What are charge nurses like at your work place?

  1. I work on a tele floor where we have 4-5 patients and I feel like there is no one I can go to when a patient is going bad and needs to be transferred to the ICU. When I do get help I have to be very forceful and demand it. The charge nurse also takes a full team of patients (4-5). We have no monitor tech to watch the monitors and I just feel it is very unsafe. On the rare occassion that I have had a patient go bad my other patients have gotten ignored - well I check on them very quickly to make sure there is no distress.

    So my questions are
    (1) Does the charge nurse get to be a charge and not take a team of patients?
    (2) If the charge nurse does take patients is it less than the other staff and is she given the easier patients?
    (3) If you are on a tele floor do you have anyone to watch the monitors? If you're not on a tele unit what type of unit are you on?

    BTW, I am a new nurse. Only been a nurse for 6 months and am just trying to figure out what the "norm" is for a tele floor.

    Kelly
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  2. 15 Comments

  3. by   ElvishDNP
    I don't do tele but....

    We have two wings (mother-baby), north hall and south hall. north-hall has 24 beds, south-hall has 21; if both sides are full, they stay in their labor rooms but south-hall nurses care for them, as the two units are next to each other. We have antepartum, postpartum/mother-baby, and north-hall has the occasional gyn pt. North-hall usually is where the higher-acuity patients are.

    North-hall usually has a free charge. South-hall is where the unit coordinator is. The UC (we call her the "uck") makes bed assignments, makes assignments for the next shift, & fights any fires that need fighting. She also functions as charge nurse for south-hall, although there is a co-charge who has a full pt. load & can act as charge if UC isn't around. But it all depends on who's in charge. There are some charge nurses/UC's who will set up rooms, help assess babies on nights, page/talk with the docs, watch out for your patients while you're getting a new admit, etc. There are others who will sit on their tails and watch you running around like a headless chicken while they are piddling on the Internet. Most are great. Some will not even take a lunch break unless everyone on the floor has eaten. It's just a couple that I hate to see in charge.

    On occasion, charge nurses/UC's will take patients, but they don't usually have a full load unless we are just overwhelmed.
  4. by   All_Smiles_RN
    My old tele floor: Always had a monitor tech. During the day, charge nurse had no team. During nights, charge had a full team.

    Cardiac PCU where I work now: Always have a monitor tech. Most days/nights, our charge does not have a team. On the occasional day/night when needed, they take a smaller team and don't have the total care type patients.
  5. by   cisco
    When I floated to a tele unit, they always had a charge that did not take patients (unless understaffed and emergent), the charge was available to round with drs, call drs for orders, updates, labs etc. She also would help to hang blood, give pain meds and help to transfer patients to ICU when needed. They always had several monitor techs. This was for a 24 bed unit. It was well known that tele and step down cardiac units didn't carry as heavy acuitities as the other general floors, med/surg, ortho, neuro, resp etc.
  6. by   RNperdiem
    In my 16 bed ICU. The charge nurse does not take a patient and is available to help in many ways. Being ICU, we watch our own monitiors.
    In smaller ICU's and the tele floors, the charge nurse takes patients, but has a lighter assignment if possible.
    The feeling of having no help when patients go bad, is often a floor held together by new grads, floaters and agency nurses. These floors do not have a core of seasoned nurses. It takes time working as a group for real teamwork to happen. Look around at your co-workers. Are they mostly floaters, per diem, or travellers?
  7. by   Hoozdo
    Quote from kellykul
    We have no monitor tech to watch the monitors and I just feel it is very unsafe. On the rare occassion that I have had a patient go bad my other patients have gotten ignored - well I check on them very quickly to make sure there is no distress.
    I have only been an RN for a year and worked at two different hospitals, BUT, I have never seen a tele unit without a monitor tech! Not even during clinicals in school. :trout:

    What good are monitors if no one watches them? You are right; it is unsafe. I think your patients are going to go south on more than rare occassions too....that is why they are being monitored and in tele.

    To answer your other questions:
    I have always worked in ICU.
    Charge nurse - took patients at one hospital, doesn't at new job unless we are extremely short staffed.
  8. by   nursemary9
    I don't work tele; I work a med/surg; hem/onc floor; we actually get everything. Our capacity is 18;

    I work nites;
    on day shift--week days---there is a Practice Leader who usually gets NO patients;(she is Charge). On weekends--if she is here, she gets pt;s but a smaller assignment
    On Pm's usually the Charge does not get pt's or else 1 or 2;
    On nites--the charge either gets the same assignment or 1 less;

    The Charge makes out the assignment for the next shift; goes to staffing meetings; a lot of other paper work ;
    The Charge also helps out when needed; makes decisions that others can't or don't make; assigns new admits to rooms; assigns admits to staff.
    All around do everything; answer questions; Lots of little stuff.

    All for a whopping $1.00;/ hr extra!!

    On tele--when I have floated, there charge person was also watching my monitered patients.

    Mary Ann
  9. by   TachyBrady
    At my place of work, the charge nurse takes a full load of patients. If possible, they are assigned an easier load. We do not have monitor techs. Our monitor banks are centrally located and automatically print out when a patient alarms. Although we do not have someone continously watching the monitors, there is always someone around to check out an alarming rhythm. Most of our patients are stable. If their rhythms needed to be continously watched, they would be in ICU. When we do have a patient with a lethal arrhythmia, the nurse is usually forwarned by the patient's physical condition, otherwise the monitors alarm, print out a strip and any staff at the monitor banks are alerted.

    Your charge nurse should be helping you when you have a patient going bad... that is part of their job. Have you talked with your dept. manager about the charge's responsibilities? You and your coworkers should also be pitching in together when a patient is in trouble, no matter whose patient it is.

    It is frustrating that other patients get ignored while you are tied up with a bad patient but that's just the way things work. You can't be everywhere at once but must prioritize to take care of what is most important or urgent.

    If you are routinely in acute situations without any help, I would search for another place to work.
  10. by   bigmona
    I work on a PCU (basically tele) and the charge nurse does not usually take patients unless we're shortstaffed, which means she almost always has an assignment on nights but not days. Her assignment is not necessarily lighter than other RN's assignments. and there is ALWAYS a monitor tech watching the patients. Usually at night the charge RN is so busy that if I need help, I will ask another nurse or call up the nursing sup.
  11. by   onarie
    I happen to be a charge nurse on a 40-bed telemetry floor. Our day is split into 3 shifts. Each shift has 1-2 monitor tech since we monitor telemetry for 3 floors and an admissions/holding unit. Our patient load for day and evening shift is 5 -6 patients per nurse and the charge on these shifts the charge nurse does not take patients. She is working on bed placements, helping with orders, on the phone with physicians, looking at critical labs,assisting in whatever needs to be done, etc. For night shift the patient load is 6-7 patients with the charge nurse taking 2-4 patients, assisting the staff, bed placement, looking at critical labs, etc.

    I am flabergasted that you are on a telemetry floor with a designated monitor tech.

    If I can be of help just let me know.
  12. by   NurseCard
    On the med-surge floor that I used to work on, for the longest time, the "charge nurse" title meant pretty much nothing, it seemed like. Someone might be designated "charge" nurse for the night, but still have just as many patients as everyone else. They were supposed to, kinda sorta, be overseeing everything that happened on the floor, but for the most part they were doing the same things, having the exact same tasks and responsibilities, as all the other nurses.

    Then eventually, the "charge nurse" role was revised and revamped and then the charge nurse was supposed to start taking much fewer patients then the other nurses, if any patients at all, and helping with IV starts, calls to the MD, emergencies, nurses who were drowning... certain paperwork... you get the drift.
  13. by   AliRae
    I work PICU. If we have a HN on, she's the automatic charge nurse. Otherwise it's one of the staff nurses who have completed charge orientation and transport training. Our charge nurses typically don't take patients, days or nights. They round with MDs, make assignments, provide break coverage, help with admissions, do staffing with the nursing supervisor, make bed assignments, communicate with the floors when we have a transfer, and are on call for transports. I've never seen our HN's end up with an assignment while being charge, and they typically just go around and tell us to cover each other for breaks. It's interesting to note the difference between a HN who's in charge and a staff RN in charge. The staff RN almost universally is more compassionate, more willing to help out. Days seem to run more smoothly.

    New staff RNs train for charge after being on the floor for at least a year ... I'm 16 months and still working on getting oriented, because we just haven't had the staff to let me get oriented and go on transports. Every time we try, I end up taking admissions. Which is fine by me, because the idea of being in charge scares me to death. =)
  14. by   ashleyjean3
    I work on a surgical unit with some tele beds. Our charge nurse never takes patients. She is there to check orders, call doctors, help when needed.

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