Charge Nurse Role

[BGSRN]

We are in the midst of discussions related to the Charge Nurse Role. Currently we have a unit where there is a charge nurse. The unit usually has about 20 pts. The charge nurse signs off orders (that are transcribed by a secretary) makes calls, speaks with physicans, basically oversees the unit and is an extra pair of hands to help. She has no patient assignment. Consequently, staff can have up to 6 pts. Another unit prefers no charge nurse so the patient assignment for each nurse averages 4 pts and is seldom if ever 5 pts. Each speaks with physicans, makes calls and oversees all aspects of the pts care. The secretary transcribes the orders and the primary nurses checks and signs off.

My question is what is everyone else doing out there and what are the feelings of a nursing module with a charge nurses with no pt assignment vs a primary nurse model with no charge nurse. I have been looking for research on advantages/disadvantges of each model but have not found much.

You feedback would be greatly apprciated!

[Tweety, BSN, RN]

We use the first model you describe. But our unit is 30 plus patients (up to 37). Our ratio if 4 to 6:1. There are advantages and disadvantages to this model. The advantage is there is usally someone there to answer simple questions when the phone rings or the doc makes rounds and you don't have to be interrupted from your patient care. When I worked charge on this unit at nights, we were talking about changing ratios and giving the charge a full patient load and there was resistance from the staff and we didn't do it.

With a smaller unit and it might work better.

[Chaya, ASN, RN]

In my experience it works so much better to have a designated charge nurse to oversee. 2 nurses may have the same number of pts but one's pts might be in a crisis situation or just have a higher acuity in general. It helps so much to have a person who can jump in and help any of the other nurses without leaving their own pt assignment. It's also good to have someone at the desk to keep an eye on tele while you're in another pt's room, or when you have to page the MD who hasn't responded to your 1st 2 pages yet.

[mtngrl, ASN, RN]

At the hospital I worked at the "charge nurse" was whoever the RN was scheduled for the shift. (A lot of times there was mostly one RN and a lot of LPN's). The charge nurse did get patients. The only thing she really did different than the others was decide who got new admissions and she also had to assign patients to the next shift. And I guess be the one to come to whenever there was a problem. Personally I think that is a stupid way to pick the charge nurse. For example, I was brand new, with NO experience, yet because I am an RN I was scheduled to be the charge nurse. I quit before I had to do it. The charge nurse should be experienced and should be asked if she wants to do it.

[Celia M, ASN, RN]

On our med/surg/tele floor (26 beds) we have a ratio of 1:5. On days the charge tends to take up to 3 patients (at a push!!, 2 is better) and fields the docs, labs and covers LVNs. At night the charge takes a couple less patients than the others. The charge nurse is someone with some nursing experience and who has been oriented to the position.

[BGSRN]

Thanks for your responses. I am wondering if there are any acute care hospitals that are using primary w/no charge RN and how that works.

[veegeern, BSN, RN]

Thanks for your responses. I am wondering if there are any acute care hospitals that are using primary w/no charge RN and how that works.

On days when we have all RNs on the floor, we USUALLY have primary w/no charge. How well it works depends on who is working and what is going on that day. If it's the normal chaos...lol...then it works fine. Most of the nurses that I work with help each other out with new admissions, procedures, etc...On a bad day, the nurse to patient ratio can be greater than 1:6, and then this does not work well at all.

[Indy, LPN, LVN]

We use the model of charge nurse taking patients. The charge nurse is supposed to take a "lighter" load and help the other nurses, so the ratio is 1:4 if it's ideal; 1:5 or 1:6 if understaffed. My definition of understaffed would be two nurses to 11 beds, charge has five, other nurse has six, and pray you have a tech that night.

Some nights there are no light patients, or there are enough heavy ones that it would be downright cruel for the charge to not take any of them. Now that's nights. Days are normally staffed with more nurses and occasionally the charge has enough that she doesn't take a patient load, but it doesn't happen too often.

[Zee_RN, BSN, RN]

Personally, I don't think the charge nurse should take patients, except in dire emergencies. He or she should be available to all the nurses for assistance and guidance. And sometimes staffing is a MAJOR time consumer. But I work in ICU and haven't worked on the floor for 8 years. Our charge nurses not only does all staffing, bed assignments, assisting each nurse, transports monitor pts. to testing and transfers, performs monitor checks and other administrative duties, he or she also runs to all inhouse codes and Rapid Response Team calls and frequently is called off the unit for IV starts too. So a patient assignment is not feasible.

[justmanda]

Thanks for your responses. I am wondering if there are any acute care hospitals that are using primary w/no charge RN and how that works.

My floor has tried it both ways and, truthfully, it sux both ways (for the charge nurse anyway). That's why I detest being in charge. Here's why. Imagine you have no patients and are in charge on a floor with 9 nurses. You are the one that has to do what nobody else wants to do. Start IVs, deal with hospital to hospital transfers, assign beds to nurses who all complain that they're too busy to take an admission. Take admissions because you don't want to have 5 nurses mad at you. Assist with bedside procedures. Handle fights between understaffed CNAs and the nurses who they say are "working them to death" Fight with Patient Placement when they try to send too many admissions. Change diapers because the CNAs are being worked to death. Help the float nurses who don't know the unit. Make the day shift assignment. And so on... Now, imagine you are in charge and have 6 patients and read the above list of duties....it's exactly the same! Granted, there are a few independent nurses out there, but for the most part, you are the relief pitcher when you are charge - patients or not. Some people like that type of chaos and it is those people who probably make the best and most efficient charge nurses. On another subject...when it comes to calling doctors for other nurses, I have always found that to be very odd. It is the primary nurse who best knows the patient and can give the MD the full picture. I wouldn't want another nurse calling a Doc for me.

[MS._Jen_RN, ASN, RN]

I work on an acute care rehab unit in a hospital. 42 beds. All of our RN's are responsible for their own orders, phone calls, MD issues, etc. There is a Charge RN (often me)who takes a patient assignment (often a "lighter" assignment). The Charge deals with all staffing issues (call offs, being short, etc), problems for that shift (Rn needs help with a patient going bad, disagreements btwn staff), and any decisions that need to be made for the unit (where to put an admit). It works pretty well for us. The Charge gets paid $1 more an hour (yipee!)

~Jen

[ckalston]

Thanks for your responses. I am wondering if there are any acute care hospitals that are using primary w/no charge RN and how that works.

I recently became nurse manager of a med-surg unit that uses the primary nursing with a so called charge nurse. I say so-called because 21 patients will often have 3 nurses even with the charge taking patients which is simply not acceptable. We are in the process of returning to the charge nurse model but we are also trying to hire into our matrix which focuses on our ulitmate goal of 1:4 or 1:5 nurse:patient ratio. The important piece is that the charge nurse be effective at the position and not just a person behind the desk. A good charge nurse will make the difference even if the primary nurse has to have more than 5 patients because they can help all the nurses. When they have their own workload, then they cannot take care of their own patients much less help with others.