Charge Nursing in Acute Care Settings

[MomRN0913]

I may have posted on this before, in a different light. I have only worked at 2 facilities in my time, one an acute care medical center where the only units that had charge nurses were the ED and the ICU's. And in the ICU's they take patients, a pretty decent load (I worked ICU) Then I went to manage an LTACH. They had charge nurses and were very very reliant on them. However at the acute care hospital i worked at without charge nurses (I have worked on almost every floor, because I started out as a float) worked just fine very busy, but worked fine without charge nurses. Each individual nurse was fully responsible for the care of their own patients, in ever aspect. If the patient is too unstable, you call an RRT. Other nurses WILL help you. If a patient is going to the OR you as the primary nurse are responsible for the paperwork, preop prep, testing so on and so forth. Any admnistrative/technical questions, you seek out the nurse manager or house supervisor, and that is really if you can't figure it out yourself.

I've seen most models. From an outside standpoint, i am sure a charge nurse would have been helpful to me, and a good resource especially when I floated as a new grad. Luckily there were some seasoned nurses I could rely on. But I also see how much more of an independent and educated nurse having to do most on my own had made me. In my first hospital (probably will be mine new one again:) I learned the paperwork inside out and policies and procedures because i had to deal with them head on, instead of just referring to the charge for such issues.

Just a topic of discussion and I was really curious about other's thoughts. Still on the fence of what the better model is and if there is a middle ground. I tried to encourage the independence of my nurses at my last hospital even though there was a charge. It wasn't working. They were so used to having a charge do everything, they never learned much for themselves. Then they think the charge is being "lazy" if the charge tells them to handle something first. I don't know if there really is a middle ground.

[Biggirl71]

I see the charge nurse as a resource not an extra person to do the work for all of those in her charge. The truth is, as nurses, we should be autonomous but also know when to ask questions. I would not expect my charge nurse to do something for me but I would expect her to help me with my questions/concerns.

I think the use of a charge nurse depends on the type of floor; how busy it is, how many nurses are working, how many problems there have been, etc. If using a house supervisor in place of a charge nurse works then so be it. If it happens to be a 300+ bed facility then I would wonder how effective a house supervisor would be in addressing the concerns of every nurse during a shift.

Hospitals try to do what is most cost effective. That doesn't always mean it's is necessarily the BEST practice but if they can get away with fewer staff members, then they will.

I personally have been in the charge position in one form or another for years and my feeling is, a nurse who comes to me with questions, is looking for an answer, if he/she is expecting me to go carry out her duties then he/she is sadly mistaken. That is not to say that I don't help. There are thousands of times that I have tag-teamed tasks but to have the expectation that I would stop what I am doing to take over the care of their patients is presumptive. I am paid to do one job; I get one salary. Having said all of that, I would NEVER let a patient go without. There is the rare occasion that I have assumed responsibility for a patient load because the nurse had to leave. We just do what we have to do to get the job done. I have the opinion that it's better to help everyone knock out what needs to get done. I am all about team work. I have put many hundreds of miles on my shoes over the years and I will gladly continue. . .there is real satisfaction for me in helping people; whether it's a patient or the nurse caring for them.

[tokmom, BSN, RN]

I think it depends on the acuity, staffing ratio and the overall experience of the nurses on the floor.

I have worked charge off and on during my career and now I'm a full time charge on a med/surg floor. Personally, I think charge nurses are needed, as they add some sort of stability and keep a central focus and pulse on the floor. At our facility, I do the admits, transfers and discharges, and put out fires along the way. I wouldn't want to work on my floor without a charge nurse. I can't imagine following up on med recs and doing the paperwork to d.c a pt to a SNF or otherwise. It's pretty involved. I once spent an hour just trying to figure out which meds a non verbal pt was on. No way could I do that and take care of my pt's.

It is true if you have to do your own paperwork you get really good at it. BTDT. But it can' be difficult to do on a busy day when you need to be at bedside.

I try to not enable my nurses. If they only have 2 or 3 walkie talkie pt's and think they can dump a med passing on me or their pre op check lists..think again. However, if you have a sick pt and need some pre op work done, I will gladly help. I relieve for breaks before I even get my own. Many days I don't eat unless I wolf something down in the breakroom. It can be so crazy with everyone wanting and needing me that I can't get off the floor until 8 hrs into the shift.