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Discussion

Calling all charge nurses!

How often are you "in the numbers" when running charge? I work at a very busy, high acuity inpatient hospice center (very symptomatic patients, some trached/vented, PLEUR-X drains, tons of PRNs, multiple drips; very complex issues requiring lots of nursing education etc.) and we feel like we're drowning trying to run charge with a full assignment (5-6 pts) plus assigning multiple admissions, handling miscellaneous staff and patient issues, and doing the assignment for the nursing staff/aides for both evening and night shift. What's your floor's protocol when running charge? Do you have a policy that dictates how many patients the charge RN cares for based on your floor's census and/or what your staffing looks like that day? I'd like to bring this up at our next staff meeting to advocate for change, and I'd love your input and suggestions.

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    • Featured Replies

    I hate having to take a team plus be charge, which I haven't had to do very often, thankfully. We typically have "enough" staff to where the charge doesn't take patients. It's not a hospital wide rule, but my floor's rule is if they have to take pts, charge takes no more than 4

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    At my hospital the majority of the med/surg units have a charge without an assignment from 3p-11p to expedite admits/discharges and staffing. All of the ICUs have a charge out of staffing. The pediatric floor has a charge with an assignment.

    Staffing typically 2:1 in ICU, 4-5:1 on General Floor

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    • Admin

    Well, I'm in a specialty unit- the OR. Our charge is never in a room circulating a case with the rare exception when a trauma or emergency is screaming its way up and cannot wait for a room to finish if another nurse isn't free. However, if a room does finish, that person relieves the charge person and the scheduled cases go on hold. Between coordinating the surgical cases (surgeons canceling cases, adding on cases, running late, running early, anesthesia got held up at an offsite...) and figuring out lunch relief, there is no way in heck that the charge can do so while circulating.

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    The charge nurse should never have an assignment. It is not possible to effectively run a unit and be a resource for your staff while caring for a patient assignment.

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    • Author
    The charge nurse should never have an assignment. It is not possible to effectively run a unit and be a resource for your staff while caring for a patient assignment.

    I feel like I'm a detriment to my patients on the days I'm running charge with a full assignment. I'm just not available as much as I should be. And I'm really not able to be a staff resource except putting out fires instead of preventing them from starting, so to speak.

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    • Experts

    There's no policy dictating how many patients I receive at my workplace. Depending on staffing, I can receive anywhere from zero patients up to 12. This is at a specialty post-acute hospital.

    I'm growing to despise my place of employment...

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    Our charges are not supposed to have a patient load, but sometimes it is simply unavoidable, when we have a sick call or are understaffed and cannot get anyone to come in.

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