Charge Nurse??? Try Ringmaster

[Harveyslake]

With the continued erosion of staffing levels and the ever more prevalent documentation burden, being in charge seems more like trying to run a 3 ring circus without enough clowns. Charge where I work ALWAYS has a full assignment and has to respond to codes and RRT's. This often leaves 1 nurse alone in the unit with up to 4 ICU patients. How can this even be considered safe?!!? Administration just says deal with it.

[Wile E Coyote, ASN, RN]

4 bed ICU= small hospital with staff that tend to wear lots of hats. I think having responding staff be the most capable of handling the things that cause codes and rapids is a good thing. I don't see the C-suite folks approving a free charge/clinical lead position, so what needs to be addressed is what's happening on your home unit in your absence. Find an ally in leadership to arrange for a second licensed staff to back up the remaining ICU nurse. Second best case would be to have the house sup be strong in critical care, which COULD reduce the need for ED or ICU staff response.

[Harveyslake]

Actually, we have 12 beds in my ICU. Sometimes census is really low. Especially on weekends. The problem is that they staff so tightly that we never have a staffed, empty bed. We routinely hold transfers so they can put nurses on the other floors on call. I've literally had to move 2 patients out after receiving a code and having the ER call for a bed. It would be much smarter to have a STAFFED crash bed rather than just an empty bed that can be used in event of a code. If I get a code, it needs my undivided attention, sometimes for hours. The only other nurse in the unit has to help AND watch the other 3 patients and answer the phone and the doorbell and run samples to the lab and answer call lights, toilette patients and everything else. 2 nurses for 4 ICU patients with all the other excrement we must deal with is not safe or reasonable. The nursing supervisor is a med/surg nurse. She tries but really is of limited help. Plus she has her own job to do. We should have at least 3 nurses at all times since we have no ancillary staff from 3p-7a. If things get especially bad, our manager is on a 24/7 pager requirement. Often she never answers the phone or the pager. So much for a back up nurse. I think the suits need to come work a few shifts and see what it is really like. We have a VP of Nursing/CNO. I have no idea what she looks like or even what she does! GRRRR!!!

[TriciaJ, RN]

If things get especially bad, our manager is on a 24/7 pager requirement. Often she never answers the phone or the pager. So much for a back up nurse. I think the suits need to come work a few shifts and see what it is really like. We have a VP of Nursing/CNO. I have no idea what she looks like or even what she does! GRRRR!!!

Time to figure out who to call outside the building. Joint commission? AHA? Is there a board of directors? If you have a union you can file an unsafe staffing report.

I don't think anyone inside the building is going to be of much help. Except to throw you under the bus when the inevitable happens. Good luck!

[TheCommuter, BSN, RN]

I am personally glad I no longer work as a house supervisor and charge nurse. The position entailed too much accountability without the corresponding authority.

[Harveyslake]

This about sums it up: Hitler, an ICU Charge Nurse Receiving Morning Report.

WARNING: Language.

[jrt4]

That sounds terrible. I think the organization has set unfair expectations on both the staff and the manager. If all you are saying is true this is unsafe and you need to lodge a complaint with the ethics and compliance department. If that doesn't work you should contact the department of public health in your state to make a formal complaint... and probably start looking for another job.