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.
When I started in an 8 bed ICU, the charge nurse did take an assignment, usually fairly light. There were 8 patients and 4 or 5 very experienced nurses. This arrangement worked well in a small, cohesive unit. Admissions and transfers were less common than on the floor, and with seasoned staff, they could ask just about anyone to help out.
The ICU doubled in size, and now our charge nurse does not take an assignment. The staff is a more mixed lot as far as assistance goes, and there is more coming and going of patients.
i work day charge on a 22 bed tely unit with 4 stepdown beds. i take no patients. I also have a float rn who deals with admissions, discharges and transfers. I deal with docs, social, transport, orders, families, meetings and anything else that comes up. I deal with any patient who goes bad or any prob on the floor. Our primary care nurses are all lpns. I make no extra money for charge. Those who do it on my days off or vacation swear they will never do it voluntarily. I love it. Its always different, stressful, but fulfilling. I get called on the carpet for all mistakes. Right or wrong. It can be tedious, frustrating and frightening. You know the docs you can trust, who you can't, and which are trainable. I have a great staff who make me look very good. I write them up for commendations frequently. I also worked in a shop for 20 yrs before changing careers and have never regretted it on my worse days. We make a difference in ppls lives on a daily basis, whether it be a life saving measure or simple reassurance. Not everyone has the personality to be a charge. I love pt care, feel i'm very good at it. There are times when i feel it would be much better to take an assignment and not have to deal with the day to day responsibilities of charge. But i also realize that someone has to do it, i am able to do it well, and it makes a difference. I realize many units have all RN's, so this one is different. The lpn's on our floor deal with many complicated situations, are extremely competent, understand when to ask for assistance, or they do not last.
RNperdiem, RN
4,592 Posts
When I started in an 8 bed ICU, the charge nurse did take an assignment, usually fairly light. There were 8 patients and 4 or 5 very experienced nurses. This arrangement worked well in a small, cohesive unit. Admissions and transfers were less common than on the floor, and with seasoned staff, they could ask just about anyone to help out.
The ICU doubled in size, and now our charge nurse does not take an assignment. The staff is a more mixed lot as far as assistance goes, and there is more coming and going of patients.