Charge Nurses are management supervisors!!!

Home Health Columnist / Guide · Jul 16, 2006

from: nlrb general counsel memo - charge nurse suprevisory issues

thus, the record should provide answers to questions like the following:

what is the function that an rn or lpn is trained and licensed to perform?
is it the case that the charge nurse's "supervision" involves the oversight and guidance provided for a small number of lower skilled, less educated employees performing routine health care tasks?
does the charge nurse's "supervision" of these lower skilled employees take place in the context of the on-duty availability, particularly during the normal workday, of a number of individuals that do hold section 2(11) status, typically a director of nursing, assistant director of nursing and other admitted supervisors?
is the relationship between nurses and aides at the facility in question any different than the relationship that nurses are normally trained to have or that prevails at other comparable facilities? do nurses work sometimes as charge nurses and sometimes as staff nurses? is the relationship between nurses and aides different depending on whether the nurse is functioning as a charge nurse or a staff nurse?
does the facility have detailed protocols spelling out management's policy with respect to various aspects of patient care?(16) do individual patients have detailed care plans specifying how they are to be treated? who prepares them?(17)
are there medicaid and medicare patients, so that the facility is subject to the guidelines that medicaid and medicare provides for such patients?
how are medicaid, medicare, or state requirements communicated and enforced in the facility? if such guidelines must be followed to meet regulatory and other requirements, who is responsible for making sure that the "letter of the law" is carried out? what responsibility do the don, the adon, and other conceded supervisors have to ensure compliance? how do they inform themselves about whether their subordinates are complying with external regulations and the facilities' own guidelines? how are they and their subordinates evaluated with respect to these matters?
do nurses have authority to depart from the facility's guidelines, protocols, and individual patient care plans?(18) are these materials the bases for the nurses' instructions to aides concerning their patient care duties?(19) if the guidelines or regulations allow discretion, who exercises that discretion?
if there is uncertainty concerning what guidelines mean because of ambiguities or apparent conflicts, who has authority to decide what action the guidelines require? does the charge nurse have authority to resolve such doubtful issues by herself or by himself, or do persons higher in authority, such as the don or a doctor, have to be consulted? how frequently do such issues arise and how are they resolved in practice?
what mechanisms are in place for ensuring compliance with the facility's guidelines and external regulations during evenings, nights, or weekends when the don is not on site? to what extent are the activities on the evening and night shift more routine than those on the day shift? for example, is the night shift primarily custodial, because patients are sleeping, and is the evening shift largely devoted to routine tasks such as feeding patients, distributing medication, and getting them ready for bed?
are higher authorities available by telephone if nonroutine problems arise on the evening or night shift or on weekends?(20)
what are the standing orders concerning when off-duty supervisors should be called and what are the sanctions if they are not called when they should be? how frequently are such calls made?(21)
are there established procedures for handling emergency situations? are nurses and aides trained how to respond to emergencies in accordance with the facility's procedures?
are the nurses subject to state licensing requirements and professional codes of ethics in their dealings with aides? do they have a professional obligation to prevent patient abuse and to report misconduct? does the facility consider that professional obligation in deciding whether its staffing pattern is adequate to ensure sound patient care?
to what extent is the nurses' authority with respect to the aides limited to making sure they keep busy?(22)
if someone puts in an iv incorrectly or fails to refill a drip in a timely manner, is the charge nurse responsible for correcting the situation? does that correction involve more than a more skilled and experienced person's directing an aide to follow standard operating procedures? does the nurse have discretion about whether to make the correction?

(b) assignment and direction of work:

the records in these cases should contain evidence of the managerial and supervisory hierarchy at the facility. as discussed above, pp. 15-23, with respect to the concept of a "minor supervisor," evidence of supervisory structure and span of control is relevant in determining the effective limits of the independent judgment the alleged supervisor is authorized to exercise. the record also needs to include the information concerning the extent of the authority that the charge nurse has concerning the assignment of both duties and hours. for example:

does the facility have staffing policies that dictate the staffing coverage that is required? can the charge nurse call in additional nurses or aides or authorize overtime for nurses or aides who are present if the floor gets particularly busy? does the charge nurse need permission from a higher authority to do this? if the charge nurse does these things without approval, will he or she be disciplined? will the employee be paid the overtime if approval was not obtained first? alternatively, are existing staffing guidelines tantamount to pre-approval of necessary overtime?
can the charge nurse reassign nurses to another floor or wing if the floor or wing is quiet and another floor is understaffed? is approval from higher authority required? who decides what constitutes "understaffing"? are understaffing determinations made by reference to a standard formula that factors in the number of staff, the number of patients, and the relative acuteness of the patients' symptoms?
can the charge nurse require employees to come in to work or stay beyond their shift, or only ask them?(23) is there a prescribed staff-patient ratio that must be maintained or is there discretion with respect to the level of staffing? does the charge nurse have discretion to decide who should be called in or is there an established routine for determining who is called in or asked to stay on?
what kinds of judgments are involved in making assignments to nurses or aides? to what extent are jobs rotated or altered in accordance with an established routine? to what extent are assignments based on the generally known skills associated with an employee's classification?(24)
to what extent does the nurse in question have discretion in deciding which of several employees should be assigned particular tasks (so that the nurse controls who gets the plum assignments and who gets the pits)?
to what extent are assignments a matter of mutual give and take?(25)
who decides, and on what basis, when employees take lunch or other breaks? who resolves disputes about breaks, and on what basis?

discipline:

again, the record needs to include these facts in the context of the hierarchy of the facility. the board's traditional analysis of the right to discipline employees or to be disciplined applies. for example:

has the nurse in question been authorized by the employer to discipline employees or to make recommendations that will be given effective weight?(26) have the employees been notified that the nurse has authority to discipline them? or does the nurse's authority to affect other employees' job status derive solely from the respect accorded his or her professional or technical knowledge?(27)

do the recommendations with respect to discipline reflect more than a routine or technical judgment that the employee has failed to perform routine work assignments in accordance with standard operating procedures that are part of the job, regardless of who is immediately in charge?(28)
can the charge nurse issue counseling forms or is the nurse limited to oral counseling?(29) if written reports of substandard performance are prepared, what happens to these reports, e.g., are they placed in the employee's folder, used as a basis for discipline, in performance appraisal, etc.?
to what extent are the incidents so reported independently investigated?(30) does the report include a recommendation as to what action should be taken against staff members involved in the incident? if so, how much weight do higher level officials give to such recommendations?(31)
does the employer have a progressive disciplinary system? does a warning given by a nurse under the employer's progressive disciplinary system have an effect on the job status of the disciplined employee? do the charge nurses have the discretion to decide on their own whether to issue a warning that places an employee within a progressive disciplinary system or do they need higher level approval to issue such a warning?(32) is such approval granted as a matter of course or only if higher management agrees with the proposed course of action? what evidence is there that higher management defers to the recommendations of the nurse with respect to progressive discipline?
do all nurses, as a condition of retaining their professional licenses, have an obligation to report incidents of employee misconduct and patient abuse to higher officials? in practice, do staff nurses or aides, as well as charge nurses, report misconduct by other employees to higher management? is the obligation of charge nurses to report misconduct any different from that of other employees? are reports from charge nurses given greater weight or are they equally subject to independent investigation?
to what extent will the facility accommodate a nurse's request not to have to work with a particular aide?(33)
can the charge nurse send an employee home for serious misconduct such as intoxication or patient abuse?(34) do the facility's policies and procedures require the nurse to do so? is prior approval by the don necessary?(35) or is that action pre-approved under the facility's policies and procedures? does being sent home by a charge nurse cause an employee to be docked pay? or does the impact on pay turn on whether the charge nurse's action is approved by higher authority?
is the charge nurse responsible for correcting faulty work? does the charge nurse report faulty work to the don and leave any discipline to that official?

(d) evaluations:

the record should contain evidence concerning the following:

does the charge nurse evaluate employees?
if so, do the evaluations contain recommendations concerning wage increases, promotion, retention and the like?(36) how much weight do higher level officials give to such evaluations or recommendations?(37)
are charge nurses the sole source of information about employee performance or do higher level officials obtain input on an employee's performance from other sources?

(e) adjustment of grievances:

the record should contain evidence concerning the following:

if there is a formal grievance procedure, what role, if any, does the charge nurse play?
regardless of whether the grievance procedure is formal, what authority does the nurse have to resolve disputes between employees or gripes about the employer's treatment of employees with respect to work assignments, rewards, discipline, and the like?(38)
what disputes must be referred to higher management? what disputes, if any, can the charge nurse resolve independently?
what discretion does the nurse have in resolving grievances? to what extent do the limitations on the nurse's authority to assign, direct, discipline, or reward also limit his or her authority to resolve grievances?

i highlighted frequent areas of charge nurse responsibilites....can you see from this nlrb memo, most charge nurses would now be reclassified.

act now for professional accountability is not the same thing as management accountability!

ZASHAGALKA, RN · Jul 16, 2006

I heard this when I was in nursing school 14 yrs ago. It comes around every so often and dies a silent death.

I just don't think it's a tenable position to take. I cannot see a Court changing the very foundations of unions. Even if they did, and this has never been upheld in Court, I wouldn't expect such a decision to survive appeal.

And even if IT DID, I would suggest that admin's newfound and total inability to recruit charge nurses would end up forcing the very advocates of this change advocating for a 'way out'.

The result: management would be clamoring to 'exempt' charge nurses from managment in the next contract IN ORDER to be able to recruit charges. Either that, or being a charge nurse will suddenly and dramatically pay tons more money.

~faith,

Timothy.

Home Health Columnist / Guide · Jul 16, 2006

i just don't think it's a tenable position to take. i cannot see a court changing the very foundations of unions. even if they did, and this has never been upheld in court, i wouldn't expect such a decision to survive appeal.

this is the case where court ruled charge nurses as supervisors:

no. 99-1815: nlrb v. kentucky river community care, inc. - reply ...

case is up for review now.

won't matter what facility says if court ruling stands, it becomes labor law standard.

please read the above "supervisory" standards that the nlrb in this jurisdiction has reviewed as having charge nurse = supervisor function. i've outlined them in above posts for ease of viewing.

ZASHAGALKA, RN · Jul 16, 2006

this is the case where court ruled charge nurses as supervisors:
no. 99-1815: nlrb v. kentucky river community care, inc. - reply ...
case is up for review now.
won't matter what facility says if court ruling stands, it becomes labor law standard.
please read the above "supervisory" standards that the nlrb in this jurisdiction has reviewed as having charge nurse = supervisor function. i've outlined them in above posts for ease of viewing.

not necessarily.

it's a 'labor law standard' now for rns to be exempt from hourly wages and 1.5 overtime.

your hospital could decide, tomorrow, to make all rns salaried employees. it's a 'labor law standard'. most hospitals don't because, lets face it, it's easier to pay your own staff 50 bucks to work ot than an agency 75 bucks for the same shift.

and who'd work ot for salary?

hospitals and nurses can negotiate local policy. the standard allows for a hospital to go to that extreme. it doesn't mandate it.

indeed, i just don't think it could be mandated in any case. if becoming a charge nurse means abandoning union representation, most won't do it. there isn't enough incentive involved. and i can't see management 'forcing' employees to take a position that requires leaving the union.

the result. if implemented, charge nurse pay is about to go through the roof. it's the law of unintended consequences. admins should be careful what they wish for.

if they want to shoot themselves in the foot, i say, let them.

~faith,

timothy.

Home Health Columnist / Guide · Jul 16, 2006

Many staff nurses don't realize that management position salary often starts lower than that of Charge RN....will bring salaries DOWN not up.

ZASHAGALKA, RN · Jul 16, 2006

It's a basic and time tested fact that the marketplace drives to equilibrium.

If successful, this rule will create severe inequities in the marketplaces vis a vi charge nurses.

The only way to 'correct' such misguided acts is the collective sound of Admins pulling out their checkbooks.

They are shooting themselves in the foot.

It's simple economics, really.

I agree that management pays less in many cases. But, charge nurses are different. Management is an 'away from the bedside' position and that is advantageous to many nurses - for many reasons. Charge nurses bear the brunt of both worlds.

Many will not accept that position for less money. Or for less representation.

~faith,

Timothy.

ZASHAGALKA, RN · Jul 16, 2006

Ask any union member this question:

Would you give up representation to be a charge nurse?

The collective answer is the inherent flaw in this reasoning.

~faith,

Timothy.

llg, PhD, RN · Jul 16, 2006

I agree with you totally, Timothy. There may be a few bumps in the road as this gets sorted out (yet again), but disaster will not happen -- for all the reasons you have stated.

llg

Home Health Columnist / Guide · Jul 16, 2006

politics: showdown at virginia mason (seattle weekly) the medical center wants to turn all nurses into supervisors--nullifying their union status.

the case of that dispute arose from a controversial virginia mason policy requiring all employees to be inoculated with flu shots each year as a condition of employment (see "shot for flu--or you're through," nov. 23, 2005). the wsna refused on the grounds that it was a condition of work and therefore had to be negotiated; it took the case to the nlrb and won.
so virginia mason dictated that employees refusing the shots must wear face masks; the wsna took that, too, to the nlrb, on the same grounds.
that's where, in a mid-june nlrb hearing, virginia mason chief nursing officer charlene tachivana offered a novel argument against the requirement to negotiate with the union: that all of virginia mason's rns were supervisors, able to hire, fire, and write policy, and therefore not eligible to be in the union at all. "that's ludicrous," says vm nurse jeaux rinehart, noting that he and other nurses cannot hire, fire, or write policies. "she's trying to take attention from masks with a much larger issue"--namely, the anticipated kentucky river rulings.

virginia mason isn't the only employer looking to exploit the potential new rules. afl-cio organizing director stewart acuff estimates that the nlrb has already deferred about 120 cases in which union election results have been disputed; employers want to wait for the kentucky river ruling to see if they can simply declare their workers ineligible to conduct unionization votes at all. in new jersey, nurses with a common contract at 12 new jersey hospitals threatened to strike before agreeing to language that guaranteed they wouldn't be reclassified as supervisors.

"you could see health care and hospital strikes across america if the decision is too broad," says acuff. he estimates 300,000 nurses could be affected by the rulings and up to 1.5 million other workers. "team leaders and gang leaders in ports, lead men in mines, lead men in docks at manufacturing facilities and warehouses, engineers, people who oversee apprentices in trades--almost every senior worker does this to some extent."