Charge Nurse Duties

mmteleman · Dec 18, 2007

I work on 32 bed med surg tele floor fast paced on average 90+% of patients are monitored. After 2 years of mass exodus of rns 9 one summer and 8 the next, our floor manager convinced nursing director that staffing was our biggest issue we now run 4-5 peeps/rn days rarely 6. Usually 6-7 RNs days, 5-6 eves and nights. No LPNs or LVNs. CNAs vary from as little as 3 to 5. Our CNAs are also trained to watch tele monitors for ALL floors so we have 1 or 2 monitor watchers depending on #tele beds (can be as high as 85). charge RNs get paid $1/hr extra. NOT worth it. My floor does a lot drips (ativan, lasix, natrecor, heparin, integrellin, amiodarone, dopa, dobuta, cardizem). Being primary cardiac floor we do cardioverts (scheduled or direct admits). Also take stable chronic vent patients. And we frequently get borderline "stable" pts coming to floor who need BIPAP. Many patient going for cardio workups. I work 12 hr 7a-7p. When in charge we take full load and always have the most pts to start. So if one person needs a fifth pt, its the charge RN. We do the daily scheduling for 3 and 7pm, schedule all breaks for CNAs, assign bed for admits. We are the first stop when a pt. or family has an issue. We dont do crach carts but have to resolve the med discrepancies in our med select dispenser. With the pace we go at, most of the RNs doing charge feel like they dont have nearly enough time for patient care. Nor do we feel like we are doing anything to make the floor run smoothly. As one of the senior RNs i get hit with a lot of Qs from the less experienced. We are just beginning a process for instituting a RN Charge Role Model so im also looking for what other facilities are doing as well

rnmi2004 · Dec 20, 2007

The charge RN on our floor rarely has a patient load. I think it is a bad idea on management's part to put someone in charge and expect them to do patient care at the same time. You can't do justice to both roles.

I'm speaking as a night shift charge (days has slightly different duties). We assign new admits/transfers, act as the unit secretary when we don't have one, check the crash cart, do the narc count with some lucky staff RN, make out assignments for the next shift, organize transfers if a patient needs an ICU bed, and act as a resource person for all staff. I'm sure I'm forgetting something. It is very hectic at times and I am often pulled in several directions at once. I usually go through 5-6 batteries a night on my phone and like mmteleman says, it isn't worth the extra $1 an hour.

I'm curious to know how many floors have a dedicated charge nurse role. We rotate charges, so some nights we're in staffing.

mdnurse1 · Dec 21, 2007

I am not a charge nurse, but at my hospital our charge nurses or PCC's as we call them ( patient care coordinators) do not have a group of patients to take care of. They are a resource person for the floor nurses, they do narc counts, check crash carts, make sure all of the admission histories and paperwork have been completed, assign admissions/transfers to beds/nurses, decides who might be lucky enough to go on call or get to float to another floor. They also do staffing assignments for the next shift. I am sure I am leaving something out that they do. Anyway, my hospital stopped having the charge nurse take a group of patients about a year ago, and it has been working great! It is so much easier to find the charge nurse because you know they are not busy trying to give care to one of their patients.

JaredCNA, CNA · Dec 22, 2007

Rarely I've seen our charge nurse take patients during the weekdays...maybe 1 patient if everyone has a full load and we get an observation pt from surgery (ie- a 40 y/o tonsillectomy).

On weekends the day charge nurse will sometimes have to take up to 4.

At night they usually take 4-6...and by that I mean usually 6. Every night. I've seen ONE NIGHT since I started in January that they don't have to take pts.

It's a 30-bed unit with typically 1 sometimes 2 CNA's at night and our census averages 28. The bad thing is we specialize in ortho and neuro med/surg. That is not enough support staff for the level of care the pt's need.

crossbow · Dec 25, 2007

Its heavy on a med-surg/tele floor. but where I work, I am usually charge and I take patients. You know what you guys are right! You cant do justice to both roles.

pink2blue1 · Dec 28, 2007

I am not a charge nursebut I am an LVN and work on a very busy med/surg floor. We are not tele, that unit is upstairs from us, but we do get patients with tele monitors on. I am also in California, our ratio is 1:5 also.

I am one of 2 LVN's on our floor. The other has been on medical leave for quite some time. The charge nurse on our floor doesn't take any patients, and she covers the LVN's IV's. We have 1 or 2 CNA's if we are lucky. We have 30 beds on our floor and they are most ALWAYS filled!

live4today, RN · Jan 8, 2008

I am not a charge nurse, but at my hospital our charge nurses or PCC's as we call them ( patient care coordinators) do not have a group of patients to take care of. They are a resource person for the floor nurses, they do narc counts, check crash carts, make sure all of the admission histories and paperwork have been completed, assign admissions/transfers to beds/nurses, decides who might be lucky enough to go on call or get to float to another floor. They also do staffing assignments for the next shift. I am sure I am leaving something out that they do. Anyway, my hospital stopped having the charge nurse take a group of patients about a year ago, and it has been working great! It is so much easier to find the charge nurse because you know they are not busy trying to give care to one of their patients.

I agree...charge nurses should NOT be given a patient load. I see what they do. I've been charge on a rotating basis at some hospitals I've worked in years past, and it is a job that requires ALL their thinking capacities to do successfully. They are as bombarded as the ward clerks are, and need to be totally focused on 'charge duties', not patient care. :specs:

Penelope_Pitstop, BSN, RN · Jan 17, 2008

Our charge nurse does not take patients, unless we are understaffed & cannot find coverage. It used to be that the charge nurse had 2 patients on midnights, but our manager has (thank goodness!) changed that. Also, LPNs have team leaders who are not charge, the RN with the assignment next to her or him. The team leader will usually have less patients than the LPN. However, the charge nurse helps out with admissions, signing off orders, pushes, that kind of thing...he or she floats throughout the department to help out everyone, LPNs, RNs, PCTs, unit clerks and carries a companion phone so he or she can be contacted, as well as a pager that alarms when rooms are posted with transfers or admissions, or out going tranfers, and a phone that the central monitoring techs use. The charge nurse must be the code blue recorder if need be, too. Of course, he or she also makes the assignemnt for the next shift.

litbitblack, ASN, RN · Feb 25, 2008

hmmm. I am a charge nurse on a 28 bed floor and sometimes we have 2 which makes it easier. but here goes. I am required assess all of the lvn's pts, check labs and place phone calls to doctors concerning those, hang blood, all ivp unless the lvn can do them, assign pts during the day and for the next shift, check the crash cart, update care plans, do all the things the lvn's say they don't have time to do, (flu paperwork, admissions if they can't) I have to sign off on all the admissions, start iv's cause the lvns might not have time, deal with drama they don't want to deal with. Take phone calls for the charge nurse, get griped out by the docs for some reason or other. Sometimes its hard to keep it straight. And we don't get paid extra....

beckalynnrn · Nov 14, 2008

I started filling the charge nurse role about 2 years ago on a 26 bed Med/Surg/Tele unit in California. At the time there was only one other charge nurse that worked opposite my schedule during the 7a -7p shift, there was never a charge nurse at night, or a unit secretary for that matter!?! In that time a lot has changed - one thing has not - according to California State Law the charge nurse is legally responsible and liable if something goes wrong. Knowing that, I have spent many months and countless hours, advocating for the nursing staff and patients. If they don't do well, I'm responsible. Sometimes that means we can't take the transfer from the ICU or the admit from the ER and trust me my communication skills have been very key when it comes to rationalizing my decisions. My role includes all of what the other charge nurses' are doing and then some! When I am asked to take a full patient assignment or oversee LVN's I make sure that my Unit Director and/or House Supervisor know that I will not assume the charge nurse responsibility. Every state has different laws... and California is probably more law suit happy than most but I caution every charge nurse to know exactly what's at risk. I know I would hate to lose my license because they couldn't find enough nurses...

arms · Nov 14, 2008

I am a regular Nurse but sometimes delegated to be Charge Nurse on a 34 bed floor. I get 4 or 5 patients as well as charge is crazy. I am busy enough to look after my patients at the same time handling disputes or problems in the floor. Help other nurses who needs assistance with their patients. It's really draining at the end of the shift. That's why I said, do not put me on charge role again when you give me patients because it's horrible, patient care-wise, you don't have enough time and also to do the staffing for the evening. Sometimes when I get busy with my patients and it's 2 hours before the next shift, I wouldn't even notice that I need to cancel a staff. It really sucks when they give you both responsibility. Taking 1 dollar per hour being a charge with patients is not worth.