Charge nurse question

Elvish, BSN, DNP, RN, NP · May 16, 2007

It makes sense that you would be the one held responsible for that order since, by signing it off you are saying "I have seen this order and will see that it gets carried out." I thought that was the reason for signing orders off. (I'm not meaning this to sound smartalecky, just trying to talk it through c myself.)

I have found many orders signed off that hadn't been carried out as of that point. Like you said, nothing earth-shattering but unnerving nonetheless. I have signed off orders for babies as charge in nursery that the couplet nurse either on my shift or on a later shift didn't do.

As for your situation, I would definitely document specific dates, times, orders, & pt initials, anything to help you remember. Kick it up the food chain to the NM. It may not be your goal to 'tattle' on someone but s/he definitely needs to know if an employee is habitually not practicing safe care.

What the charge nurses did at a former job was sign the order off and place a copy (they came on duplicate or triplicate forms) with the pt's kardex so there was no excuse for the nurse not to see it. If they were free charge & actually carried the order out (d/cing a foley, f.ex.), they'd write "done @ 0915" & initial it so that nurse would know it was ordered & done.

Just a few ramblings. Hope something is helpful.

Tweety, BSN, RN · May 16, 2007

1 - do you as charge nurse take patients or just run the unit?rarely start with patient. may take an admission or two, but usually i have no assignment.

2 - do you sign off orders for the entire unit or just your patients?i sign off all the orders. i'm verifying that they are appropriate, and the secretary entered them appropriate.

2 - have you ever had problems because you signed off an order that the primary nurse did not carry out?never. nor in the 15 years have i have heard of this being a problem where i work. i assume that when i note an order, i'm delegating it to the primary nurse who has a license of their own. i can see that if an order was inappropriate for instance doing a procedure or giving a med that was contraindicated, and i noted it, and the nurse carried it out, and it harmed the patient then i might have some accountability. i also understand there might be some accountability if they didn't carry out an order and the patient was harmed. but i've seen nurses not do many an order and never has the charge nurse gotten in trouble.

lauralassie · May 17, 2007

When I worked ICU, the one who "red - lined" the chart at the end of the shift , signed it : dated and timed it , was the one resp. for being sure that the order were done correctley. It's unfair for the charge RN to be respon. for that, unless they are the one taking off orders. Any one can red line a chart. It's just saying that you checked the orders.

gemcitygirl · May 27, 2007

yes when I am charge not only am I responsible for my shifts orders, but if a test is ordered, entered into the computer for the next day, but the day shift nurse fails to follow up what is clearly in the cardex, it's still my license on the line. I had charge over 14 patients today, and had my own 5 patient assignment in acute care, plus 4 complete discharges, just me and an LPN. I've had about enough. I graduated a year ago last week. I'm already thinking about calling it quits, and reinstating my LPN license. No amount of money is worth this stress and verbal abuse from mgnt and drs.

DutchgirlRN, ASN, RN · May 27, 2007

1 - do you as charge nurse take patients or just run the unit?
2 - do you sign off orders for the entire unit or just your patients?
2 - have you ever had problems because you signed off an order that the primary nurse did not carry out?

i worked charge for years ending in 06. (42 patients) i have never heard that i was responsible if any of those orders were not carried out. i think that's absurd! my signature meant only that the unit secretary had properly ordered the tests and that the orders had been scanned to the pharmacy. the nurse assigned to the patient was solely responsible for carrying out the orders. i very occasionally took a patient when all others already had 6. as soon as a pt was discharged the nurse with the dc'd pt would take mine over.

withasmilelpn · May 27, 2007

I only write that I've noted the order if I've done just that. Transcribed on the TAR or MAR etc. I write faxed only after I actually faxed it. Keeps me honest, I guess. Sometimes since I work in LTC/rehab the order really can't be carried out until the following day like a f/u appt or test, I leave the order flagged and make sure to pass it on in report. I also write a note that says I am passing it on and place it on 24 hour report so all bases are covered. I do not write noted though on the order, because in my eyes it hasn't been until carried out.

DEB52 · May 31, 2007

Why isn't the nurse who has been assigned to the patient taking off her/his own orders? As the person in charge, I take off my patients orders. If a problem occurs with implementing a order or the nurse has a question about the order she will come to me. :confused:

PoppaD · Jun 16, 2007

yes when I am charge not only am I responsible for my shifts orders, but if a test is ordered, entered into the computer for the next day, but the day shift nurse fails to follow up what is clearly in the cardex, it's still my license on the line. I had charge over 14 patients today, and had my own 5 patient assignment in acute care, plus 4 complete discharges, just me and an LPN. I've had about enough. I graduated a year ago last week. I'm already thinking about calling it quits, and reinstating my LPN license. No amount of money is worth this stress and verbal abuse from mgnt and drs.

In regards to a 14 pt load distributed between you and a LPN...assuming you are working in an Acute M/S area...that sounds feasible. Here in my neck of the woods a nurse routinely cares for a group of 1 - 6 or 7 pt's. Sure...it can be daunting...but it can be done.

In regards to "your license being on the line": I do not think that you really have to worry about your license being placed in jeapordy provided that you or your designee have taken the order off correctly ( order entry, proper notation in the pt's maedical record/kardex, etc.) and you have reported off to the oncoming nurse. Your duty ends when another nurse properly relieves you of your duty to your patient.

For example: you receive an order for a pt to receive: H/H q 6 hrs; BMP (chem-7) q AM x 3 days. You carry out your orders...report off and go home for the weekend...the on-coming nurse carries out her orders faithfully...but the dayshift nurse fails to carry out her orders----how can that be construed to be any else's failure but his/her own?

We do not share our professional licenses with our coworkers...and we do not share in their dereliction of duty/negligence.

I do not u

ladylynx · Jun 25, 2007

In regards to a 14 pt load distributed between you and a LPN...assuming you are working in an Acute M/S area...that sounds feasible. Here in my neck of the woods a nurse routinely cares for a group of 1 - 6 or 7 pt's. Sure...it can be daunting...but it can be done.
In regards to "your license being on the line": I do not think that you really have to worry about your license being placed in jeapordy provided that you or your designee have taken the order off correctly ( order entry, proper notation in the pt's maedical record/kardex, etc.) and you have reported off to the oncoming nurse. Your duty ends when another nurse properly relieves you of your duty to your patient.
For example: you receive an order for a pt to receive: H/H q 6 hrs; BMP (chem-7) q AM x 3 days. You carry out your orders...report off and go home for the weekend...the on-coming nurse carries out her orders faithfully...but the dayshift nurse fails to carry out her orders----how can that be construed to be any else's failure but his/her own?
We do not share our professional licenses with our coworkers...and we do not share in their dereliction of duty/negligence.
I do not u

In another world maybe this would be true. But please, I advise all to speak with the Risk Management Department in their facility and go to a court session involving a health facility law suit. Yes we all can be held responsible and now that nurses are being named in law suits and not just hospitals (I have had the experience), even the charge nurse is held accountable for all those under them. The red line also means nothing when a med order or any order is missed...all can be held liable from the first day the order was written (had that experience too). These are the reasons new nurses are quitting. There used to not be "accountability", but now with increased knowledge and the "internet"...accountability is demanded and situations are not going unnoticed.

As an LPN, I truly feel for the charge nurse, because unfortunately the nurse practice acts and the facility job descriptions clearly states the responsibility the charge nurses have. And we wonder why facilities don't have many volunteering to be the charge nurse (especially for $1.00 - $2.00/hour more).

EmmaG, RN · Jun 28, 2007

As a charge nurse, I was ultimately responsible for all that happened while I was in charge. It was a 33 bed onc unit with med/surg overflow, and as charge I received a pretty detailed report on all patients.

I was also responsible for staffing day shift and making their assignment, and for knowing the strengths and weaknesses of the staff that followed us. I was held accountable should I make an assignment beyond the scope of a nurse's abilities.

Although we were staffed according to patient census and NOT acuity, I was required to take acuity into account, and therefore the assignments were not 'equal' (but higher acuity did not equate to more staff). Some would have 2-3 patients, some up to 6 (or more) on day shift.

I took a full load of patients on my shift, was responsible for all chemos and transfusions (LPN"s could monitor after the I had hung and monitored the patient for the first 15 minutes), epidurals, IVIG's, etc., and also had to do full history and physical assessments on all admissions that came on my shift for those assigned to LPN's. Since I was most often the only RN working, essentially I did all new admits. We had no secretary after 7 pm, so I entered all orders.

I'm sure there was more, but I'm half asleep and besides, typing this out is depressing lol.

head injury unit RN · Jul 9, 2007

1---yes unfortunately i do have to take an assignment due to understaffing---tonight i was in charge with 3 patients (sometimes have 5 pt's:angryfire) 2 of them were on vents.

2---yes i am responsible for taking off all orders, checking all labs, and placing any calls that need made to dr's,etc ---many many times with no secretary at all and if we do have one she is "shared" with the other unit and count as a staff member also (as far as staff/pt ratio goes)

3--- :nono:absolutely not---when i take off an order i make sure to tell that nurse of the new order and what she is to do--- she has a license herself and i should not need to baby- sit her/him --my job is hard enough already. any orders on my assigned pt's i carry out myself as should she/he when made aware of the order....