Charge nurse taking patients in ICU

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A "magnet" hospital and this particular ICU had previously rarely had the charge nurse take patients. There are plenty of float staff and RNs willing to work extra shifts; but now it is becoming common for the charge nurse to take her own two patients as well as having two patients while one may be on CRRT. Understood, this is a cost saving strategy.

Although in the long term, can only lead to legal issues in regards to safety, obviously. Which seems much more costly.

I'm probably naive, but how common a practice is this? Of course, this state does not have a union. Otherwise I am sure this would not be happening.

The problem is that when something does occur; i.e.: an RN has to go home because of their own medical emergency, there is no one to care for the patient/s for hours because of this kind of staffing practice. Besides the obvious problems with this practice; being just impossible to properly monitor an entire unit (this one with 28 beds) as well as provide good care to the two patients of the charge.

I've seen it quite commonly on less acute units...but the ICU!!?

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Unfortunately this is becoming more common, as is tripling in ICU, neither of which is good for patient care.

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Specializes in ICU.

I've seen RNs sent home so the charge nurse can take an extra patient in order to 'meet the staffing matrix'.

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We've had a lot more push to improve "productivity" lately. It does create unsafe situations and it is frustrating to see the things our unit does to save money and then talk to people who work on the business side and hear they sit around doing nothing a lot of the day. I understand it is a business, but there have to be limits. As far as our charge taking patients, it does happen, but not very often. Which is good since our charge also responds to code blues throughout the hospital...

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Specializes in Quality, Cardiac Stepdown, MICU.

I asked the director when I interviewed if the charge takes pts, and he said never. "I want the charge nurse to actually be able to be in charge, to be a resource." I've found he is not lying. We will triple before the charge takes a pt. That nurse is also the code/rapid response nurse. (We divvy up the rapids with two other ICUs, but we staff every code, no matter where.)

S/n we are not usually 1:1 with CRRT.

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Specializes in ICU.

I work in a smaller regional hospital in Ohio, and our charge nurses do not take patients, if for no other reason than they have to respond to codes and rapid-responses on other units and could be gone for an hour or more at a time. We're also 1:1 with CRRT, IABP & Arctic Sun.

I guess, for all the complaining and people leaving our unit for the larger hospitals, we have it pretty good from what I'm reading here.

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Specializes in Pediatrics, Women’s Health.

I have only seen a charge take a patient once - and it was just one patient on floor orders awaiting a bed. What happens if you get a trainwreck admission or a patient codes? The charge should be available as a resource for these things. Also, we are always 1:1 for CRRT and triples happen maybe a couple times a year (and always step down patients, never ICU level pts). For as much as people complain about our staffing, I think we have it pretty good.

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I have only seen a charge take a patient once - and it was just one patient on floor orders awaiting a bed. What happens if you get a trainwreck admission or a patient codes? The charge should be available as a resource for these things. Also, we are always 1:1 for CRRT and triples happen maybe a couple times a year (and always step down patients, never ICU level pts). For as much as people complain about our staffing, I think we have it pretty good.

If you're still getting singled just for having CRRT, I'd say you're doing quite well.

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I work in an 18 bed MICU in a Level I Trauma Center. The charge nurse has always taken an assignment. At times the charge may only have 1 patient but usually it's 2. We also respond to code blues for half of the campus and the other half is covered by the CCU, although majority of codes happen in the units covered by MICU. With that said, all CRRT, Hypothemia and ECMO are 1:1. We would never think of pairing those patients. That's the way its always been and I think the nurses on my unit would revolt if they tried to change it. We also single any other train wreck that needs it although this may cause someone to triple.

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Specializes in SICU, trauma, neuro.

In my unit, the preference is to not give the charge an assignment. If they do, they take the most stable pt (think the one who is transferring to the floor or stepdown the next day, or could have already if they'd had a bed). However we've been SO short lately...I've actually felt guilt for the first time in YEARS because I generally won't double (I'm not a VSS, but I do have five kids ages 1-12 and have to plan my work ahead of time), and I've said "no" so many times while 4-5 other nurses are. So anyway, there have been times recently where the charge RN has two pts.

We do have a handful of float pool RNs each shift who are resources for the entire hospital that have on occasion been pulled. That all depends on if they are ICU trained or if they are RRT RNs for the night, of course. Once they actually did that for me--I went in feeling perfectly fine, and in the middle of report I spiked a fever and began vomiting.

At the moment, our NM still refuses to give us 3 pts, and CRRTs are always 1:1.

But if the charge RN has an assignment, we're all pretty good about being aware of the situation--especially if our pts are in close proximity to the charge's pt. We keep ears open for alarms and call lights and respond to them. If things really start to go south--say, charge RN has to respond to a code (the ICU charges respond to every code) or we get slammed w/ admissions, those of us near the pt will open up the chart and see what meds they need, if they need labs soon etc. Teamwork is VITAL!!

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Specializes in Quality, Cardiac Stepdown, MICU.
(I'm not a VSS, but I do have five kids ages 1-12 and have to plan my work ahead of time)

Sorry to hijack the thread, but I've seen this in a few places already: What is VSS?

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Specializes in MICU - CCRN, IR, Vascular Surgery.
Sorry to hijack the thread, but I've seen this in a few places already: What is VSS?

"Very special snowflake"

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