Charge Nurse?

TheCommuter, BSN, RN · Oct 4, 2014

The answer to this question is highly dependent on the specific policies and procedures formulated by the hospital.

At some facilities, every unit does not necessarily need a charge nurse if there's a nursing house supervisor in the building. This is why the policies and procedures of the specific hospital are highly determinant in this scenario.

EmpathyInAction · Oct 4, 2014

It's a small, private exclusive nursing home. The RN policy/procedure manual I looked at today basically just says the charge must be an licensed RN. I'm orienting here and there was a comment made in passing about me needing to review the STNA policy/procedure manual for when I'm charge. It dawned on me later that maybe I'm intended to be charge on my shifts since I'll be the only RN on the unit. Of course I can clarify Monday when I go in, but I thought I'd post while thinking about.

chiandre · Oct 4, 2014

Yes, the aides will be working under the license of the RN. In this situation, only the RN has the legal authority to care for the patients on that unit. The aides are certified to assist the RN.

TheCommuter, BSN, RN · Oct 4, 2014

It's a small, private exclusive nursing home.

Floor nurses in LTC facilities are, by default, charge nurses of the units where they happen to be working during a particular shift.

firstinfamily, RN · Oct 4, 2014

LTC uses LPNs and RNs as charge nurses. If you are the highest licensed professional in the entire building, you will be held responsible for what goes on---in the entire building. The facility where you work may deny this, but in a court of law, you would be held accountable. Now, you cannot be held accountable for what you do not know. For instance, if an LPN does not report something abnormal to you, you would not know about it. This sounds like a place that may be setting you up for failure. Step carefully, and if you do not have malpractice insurance of your own, get some.

klone, MSN, RN · Oct 4, 2014

Nobody "works under the license" of the RN except the RN.

The only time the RN can be ultimately responsible for the malpractice of an aide is if the RN inappropriately delegated.

EmpathyInAction · Oct 5, 2014

It's a really good facility from everything I know (word of mouth, accounts of individuals I know whom have worked there, etc.). However I'm still in the beginning of the mandatory orientation for new employees. I start floor orientation Monday. So until it was mentioned in passing that I would be charge on my shift, I did not know that was in my job description. The good thing however is that I was basically told I can orient with a preceptor as long as I need to. Which I like not feeling I'll be pushed in too fast.

RNsRWe, ASN, RN · Oct 5, 2014

Nobody "works under the license" of the RN except the RN.
The only time the RN can be ultimately responsible for the malpractice of an aide is if the RN inappropriately delegated.

^This^

I'm frequently surprised by the number of CNAs who believe they work "under" the RN's license who assigned them a task. They have a certificate that indicates they are capable of completing a task that is appropriately assigned to them. If they screw it up, that's not the RN's responsibility. If they fail to do it at all....same thing.

The RN is ultimately responsible to be certain the tasks ARE completed, and that they are completed competently. Anything the aide has done, however, is ON the aide, should there be ethical or legal ramifications of that action (or inaction).

lifelearningrn, BSN, RN · Oct 5, 2014

So on the NOC shift, there is only 1 RN for all 300 beds (or did I misunderstand?) --- It sounds nice that they're giving you all the orientation that you need, that seems to be somewhat rare in LTC.

You will definitely be in 'charge' of the CNAs, and as an RN, you can also delegate tasks to LVNs. In the LTC facilities I worked, LVNs worked independant of the RNs, some being in supervisory roles, so your charge role over an LVN may not differ from one to another. I had LVN's precept me, and I never could imagine being 'in charge' of any of them.

EmpathyInAction · Oct 6, 2014

No, one RN per unit, 2 units per floor, 7 floors.

workinmomRN2012, BSN · Oct 20, 2014

It's a slippery slop. There are loopholes in SNF/LTC facilities. I was working at one place that had 60 beds, one side had 30 beds and an LPN, the other side had 30 beds mixed rehab/LTC with an RN. Sometimes there was also an LPN that did tx's and she was also the nursing coordinator aka charge nurse. So some nights I was the only RN in the building. Let me clarify before anyone thinks that I have something against an LPN being charge... she was an aid and then a nurse for the same amount of time as me, I just had more schooling than she did.

I was concerned about this issue so I went to my DON and voiced my concerns, guess what she said "they are just letters behind a name". All while I'm looking at the degree hanging on her wall that stated she was a BSN, well if it doesn't mean anything why hang it up?