Charge Nurse in ICU

  1. Do you feel you are responsible as the Charge nurse in your unit for the actions of the nurses that work in that unit with you? We had agency nurses working in our unit that only have Tele experience. When the charge nurse balked at giving her an ICU assignment because she didn't want to be resposible if something happened (as well as concern for pt safety), she was told by management she WOULD NOT be ultimately responsible but the nurse accepting the assignment would be???? The charge nurse decided not to give this nurse an assignment and have her swat and help out and tripled 2 other CC RN's. Now she is in trouble with the Manager who felt she was insubordinate by not giving this nurse an assignment as told by the Supervisor. How would you deal with this problem?
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  2. 15 Comments

  3. by   mdslabod
    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
  4. by   wendyssmile
    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
  5. by   sockov
    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.
  6. by   BadBird
    Ask yourself, in a court of law would I be responsible? You bet you are, and administration will hang you out to dry.
  7. by   dv8rn
    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.
  8. by   passing thru
    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)
  9. by   passing thru
    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.
  10. by   mattsmom81
    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.
  11. by   rmprn
    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.
  12. by   jadednurse
    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.
  13. by   pickledpepperRN
    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
  14. by   A/A/OX3
    Can anyone spell S-A-F-E H-A-R-B-O-R ?

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