needed to be wheeled off for acute treatment. Otherwise if it's anything less serious I'love usually call on my former preceptor or other nurse on the floor that act as preceptors.
  12. by   blackmamba123
    I remember starting out on my current unit, which is postpartum unit. I too am the type of person who asks everyone a ton of questions as I'm getting familiar with the unit and patients. I totally agree with the suggestion to spread the questions/concerns around to other nurses as you're finding your feet, and reserve major changes or concerns for the charge nurse. I've actually been learning more of what the charge nurse role is on my unit, with a goal of becoming one myself. The more that I learn, the more I realize how much a charge nurse has on their plate throughout a shift and beyond that. I imagine it could become overwhelming being approached with non-emergent stuff all shift. But it sounds like what you're reporting is important. Maybe worry less about her response (take it with a grain of salt), ask or report what you need to, chart it if necessary, and keep it moving. A year in, and this will be a distant memory. I'm very interested to hear the difference in how you feel a year after being on your unit. Best wishes and good luck in your career.
  13. by   Workitinurfava
    You need to not tiptoe around her sarcastic remarks. I would pull her aside and ask her why she is making those types of comments towards you. If you don't stop it now it can continue to the point of bullying. On another note you should seek out others to assist you but don't completely stop asking the charge questions. The charge is someone you will have to work with more often than not so try to get this figured out asap.
  14. by   nursej22
    Is it possible to have a conversation with your charge nurse about what he/she does or does not want to be reported? And this should happen in private, not in the hall or in a confrontational manner.

    Yes, he/she should know when a patient may need to go urgently to a procedure, or need a higher level of care, or a rapid response. But if you are doing everything necessary, the charge may think you are seeking validation for just doing your job.

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My Charge Nurse acts like I ask too many questions