Charge Nurse in ICU

mdslabod · Sep 2, 2001

I would have asked the agency nurse about her/his comfort- zone when assigning patients. (Even seasoned unit nurses get nervous with certain types of patients).

The least critical could go to the least experienced person.

I was an agency nurse and an experinced ICU nurse. When a charge nurse did not ask my credentials and gave me easy patiens, well, easy money and their loss.

MicheleRN

wendyssmile · Jan 31, 2002

I have been recently oriented to the charge role and have had my eyes opened. First of all I work in a CCU/CTICU and our travelers are usually well qualified to handle an ICU assignment. We have had a few which we had problems with and subsequently recieved chronic vented patients to care for.

As far as being responsible as the charge nurse I had a situatuation with a seasoned nurse not dealing with a patient problem and I felt responsible! But the nurse knew better and was capable of caring for the patient. I learned that as a charge nurse I need to keep an eye out for problems but it is not solely my responsibilty, as a charge nurse I am not there to micromange everyone's patients.

being charge is not something I enjoy and being a new grad in an ICU I avoided it for 3 years :)

sockov, ADN, ASN, BSN, CNA, LVN · Sep 4, 2002

I think the charge nurse for the shift has responsibility on the unit. If something went to court, I would be the charge nurse would be listed on the documents and would have to testify.

But, the nurse manager falls into the same category for being responsible.

It is the managers responsiblitlity to make sure the unit is safe and the staff RN's are competent to take care of the acuity of the unit, so if something "bad" happend.. then that would go to court.

Not sure though. Best to research with the local legal people.

Guess it is good to know the law and protect yourself.

BadBird, BSN, RN · Sep 4, 2002

Ask yourself, in a court of law would I be responsible? You bet you are, and administration will hang you out to dry.

dv8rn · Jan 19, 2003

I've been a Critical Care Charge Nurse for 16 years, and there is such a thing as vicarious responsibility. It is when you are responsible for what goes on in your abscence. As Charge, I am responsible for the unit while I'm at work. I am not responsible for the actions of nurses outside scope of practice, or deviation from standards. "a reasonable and prudent nurse would": is the buzz phrase to remember.

passing thru · Jan 30, 2003

A suggestion: As charge, I always ask agency and floaters to consult with me prior to calling the docs, (at 3 a.m.). Usually I can advise and suggest a resolution, provide options that a newbie on the unit is not aware of....e.g., meds that are part of standing orders for the doctor's group that may not even be in the chart or on the MARS. Or, I can write an order for a couple of Tylenol for that low grade temp, and assess I&O, ....oh,? the IV infiltrated 5 hrs. ago...the patient is NPO , and you haven't had time to start another?? Let's not call the doc for the low-grade temp, lets give the Tylenol supp and get some fluids going..(actual problems)

passing thru · Jan 30, 2003

Or last week, the patient is back in a-fib, wants to call doc...hello? ...look the afternoon beta -blocker was not given.

This could be another thread, we could share tales.

mattsmom81 · Mar 24, 2003

No desire here to do charge anymore, no need to prove myself or take on excess duties after this many years as nurse. Just want to take care of MY patients now.

Charge in ICU is just a double headache IME...as we have our own patient(s), manage the unit, AND are expected to be preceptor/ resource for the less experienced nurses. This gets out of hand in my understaffed part of the world where any warm body can show up in ICU too many nights....

All this for a lousy buck an hour...no thanks.

rmprn · Mar 31, 2003

At least you get a buck an hour! In my M/S ICU, we all take turns being charge for free (there is no charge nurse on nights right now, hasn't been for at least 6 months)! AND, if there is no charge nurse for either CCU or ICU, we have to do staffing for BOTH units. Plus take a patient assignment.

jadednurse · Apr 21, 2003

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.

pickledpepperRN · Apr 21, 2003

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