charge nurse role responsiblities

[Guest02/04/2016]

i am not sure what quantifies/qualifies an excellent charge nurse... but i think there is an issue with mine. i work on a medical/surgical unit.

i felt a patient admitted should've been on a monitored floor. change of shift arrives, charge nurse from oncoming shift blasted me for not transferring pt elsewhere.

another instance, i discussed with my charge. the charge was contemplating on keeping the pt on floor (while the patient declines). coincidentally, my preceptor was working and emphasized we should transfer the patient. the patient was moved to the Intensive Care Unit the following day.

i also experienced other instances where i needed my charge to brainstorm possible critical patients with me, but she was too busy jotting down vacation days.

charge would tell me to give multiple narcotics and synergist, but never do themselves. (for instance, when i am on break.)

to avoid confrontation with a patient, my will falsely redirect their tension towards me. like lying to a patient and telling them we had the MD order hours ago. speaking off... my charge would rather have me execute and order WITHOUT MD approval, to get a patient off the call light.

unfortunately, i am not the only person on my unit who experienced the like. i'm not sure what the duties of a charge nurse is, but mine never assists me when i need it. hat do they do?

[Karou]

Are you a new nurse?

Where I work, it is never the charge nurse who determines if a patient needs to be transferred to a higher level of care. That decision is made by the physician. The only exception is of a rapid response or code blue has been called and the physician is not reachable, in that case the house supervisor will place the order to transfer. The charge can certainty assist through the process and (on occasion) is needed to convince a physician that the patient needs to go to ICU.

If you felt your patients were not appropriate for the floor, did you call the doctor? What did the doctor say? Did you call a rapid response when you felt you weren't being heard? You said a lot about what the charge nurse did not do, but nothing about what you did to advocate for your patient, including calling the physician. I can't imagine why you would need the charge nurses permission to call a physician, initiate a rapid response, or receive an order to transfer a patient to ICU from a physician.

As a charge nurse, I can tell you that I am not always able to medicate a patient for pain. When I pass the message along to the primary nurse, I often have a list of ten other things that I need to do (cosign medication, insert IV, take report for another nurse, ect...). I will medicate a patient if I have time, of course, but I am often unable to.

Your last statement about redirecting the patients frustration to you and asking you to place orders is actually concerning. What kind of orders? Examples? Did you talk to the charge nurse about her redirecting the patients tension to you?

Perhaps you can ask for a day to shadow a charge nurse to see what all they do and what their duties and responsibilities are, as this differs slightly from facility and unit.

Does your charge nurse have patients of their own, or are they a "free" charge? How many patients does your unit have, how many patients do you have? I am asking so I can get a grasp of why you are dependent on the charge nurse, and why the charge nurse may not be as available as you need them to be.

[RNperdiem, RN]

In many hospital there are specific parameters for determining level of care-floor, intermediate unit or intensive care. The doctors are the ones who determine this, and they are the ones who need to be contacted if a patient needs a higher level of care.

For example if a patient needs oxygen greater than a 50% mask to maintain a minimum level of oxygen saturation, they don't stay on general medical floors. Look up the policy. Then you will have to power to call the doctor and say "Pt X. has respirations in the 40's on a 50% face mask, can we transfer him to ICU?"

[Been there,done that, ASN, RN]

I am having difficulty following your train of thought. "My preceptor was working " leads me to believe you are on orientation.

It is not up to you deal with the charge nurse, any issues should be handled by your preceptor and then the outcome is explained to you.

" i'm not sure what the duties of a charge nurse is". Charge nurse duties and responsibilities vary by facility and unit.

A newbie's responsibility does NOT vary. Follow your preceptor recommendations and stop questioning the charge nurse.

[Guest02/04/2016]

I am having difficulty following your train of thought. "My preceptor was working " leads me to believe you are on orientation.

It is not up to you deal with the charge nurse, any issues should be handled by your preceptor and then the outcome is explained to you.

" i'm not sure what the duties of a charge nurse is". Charge nurse duties and responsibilities vary by facility and unit.

A newbie's responsibility does NOT vary. Follow your preceptor recommendations and stop questioning the charge nurse.

i am not on orientation... sorry. the person who precepted me, i meant.

[Guest02/04/2016]

i wasn't oriented properly and there are issues with my facility i will not go into details about.

it is to my understanding, i must have a discussion with my charge about patient status and they ultimately make the call. i do not utilize my charge for any other reasons, other than discussing my patients change of status. all i need to know is if there is a chain of command i need to follow...? if can completely bypass my charge nurse, great~!

that is my only question.

- when i write my preceptor, i meant my preceptor from a year ago. i voiced my concerns about transferring a patient. my charge nurse refused to transfer because it will add to her workload. my preceptor (from a year ago... i am off orientation) walked into the room and told me... "you should get this patient off this floor, stat." the patient was transferred to a monitored unit, and they transferred the patient to the ICU, the next day. sit there and absorb this for a moment. this isn't the first time this has happened to me. i only wrote of 2 instances, however.

[Karou]

i wasn't oriented properly and there are issues with my facility i will not go into details about.

it is to my understanding, i must have a discussion with my charge about patient status and they ultimately make the call. i do not utilize my charge for any other reasons, other than discussing my patients change of status. all i need to know is if there is a chain of command i need to follow...? if can completely bypass my charge nurse, great~!

that is my only question.

- when i write my preceptor, i meant my preceptor from a year ago. i voiced my concerns about transferring a patient. my charge nurse refused to transfer because it will add to her workload. my preceptor (from a year ago... i am off orientation) walked into the room and told me... "you should get this patient off this floor, stat." the patient was transferred to a monitored unit, and they transferred the patient to the ICU, the next day. sit there and absorb this for a moment. this isn't the first time this has happened to me. i only wrote of 2 instances, however.

I still have questions I asked that you didn't answer. Most importantly, what did YOU do in these situations.

1. Did you ever call the doctor about your concerns? What did the physician say? What did you do to advocate for your patient? From your post, all you did was talk to the charge nurse, which isn't very much. How did the patient get end up getting transferred to a "monitored unit" if the charge nurse wasn't taking your concerns seriously?

2. Is the charge nurse a "free" charge, or do they have patients of their own? How many patients do you have? Additionally, I don't see how transferring a patient to ICU adds to the charge nurses workload. It doesn't effect the charges work nearly as much as it does yours.

You precepted a year ago? You are a nurse with a year of experience? You should know your chain of command by now!! That's inexcusable, and probably the most shocking part of your post. You let a patient sit on the unit, who YOU felt should go to a higher level of care, and you didn't purse any action besides talking to the charge nurse?

You have a nursing license to protect, and patients to protect. It is VITAL that you know the chain of command. Not knowing your chain of command is absolutely not an excuse!!!

***Has any other poster ever worked at a facility where the charge nurse decides if a patient is transferred to ICU and not the physician??? I have never heard of this. I doubt it's true.

[Guest02/04/2016]

I still have questions I asked that you didn't answer. Most importantly, what did YOU do in these situations.

1. Did you ever call the doctor about your concerns? What did the physician say? What did you do to advocate for your patient? From your post, all you did was talk to the charge nurse, which isn't very much. How did the patient get end up getting transferred to a "monitored unit" if the charge nurse wasn't taking your concerns seriously?

2. Is the charge nurse a "free" charge, or do they have patients of their own? How many patients do you have? Additionally, I don't see how transferring a patient to ICU adds to the charge nurses workload. It doesn't effect the charges work nearly as much as it does yours.

You precepted a year ago? You are a nurse with a year of experience? You should know your chain of command by now!! That's inexcusable, and probably the most shocking part of your post. You let a patient sit on the unit, who YOU felt should go to a higher level of care, and you didn't purse any action besides talking to the charge nurse?

You have a nursing license to protect, and patients to protect. It is VITAL that you know the chain of command. Not knowing your chain of command is absolutely not an excuse!!!

***Has any other poster ever worked at a facility where the charge nurse decides if a patient is transferred to ICU and not the physician??? I have never heard of this. I doubt it's true.

thanks for your time/response.

[TheCommuter, BSN, RN]

Speaking as someone who worked as a charge nurse and house supervisor for several years, the charge nurse role entails a massive amount of accountability without the corresponding authority.

In all likelihood, even though your charge nurse is not a sterling example of a great nursing leader, she does not have as much autonomy to make independent clinical decisions as you seem to perceive.

[Been there,done that, ASN, RN]

i wasn't oriented properly and there are issues with my facility i will not go into details about.

it is to my understanding, i must have a discussion with my charge about patient status and they ultimately make the call. i do not utilize my charge for any other reasons, other than discussing my patients change of status. all i need to know is if there is a chain of command i need to follow...? if can completely bypass my charge nurse, great~!

that is my only question.

- when i write my preceptor, i meant my preceptor from a year ago. i voiced my concerns about transferring a patient. my charge nurse refused to transfer because it will add to her workload. my preceptor (from a year ago... i am off orientation) walked into the room and told me... "you should get this patient off this floor, stat." the patient was transferred to a monitored unit, and they transferred the patient to the ICU, the next day. sit there and absorb this for a moment. this isn't the first time this has happened to me. i only wrote of 2 instances, however.

Again, charge nurse duties vary widely. It does sound like yours is trying to do as little as possible.

However, if her manager is satisfied with her performance, there's not much you can do.

When you note a decline in patient condition, that you feel may warrant a transfer.... you must notify the physician first. Using the SBAR format suggest a transfer to a higher level of care. The physician may or may not agree and order the transfer. It's not the charge nurse's responsibility to assess level of care.

This is where the charge nurse assists with the transfer by finding a bed . Document you notified the charge nurse of the change of condition and the physician response.

[Guest02/04/2016]

please don't think this is 1 of those "hey... i'm a new graduate, i'm more knowledgeable than the charge... etc..." i'm still too new at this to feel that competent. i'm in the process of looking for a new position because it scares me knowing i do not have an experienced resource on the floor with me. i work at a s***hole. 75+% of us are new graduates.

i want to keep my patients safe... and alive. after a hand full of incidents, i decided to share with the few trusted veterans and the person who precepted me (a year ago...) they tell me... keep that particular person/charge out of your care. she doesn't give an F about anybody/anything. i'm not going to share details, but i heard "interesting" stories.

thanks for the responses/time. i'll go straight to the MD, moving forward.

[tokmom, BSN, RN]

As a full time charge, my duties are a bit different so I won't go into them here.

I look at my role as an overseer of the floor. The staff is responsible for assessing their own pts and talking to the md about a higher level of care. I'm pulled in for status changes or a need to talk to a physician with the nurse if i think the nurse is getting brushed off.

You need top look at your policy and procedures to see what the COC is at your hospital.