Night shift charge nurse issue

Specialties Med-Surg

Published

I'm a new nurse working night shift med-surg at a small town hospital. Been off orientation 11 months. Just barely gaining my footing... I've been forced to be charge nurse a few times lately due to being the only rn on the floor. This is not ideal, but I've gotten through it. My only real issue has been with one certain lpn who worries me (only once have I worked with her as charge, thankfully). She doesn't do her charting, is off in la la land (to put it nicely, many times questioned her sobriety), and spend lots of time off the floor. I don't feel comfortable signing off on her. Other noc charge nurses just don't sign after her. I feel like its a liability either way. IF I sign after an incompetent nurse... well, I can't put myself in that position. On the other hand, if I just don't sign after her and a pt has a bad outcome, how can I show up in court and NOT have done anything about this nurse that EVERYONE knows is a liability? I want to cover my butt and ensure pt's are well cared for. The rest of the lpn's I work with are awesome and I'm glad to work with them!

The night in question: I told the oncoming charge, dayshift house sup, and my manager that I didn't sign after her and my reason why. I feel that I covered myself, but I don't know...

I have NOT blatantly confronted the bad nurse. I've purposely mentioned charting to the "group" of lpn's ("have you got your charting done? OK, I'll sign after you then" ) This nurse has loads more experience than me, I just graduated last yr. I really don't want to confront her. I don't feel I have any business doing so... I just really, really don't want to be charge when working with her. It takes all of my energy to take care of my full load of pts without worrying about a possibly dangerous nurse.

I will say I work with a great group of people and feel well supported most of the time.

Specializes in Infusion Nursing, Home Health Infusion.

I need to know what state you are in or where you are practicing.In many states there must be an RN assessment within a certain time frame and if you are the RN overseeing the patient because an LVN or LPN is assigned to the patient you are still liable whether you sign or not and even more so if you do not sign.If you are responsible and do not perform an assessment and make certain care was delivered to the current standards and by the current orders and plan you are abandoning your patients and will be liable.You must know exactly what your nurse practice act states and legally wjat you ate responsible for as well as what the LVN is.I can tell you that it is the assessment piece that is critical and the nursing actions that follow...Yes you can tell that LVN what she needs to do if you are assigned to oversee him or her....sorry but that is the way it is...you have the RN license.

Specializes in Infusion Nursing, Home Health Infusion.

Forgive typos. ..can't correct from my phone

My state requires rn assessments q24 hours. My hospital has rn's cosign with lpns on their charting. IMO, we have too many lpns to rn's. I am not comfortable at all being charge, but I'm not sure what I can do about it. I guess that's why I'm asking advice here... I have had zero charge training. Just bits and pieces of info about what the responsibilities are.

Part of your job is to confront those that aren't doing their job in a respectful manner. As a charge nurse, you have to identify issues on your shift and try to solve them on the spot. If that doesn't work, you go a step up.

ER nurse here. What does it mean to "sign off" on somebody else?

When you do this, what exactly does your signature mean?

Specializes in Med-Surg.
ER nurse here. What does it mean to "sign off" on somebody else?

When you do this, what exactly does your signature mean?

I think it means to sign off on their assessment. Hospitals that still use LVN's require an RN to "sign off" to say you agree with their documented assessment of the patient. So if something goes wrong, and the LVN's assessment is called into question, potentially that drags the RN into the mix as well.

That's just my interpretation of the OP.

How can an RN agree or disagree with somebody else's assessment?

If I don't listen to somebody's lungs, what does it matter if I agree or disagree with what you heard?

Serious questions, I really don't get how this stuff work.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
How can an RN agree or disagree with somebody else's assessment?
It's just a technicality. Personally, I'd happily co-sign almost any LPN's assessment because providing a signature is less labor-intensive than if I had actually assessed the patient myself.
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