Charge Nurse in ICU - Page 2

I once worked on a unit that had a mandatory rotating charge position. While at that point in my career I enjoyed the challenge of being in charge (hey, I was young, fresh and naive) I think the practice of forcing nurses to be in charge is neither safe nor productive. Not all nurses make good charge nurse...period. Either they lack the confidence or organizational skills or both and can really create chaos for the staff their "in charge" of.

That said, I tend to agree w/ mattsmom81 and others who feel like there's just very little incentive ($$ or otherwise) for a nurse to take a patient load and be in charge.

I only know the regulations in California. See the "RN Responsibility When Floating, number 24 on the link below:

http://www.rn.ca.gov/policies/policies.htm#RN

http://www.calnurse.org/cna/np/np61798.html
FLOATING, according to the Rules

Both the California Code of Regulations, Title 22 and the Board of Registered Nursing
address the concerns of Registered Nurses, and the safety of patients regarding
"floating" assignments.

Title 22 Protects Patients and Nurses from Inappropriate Assignments to "Floats".

Title 22, Section 70214 requires that all patient care personnel, including float and
registry staff must complete competency validation specific to the patient care unit to
which they are assigned. The following requirements apply to "floats" ("staff temporarily
re-directed from their assigned units") and temporary (registry) personnel:

(1) Assignments shall include only those duties and responsibilities for which
competency has been validated.

(2) An RN who has demonstrated competency for that particular unit shall be
responsible for patient assessment, planning and evaluation of care, patient
education and the evaluation thereof, AND supervision or coordination of care
provided by LVNs and/or unlicenced personnel, and SHALL be assigned as a
resource nurse for RNs and LVNs who have not completed competency validation
for that patient care unit.

(3) RNs shall not be assigned total responsibility for patient care, including the
duties stated in (2) above, until ALL standards for competency for that unit have
been validated.

The Board of Registered Nursing Seeks to Assure Safety
for Patients

The Board of Registered Nursing has stated that a Registered Nurse has an obligation
not to accept an assignment to give care he or she is not competent to provide. Any RN
who accepts such an assignment, and the supervisory RN who makes the assignment,
may both be subject to discipline by the Board for incompetence/gross negligence in the
event of injury to a patient. However, in an emergency an RN may need to cooperate with
an experienced registered nurse to provide necessary services to assure the safety of
patients. The floated RN should only be providing care for which he or she has acquired
competency.

Registered nurses who are asked to float "should consider whether the request is to float
to an area of nursing for which she/he lacks the required nursing skills or is it simply to
float to a unit with which she/he is unfamiliar." Competency may be involved where a
nurse is asked to float to a unit where he or she has had no experience with the type of
nursing involved. Competency may not be an issue when asked to float between different
units which care for the same types of patients." ( BRN Statement on Floating, April
1992, reprinted from BRN Report, Spring 1987).

STRATEGIES FOR FLOATING SAFELY

1. Inform the supervisor that you are not competent to provide care to patients on a
unit to which you have not been (1) oriented to the physical environment; (2) have
not received sufficient orientation to patient care policies and procedures specific
to that unit and had documentation of your competency in those specific policies
and procedures. Be aware that an orientation "once upon a time, long ago" is not
necessarily valid forever.

2. Inform the supervisor that you cannot accept full responsibility for a patient
assignment on a unit to which you have not been oriented as above, you should be
assigned to a resource RN normally assigned to that floor. You should not provide
any care or perform any procedures for which you have not demonstrated
competency.

3. Refusal to float and accept an assignment for which you are competent may be
interpreted by the hospital as insubordination and subject you to discipline.

4. Charge nurses and supervisors are responsible to make assignments according
to demonstrated competencies.

http://www.calnurse.org/cna/np/na.html

Can anyone spell S-A-F-E H-A-R-B-O-R ?

I've been charge for 6 weeks now in our m/s ICU. We do not take a patient assignment. We have steady charge nurses so no one is forced into a charge role. I'm not sure of what my liability would be for another nurse's actions. I'll have to look into it.

Charge nurse pay is $1.00 more per hour. Should it come to taking a patient assignment along with being charge, I would resign charge. Not worth it. I like the role the way it is now but it would be impossible to manage the paperwork, staffing and bed placing issues with a patient assignment too. My humble opinion. Hats off to those of you who have to do it!!

We did charge for free as well. l Loved it. Even when I worked with people that floated. I took them under my wing.

renerian

As both a practitioner and an administrator, I suspect that EVERY nurse that comes into your facility, whether traveler, regular staff or agency, has to have some kind of DOCUMENTED skills check list. Either with his/her agency or else on file in you staffing office. Ask for a copy of this to be FAX'ed to you, given to you, or ask the agency nurse to fill out another one and sign and date it. Do not then assign this individual anything that is beyond their stated competency This is not nearly as realible as demonstrated competency of course, but if you do this, keep a copy and give a copy to your manager next day along with your documentation that this was not an appropriate nurse to assign to critical care, they will get it before long. Alternatively, perhaps some of the patients may be able to have their status downgraded if appropriate to more clearly reflect the actual type of nursing care they need, which may be appropriately given from the agency book. In my opinion, you did the right thing, but did not take it far enough. ALWAYS go on written record with the shift supervisor that you are protesting the assignment of the non-qualified individual. KEEP A COPY. Good luck, and thanks for looking out for your patients.