New Charge RN

  1. i need some help/advice from Charge RNs out there.

    I work in a busy, 20 bed CICU. where not only do we have cardiac and heart failure patients, but lots of MICU, SICU, and CTICU borders. we do a lot of transfering in and out, admissions, and discharges.

    I have just been oriented to charge nurse (against my will...it seems) and absolutely hate it. i left each day of orientation in tears.

    my problems, i believe, are:
    1. I don't think that i am experienced enough. i just started a little over a year ago as a new grad. what will happen if i am charge, with less experienced nurses, something happens and i don't know what to do?

    2. iI don't think i am assertive enough. i guess the supervisors intimidate me and whatever they say goes, even if i disagree. and i don't know why i feel that way. how do i deal with this?

    3. I care to much of what my coworkers think. if they don't like their assignments and *****...i get all upset. if i set the census to high for the next charge nurse and she complains about it i get upset. i don't get upset with them, i get upset with myself, like it's all my fault and can't let it go...i guess i feel that i am always wrong. i don't know.

    i have spoken to my nurse manager about all these things without avail. she just says "well...we need charge nurses" and "hang in there...you'll do fine" what do i do???


    thanks for your help!!
    becky
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  2. 12 Comments

  3. by   huckfinn
    I would once again express my concerns to the manager and impress upon her/him that this is an assignment I am not comfortable with. IN WRITING and request a response in writing.
    If after this exchange you still are not satisfied....show it to their supervisor.
    Then and only then will you sleep well.
  4. by   hoolahan
    As for your co-workers who complain about their assignments when you are in charge, turn the tables on them, ask them how you you have made up the assignment?

    I had one mean b*#ch come up to me and have the audacity to tell me "You can't make the tough decisions." She was angry b/c I gave a lesser experienced nurse a challenging pt (OK, the pt was a no code on CVVHD, and I figured, she could learn, and if she screwed up, at least the pt was a No Code) I also had a very experienced nurse who was a float to support the newer nurse. Mean nurse thought I absolutely should give the tough pt to the experienced nurse and let the new nurse float, which in my opinion was useless, what can she do if I really need someone strong? So, yes, she told me that in the middle of the unit in front of my peers. She was testing me. I passed. I stepped right into her face, and she was very tall, and I am short, so she leered over me, trying to further intimidate me, and I said, When it is your ship, and you are in charge, you can run it your way, and when it is my ship, I'll run it my way. Then she proceeded to loudly complain about me to everyone, esp her best pal, who loudly agreed with everything she said. It was the weekend, the next day, and I swear it wasn't on purpose, but they way the 12 hour and 8 hour assignments were, I had to give her best buddy a new admit, and she had another pt who was on a vent. She complained loudly to me, and I simply looked her in the eye, smiled and said, well, this is one of those tough decisions I have to make, sorry. They NEVER bothered me again! LOL!

    Not to make light of your concerns, but you will learn. If you never are in this position, you will never learn what to do. You are still green, and that is why you are feeling insecure, I don't think it has anything to do with being a "bad" charge nurse. Being in charge blows!!!!!!! I HATE it, truly, the most thankless job in the world. But, as a RN, it is part of your responsibility and you will have to do it sooner or later.

    If you feel you are in a situation where the less experienced nurses and yourself are unsure of what to do, you need to find out who your resources are now. Are there other ICU's, like the MICU, PICU, etc, with nurses you can ask advice when you are on duty? Does your supervisor have critical care experience? Are YOU ACLS certified? Who is the best at reading EKG's? Who is the best at starting IV's? Who is the best IABP resource? Call your manager at home if it is nights, ask her what to do if there is a problem. During a code, yes you should know what to do, but ultimately, it is the docs who write the orders, Yeah, I know, some of those residents are greener than you, that's why you need ACLS if you don't already have it. Make a plan for how assignment will change if you are hit with the unexpected, have to triage etc. When you do advanced planning, you save time worrying about what you would do. Propose scenarios to the other charge nurses and ask them how they handle things in the same situation.

    I had to be in charge of my 42 bed med-surg floor the second day after I passed boards. It was horrible, but I just asked questions, and I'm still here to tell about it.

    The bottom line is, and I apologize if I offend anyone here, you need to grow your b*lls when you are a charge nurse. It is not an easy job, all the doo-doo rolls down onto you, that doesn't mean you have to be someone's whipping girl or boy. Explain why you made assignments the way you did, if you can. If you are busy, tell them, I know you're not happy, but I can't talk about it now. I need you to help me out with this, and I'll talk to you later, then do it. Do you also have to take an asignment while in charge? That is the pits.

    I could tell you a hundred stories about being in charge, how many times I was challeneged by my "friends", how some people love this and it is a little power trip for them, and other of us, like you and me, just want to get our shift over with and take care of pt's tomorrow. Probably just about anywhere you go as a RN, you will need to be in charge at some point, I think it is surprising that you have been given a year without having to. You are doubting your own abilities, and maybe your manager sees things in you, your growth, that you can't b/c you see only all the things you still have to learn, and are forgetting how very far you have come already in the last year. Maybe she is giving you the little push you need b/c you would never do it yourself. There is never really a good way or a right time to learn how to be in charge, it is trial by fire usually. I hope some of what I said helps. If it is really horrible, you need to talk to your manager, and don't be afraid to ask questions, even if they feel stupid, it's the only way you will learn. You will also be surprised that many nurses would do things different ways. Give four nurses the same charge nurse scenario, and you will probably get four sets of assignments. There is more than one way to do things, you will find your own style. Just don't be a phony, that is my personal advice, not anything you will find in a management book. People can see right through BS! Good luck, I have faith in you!!
  5. by   debbyed
    At most the hospitals I have worked at being in charge was part of the RN job description, especially after being on the job a year. I know of few people, including myself, that were confortable with the role at first. The advice you have gotten here is good advice.

    All I can add is follow your instincts, do what you think is right. If you truely do not know what to do, know who your resources are. I hesitate to tell you to contact the House supervisor unless the problem is administrative. Their speciality is running the hospital smoothly and have found that they are not always the best people to call for advice related to medical/assignment.

    Find a resource amoung the nurses you work with. Someone whose opinions you value. Ask that person if you may use him/her as a resource. When all else fails call your nurse manager no matter the time.

    Good luck and know that as with everything else you have conquered along the way, this to you will conquer.
  6. by   nilepoc
    There is some really good advice in the responses above. I don't have much to add, except a funny thing my friend said after being in charge for the first time.

    Charge has taught me one thing he said, how to dislike my co-workers.

    I find that this is true for myself as well. When I started doing charge, I wanted to please everyone including myself all the time. It just isn't possible. So I stared out by emulating one of the charge nurses I trusted. After a particularly trying evening, I would go to her and ask what she would have done in a similar situation. Most often I found that she does things similar to the way I did. I found it very relieving to know that I was not alone in my thought processes, so if you have someone there who does the job well in your opinion, form an alliance with them and see if they will help you grow.

    I started doing this position in much the same way you did, it is possible to grow into a great charge nurse, if you put your mind to it.

    You on the other hand could try the aproach of my friend who is quoted above and do the worst job you can purposefully sabotaging yourself, in the hopes that they won't let you do the job again. This however usually does not work, as the people who are picked to do charge generally have some ability to lead, and can't let things get to out of hand no matter how much they would like to.

    Hmmm, there is a great deal of rambling in what I said, I hope it helps in some way. Good luck.

    Craig
  7. by   Jenny P
    Hoolihan gave you fantastic advice; but I do have a few things to add to it. When I first started working charge in each new unit (or shift) I worked, I would take and write down the things that needed to be accomplished for that shift and make sure I checked the list as I went along. Among those things were some of the usual jobs such as assignments, checking code carts, etc., but also if one of the nurses was diabetic or hypoglycemic, it was important to make sure they got to eat for first break; or if any nurse was breast feeding, making sure they had enough time to pump their breasts. If I made sure to think about these courtesies for my peers, the shift usually went much better than if I was too busy to do these things (especially re: the hypoglycemic nurse!). Sorry, people, I don't feel it is the charge nurses duty to relieve nurses for cigarette breaks, however. I've been "burnt" too many times through the years on that one; relieving for cig. breaks and never getting my own work done.
    I also made sure that I would be available for anyone who needed help; NOT just sitting at the desk, but rounding as needed; offering help to those whose assignments were heavy. This is not to say that they could dump some of their patient load on me; but rather offering short term help. Sometimes just offering help is enough to make their shift go better.
    If you have to carry a patient assignment PLUS work charge, it is the pits; but pick an easy assignment, and still try to round once or twice a shift and offer help if at all possible.
    And act calm!!!! If the charge nurse is calm, the unit is usually calm! I've had so many people that have told me that they like it when I work charge because the night goes so well when I'm in charge (little do they know what I may be feeling inside!).
    Plan ahead! If you know you will be getting "X"# of patients in during your shift; plan on getting "X"# +2 in instead! ICU censuses can be unpredictable, so keep in mind that you may have 1 or 2 in-house codes during your shift; and where are you going to put them? I know one nurse who gets so frazzled that she ends up moving patients all over the unit by the end of her shift-- and some of those moves do not help the next shift at all, so the patient gets moved again (our unit has several 4 bed suites, plus private rooms, so if 3 patients are 1:1 in a suite and 1 other patient is 1:2 and you are short staffed, do you move that 4th patient or pair it with the most stable of the 1:1's?)
  8. by   longforseaair
    Wow, these are great posts. I get so tired of being griped at for the way I give admits. It should be easy at our facility, since we basically keep tabs and go by roll call no matter the acuity. I was told that that was the case when I started and sometimes a co-worker will tell me that it's not their turn and that it has changed since shift change. I stick to the roll call order, because it is too much of a huge hassle to assess everyone's acuity acurately and open myself to the bickering. It has always been the way to go in turn no matter what and I don't fell like I can deviate. I tried being nice and flexible and certain ones would start sweet-talking me into giving them one less patient, or me taking the first admit since I was charge. I learned that they had a pretty good night, taking multiple smoke breaks, while I was running my tail off and no one offering to help. The LPN's whining and I have to give all their push meds, etc. then they flop down to talk on the phone or chart, while I still have my own meds to finish. Until I decided to just stick with the admit in turn and split the census evenly, change of shift was a total headache and I always started behind. Some nights you get a good group and some nights you get a nightmare group and some nurses will help you, and some will never help. I tell myself that it will balance out sooner or later.
  9. by   Debee
    Originally posted by ICUBecky
    i need some help/advice from Charge RNs out there.

    I work in a busy, 20 bed CICU. where not only do we have cardiac and heart failure patients, but lots of MICU, SICU, and CTICU borders. we do a lot of transfering in and out, admissions, and discharges.

    I have just been oriented to charge nurse (against my will...it seems) and absolutely hate it. i left each day of orientation in tears.

    my problems, i believe, are:
    1. I don't think that i am experienced enough. i just started a little over a year ago as a new grad. what will happen if i am charge, with less experienced nurses, something happens and i don't know what to do?

    2. iI don't think i am assertive enough. i guess the supervisors intimidate me and whatever they say goes, even if i disagree. and i don't know why i feel that way. how do i deal with this?

    3. I care to much of what my coworkers think. if they don't like their assignments and *****...i get all upset. if i set the census to high for the next charge nurse and she complains about it i get upset. i don't get upset with them, i get upset with myself, like it's all my fault and can't let it go...i guess i feel that i am always wrong. i don't know.

    i have spoken to my nurse manager about all these things without avail. she just says "well...we need charge nurses" and "hang in there...you'll do fine" what do i do???


    thanks for your help!!
    becky
  10. by   pts1st
    Becky, I'm so glad you brought up this topic, because I am going to be hit with this anytime now, and I'm honestly not looking forward to it! I've been a RN for just over a year, but floated so wasn't ever in charge. Now that I'm on a unit, I know one of these days it will be my turn!

    Thanks to whoever suggested using a resource person for advice; I know of a couple of nurses who have taken me under their wings, and helped me out, and who I know I can trust.

    I figured there'd be an inservice of some type as preparation, but I am told there no longer is where I work. Guess it's because we're all running around like chickens with our heads cut off! And yes, I would have my own assignment--and what is an easy one? I've yet to have one of those! And yes, I've been told that it's best to take the first admit to avoid the catty politics. I guess I'll survive like the rest of you!

    I hear ya, frustrated RN!

    P. S. Despite the previous, I do love nursing, and know that it's my calling, but hate all the extra baggage!
  11. by   ICUBecky
    hi everybody!!
    thanks for all your advice. i feel a little better. i guess it will just take some time.

    we do have charge classes. but it seems like they only offer them 2 or 3 times a year. so you can be charge for 4 mos. before you take the class. i don't quite understand that concept. why don't they send us to the class first and then orient?

    i guess i have to do what i have to do....

    becky
  12. by   psnurse
    These are the words I remember best from a fellow charge nurse when I was new at the role:

    "If everyone liked me all the time I probably wouldn't be doing my job."
  13. by   P_RN
    I don't believe it! For once I am speechless. ALL of the above is PERFECT. LISTEN WELL!!
  14. by   ICUBecky
    hey everybody...
    well...i have been charge nurse on my own for 4 12-hour shifts this week! everyday was really busy and sh**ty...but i got through it!! and i'm feeling pretty good about it. a few ppl have complained...but i'm trying to just blow it off! that's all i can do...right? THANKYOU for all of your advice..it really helped!!

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