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Charge Nurse in ICU

pjdRN pjdRN (New) New

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? :confused: 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? :(


Specializes in ED, MED-SERG, CCU, ICU, IPR. Has 43 years experience.

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.


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

Specializes in Emergency nursing, critical care nursing..

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

Specializes in Critical Care.

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

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.

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)

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.

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. ;)


Specializes in micu ccu sicu nsicu. Has 8 years experience.

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.

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:



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


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).


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


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.


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


Specializes in Hospice, Critical Care. Has 17 years experience.

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!!

renerian, BSN, RN

Specializes in MS Home Health.

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


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.

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