Charge Nurse with patient assignment.

  1. I really need to understand something and am asking for some help here. I need to understand how many nurses on this board function in a charge nurse role. In addition, I would also like to know how many are required to take patients in that role? Finally, when you are in charge, how many patients do you normally assign to your staff nurses as well as yourself (if you are required to have a patient assignment)?

    I am really struggling with this at my present position. I function as the charge nurse, along with some of the other nurses. We rotate the charge responsibility. However, when I am in charge, it always seems like I am taking a full load. Today I was charge of the floor and had a 6 patient load. I left work this afternoon feeling terrible about the quality of care I gave my patients today and really need to understand if this is what nursing has come too.

    Thanks to everyone for helping me with this issue.
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  2. 24 Comments

  3. by   susanmary
    Last edit by susanmary on Jan 14, '05
  4. by   bellehill
    I have refused charge 3 times now since I am a traveler, but I would have a 7 patient assignment just like everyone else. The charge nurses here do get extra per hour but I am not sure how much.
  5. by   Ortho_RN
    Our charge takes the same number of patients as other nurses... no difference
  6. by   Shed13911
    Last bedside nursing I did was the same. Took charge and a full pt load. It was no diff in pay but a lot more stress. No more, thank you very much!! LOL.
  7. by   plumrn
    I think it is ridiculous to expect someone in that position to handle 2 jobs- primary care, and charge of a whole unit. You can't do both jobs well, so everyone loses. I just don't understand how hospitals can advertise highest quality care, when they do their best to provide just the opposite.
  8. by   moia
    well...in critical care..we call it the"resource" position so the management can get away with piling on a patient load ...see you are not in charge...you are a "resource" for your coworkers...nice isn't it


    We ignore them in the ICU..the "resource" Ideally shouldn't have a patient assignment at the start of the shift because of multiple unstable open heart surgical admissions and multiple transfers of patients to the ward...by the end of the shift she most likely will have either a couple of longstay trached vents to cover or a trainwreck holding on by their fingertips to code.

    On the ward usually 2-4 patients stable awaiting next day discharge..this is the ideal..on an uderstaffed overstaffedwith agency the resource nurse will have less patients but they will be more acutely ill. The agency nurses will have a higher patient load but they will be loaded up with all the most stable closest to discharge non IV patients available...this is on the cardiac/vascular ward. The resource nurse can change patient assignments all night long according to acuity and how experienced her staff is.
    It is a really hard job with almost no rewards...you really need to sit down and think about it and ask yourself some tough questions before you accept the responsibility. Never acccept it out of ego...just because you have been on the unit longer than someone else does not make you a charge nurse candidate. Think of it as a RESOURCE position...are you a resource to your coworkers?
    Do your coworkers regularily approach you and ask you for help? NOT physical help like turning and lifting...help like dosage and route and side effects and assessment skills and patho and disease process and reading xray and how to talk to doctors and how to talk to families....if you are already doing that...you are functioning as a resource already so taking on the "official" title will be an easy transition .
    However..if you have a poor relationship with your coworkers becoming resource will not make the situation any better. It would be better to wait and work to improve your relationships before taking on the role.

    The Charge nurse needs to set the tone. If you choose to accept 6 or 8 patients and the charge role be sure you can do it.
    If you feel like it is ridiculously impossible say so and refuse. Some MArTYRED
    supernurse did it one night and announced to management that it could be done...if you could find this idiot and put your knee on her neck I would do it but ofcourse she is probably in a home for broken down nurses somewhere unable to move because she looked after 8 patients and did charge one night shift too many and she broke in half.
    Personally I would fill out a Workers Comp Incident report of Injury in the workplace every shift you have a full patient assignment and full charge responsibilty...lower back pain while assisting patient from bed to commode for 8 patients 4 times each for a total of 32 assists in 12 hours...you worked 3 12 hour shifts in a row for a total of 96 lifts..causing a repetitive lumbar back strain injury which was severely aggravated by the fact that your charge duties required you to round on the entire unit hourly and recieve report and assess the acutely ill patients yourself. You needed to conference with staff rn and MD regularly about high intensity patients. Agency staff also required orientation and supervision aggravating lumbar strain by decreasing any available time for resting of injury.

    Look at your duties objectively..write down what you do in 12 hours...be honest and don't downplay your role...we aren't super heroes and just because some dumba** did it years agoo doesn't mean it was a good idea and they were the bestest nurse ever...they did noone a favor...the patient did not benefit and the nurse did not benefit and the practice needs to stop.

    The very idea of ONE nurse looking after 8 patients makes me crazy.
    One nurse can comfortably care for 4 normal appropriate ward patients....the fact that one nurse is expected to care for 8 patients...and four of them could be completely bedbound demented incontinents, two of them trached and require hourly suctioning and they all have IV's and dressings and never ending meds and they have NG's or pegs or Jtubes... and the never ending charting....................ahhhhhhhhhhhhhhhhhhhhh hhhhhhhhhhhhhhhhhhhhhhh
    how did things get so out of control???????

    The worse shape the patients are in the less nursing staff are hired.

    I think we need to start bringing WSIB in more and more as WSIB fines the hospitals for each claim...it soon becomes cheaper for the hospital to hire more nurses then to pay the fines...
    Sad the lengths we need to go to protect our patients and ourselves...but sometimes I think we dug ourselves into this hole ...the very first time that mysterious nurse said okay I can take 8 patients and do charge too she ran all of us into a ditch we are all going to have to work really hard to get out of.
    We learned a really hard lesson though and hopefully the next time management asks for something outrageous we will have enough sense to say no thank you.
  9. by   fergus51
    I don't do charge, but ours never takes an assignment. No patients at all for them, they have other things to do.
  10. by   XIGRIS
    I am a charge nurse for CVICU/ICU for 14 years. In my experience, if I had to take patients I get the easiest one so I can be the "resource" person of the unit. That was in my old hospital. In the current seeting, I rarely take patient. Although, I tried to weigh things before I start the shift. If a fellow nurse had worked for so many nights or if someone had a bad night, I usually unload them. I take one of their patients or just give them one patient. I also see the strenghtts of the crew for that shift. I try to devide the patients according to nurses' strenghts. I must admit there are a few nights when the unit is slammed. Sometimes I have to take patient.
    Like mentioned earlier here, it is up to the charge nurse to take up responsibilities. If the pateint care is jeopardized, then ask for an extra help. If supervisor can't find someone to work extra, I always ask the enitre crew for that night if we can handle this. I must admit that all the nurses I work in the unit is willing to do the " extra mile."
    We get $2.00/hour for charge nursing.
    Plus one you command respect both from the staff and management, they always take care of you.
    I will surely miss this job. But it is time to move to another dream of mine.
    CRNA school here I come.
  11. by   teeituptom
    I always had my own patients also while in charge

    Ive done charge 70 percent of my career


    Not no more no more no more
  12. by   LolaRN
    Our charge nurse takes up to three patients. The rest of us take up to 7 or 8. It does vary between shifts though. At night, the charge nurse takes 7-9.
  13. by   Tweety
    I'm a charge nurse and it varies. Our budget is that the charge nurse is free on all shifts. A lot of times this doesn't happen at night if we are short, or if another unit is short, I'll take an assignment and let them pull a nurse. Quite often I'll start out free and then take admits.

    We just went through a crunch where I had patients every night for several weeks and my boss was on my case out some chart reviews that I had to have done by the end of the month. I didn't do them. I can either take patients, which I prerfer, or I can do management paperwork, which I hate, but I'm not doing both. Patients first.

    Once several years ago we were going to change the system. Have the charge take patients, and everyone do their own thing without a charge, but maybe a patient or two less in your assignment. We took a vote and everyone said they like the old way with a free charge, even if it meant having one or two more patients. Of course, you have to have a good hardworking charge nurse to have the staff feel that way.

    Depends on the institution. If the expectations of the charge nurse take a lot of time time, then that charge should be free or have a lesser assignment.
  14. by   RNPATL
    Wow - thanks for all the great information. It seems like taking patients and holding charge responsibility is pretty much the norm. That is truly sad! In my case, we do not get any extra pay for the added responsibilities.

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