In 1998 I worked at a small hospital where we had no charge nurse. The way it worked was the nurses took turns making out the assignments. Basically, whoever arrived to work first that day made the assignment out. Of course, we tried to give people their same assignment whenever possible. As far as having no charge nurse on the med/surg floor, we made due with our house supervisor as back up for any questions. The way we decided who would get the first admit was by taking turns. Usually we wrote down 1st, 2nd, 3rd admit on the assignment sheet. It was a bummer when you had a bad night & were up for an admit anyway. It was my first nursing position and I knew no other way. This was an 82 bed hospital, so on the small side. Our house sup (RN) would come when paged or return our call. But even so, it was a hard place to work. We took off our own orders. We tried to help eachother out as best we could. I stayed 1 year to get my experience in, then moved to a 225 bed hospital which had Lead RNs.
I think hospitals are stupid to eliminate Lead position. Where I work now, the Lead helps oversee & coordinate care. They help with order entry & noting orders. They make calls to doc or other depts for the extremely busy nurses, and help out with various tasks.They do bed control.And I would like to add that my floor has had a mass exodus of RNs, too, due to burnout. It has been so bad in the 3 yrs I've been there, that now "management" has come up with creative new ideas to "make it work." Want to guess what some of their brilliant ideas are?!!!! Yep, you guessed it...eliminate the Lead RN position. Another idea they had was to give us one more nurse aid and then let the nurses have 1-2 more patients a piece!
It infuriates me that these are their "solutions." We have given them OUR ideas to solve the problem. We have come in to work on days off to help reorganize and brainstorm creative ideas to make our floor more organized.
When I started at this current hospital, the Lead RN didn't have an assignment.They were able to help start IVs, help with admits, and basically a godsend to us on the floor. Over time, managemnt has reorganized our floor in an attempt to make it "better" and one of the changes was that Lead RNs now take an assignment of 2 patients. That's all fine, but keep in mind that's time taken away from other things like noting orders & helping out on the floor. Our renal patients (we are the renal floor too) are extremely high acuity with MRSA/VRE often, brittle diabetics, complex wound care, 3 pages of meds, etc, etc. Taking 2 patients and being Lead is really detracting from the Lead role, in my opinion.
What it all boils down to is they aren't willing to pay for the staff that is needed to run the floor safely. I'm sooooo tired of managment's excuses!
In fact, we have gone thru 3 nurse managers in 3 years (one of them we all loved) and three nurse educators. I've lost count of how many valuable veteran RN (with 20+ years experience) we've lost to other floors & settings.
Now there is another mass exodus...about 8 of us are leaving, myself included. I am actively seeking transfer to another floor (one where they are keeping their Lead RNs).
Of course, they try and tell us about new meetings & ideas to make it better...but we don't like their ideas. They are only making it worse by eliminating the charge nurse position. Next thing you know, our nurse aids will be gone too. As it is, I feel I am expected to do EVERYTHING.
Good luck to you & your coworkers