Do your Managers and Charge nurses work on the unit?

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I've recently started work in an ER and have been a little bit bothered by the fact that the Managers and Charge nurses do not ever work on the unit or take a patient assignment. It is kind of strange to me, and I was wondering if this is standard practice in nursing? I worked as a tech during nursing school and on that unit everyone worked as a staff nurse at least once in a while. It seems odd not to, since they are the ones making decisions about how things will run, yet they don't know from experience what is working or not working.

I worked in a very busy ER and my charge nurse and manager could not take a full assignment because they have to be able to deal with the issues when they arise and be available to go where they are needed when they are needed. With a full load of patients you cannot be the resource you need to be for your nurses.

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Specializes in Adult ICU.

I have never seen my NM take on patients. I did see our director one night, I'll never forget, where it was literally hell as we were swamped with crash patients and CP. Our crash beds were overflowing with ICU patients.

We had to put some in the hall. I never did so many EKGs in my life or CP protocols. Our director came in at 12 midnight after my CN was literally begging for help. We all banded together that night in team work. Never seen anything like it again and don't want to.I gained a different level of respect for the director that night

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I'm charge nurse and I take a full load of pt's. Our NM, 2 PCC's, never take a pt. load. When I worked in the ER, the NM, Charge, and PCC never took pt's in the day. Night shift charge will if busy. I've even seen both NM's come in if slammed and take pt's. Just depends on the dept and hospital and the policy & procedure.

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It seems to be much more common for charge to routinely take a pt load on the floor than in the ED.

Personally, I don't think the charge nurse should ever routinely take a pt load unless it's a very small hospital and charge has few other responsibilities. Even then, they shouldn't take as many pts as the other nurses so they have time to help others where needed.

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Specializes in Step-Down.

I work in LTC/Sub acute rehab which also has a psych floor. The LPNS and CNA's do all the work. The charge RN's are on each unit 7-3 for 5 days a week and there are always nursing supervisors in the nursing office 24/7. The chage nurses on the unit literally sit at the nursing station all day and do paper work: monthly's, making DR appointments ect. They have absolutely no patient interaction/if any its insignificant. The LPNS do all the meds, dressing chnages, and treatments, as well as deal with the family members, do the shift report ect. The LPNs are the ones to bring any change in pt status or any kind of new skin breakdown/discoloration.

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I work in LTC/Sub acute rehab which also has a psych floor. The LPNS and CNA's do all the work. The charge RN's are on each unit 7-3 for 5 days a week and there are always nursing supervisors in the nursing office 24/7. The chage nurses on the unit literally sit at the nursing station all day and do paper work: monthly's, making DR appointments ect. They have absolutely no patient interaction/if any its insignificant. The LPNS do all the meds, dressing chnages, and treatments, as well as deal with the family members, do the shift report ect. The LPNs are the ones to bring any change in pt status or any kind of new skin breakdown/discoloration.

Not to discount your personal experience, but this isn't a discussion about RNs vs LPNs and CNAs, and I'd hate to see it dissolve to such. The OP asked about charge nurses taking pt assignments or not.

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Specializes in Emergency & Trauma/Adult ICU.
Not to discount your personal experience, but this isn't a discussion about RNs vs LPNs and CNAs, and I'd hate to see it dissolve to such. The OP asked about charge nurses taking pt assignments or not.

Agree. And ... OP was specifically describing an ER setting.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

In my old civilian ER, the charge would not take an assignment unless we were short (which did happen sometimes ... it seemed like we were always short when we were working short, you know what I mean? LOL). The NM would work the floor in times of crisis; the NM who was the NM when I left was one of the most fabulous nurses I've ever worked with, and I loved the opportunity to work side-by-side with her!

In my Army ER, the charge will usually take an assignment, more often than not. Frankly I'm still trying to figure out why, because to me, staffing seems adequate to allow him/her not to, but I suspect it has to do with the desired nurse-pt ratio that the nurses are accustomed to enjoying ... I'll just hold my tongue on that. My OIC (Army-speak for NM) is awesome, and this is his first assignment off the floor. I know he misses the bedside, because he won't hesitate to come out and play if we get a trauma, and he came in the other night when we were slammed with sick-sick patients and about 15-20 in the hole in the waiting room.

I believe when it comes to staffing, the ENA recommends that the charge RN and triage RN not be considered in the staffing pool when making assignments. I always love to quote the ENA recommendations to people, like it's law. :D

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Our director of nursing is absolutely amazing. She will work on the unit almost daily if needed. If there is a call out she can't fill, she'll fill it herself, day or night, even if it's a CNA position.

Actually, even our head administrator will work the floor providing food/drink, answering call bells, rolling silverware into placemats for meals, what have you.

The management at our facility blows me away with their presence on the floor

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Specializes in Trauma/Neurosurg ICU, MSICU, ED, Rural.

I've seen it both ways and IMO the best places I've worked have been where the NM stays active in bedside nursing, even if it's just one or two shifts a month. It seems to make a big difference in how the unit is managed because they are in tune with the realities of patient care and are strong advocates for their nurses and the patients with upper management.

It seems much better though, when the charge nurse for that shift does not take a patient assignment, or at least has a lighter load. Gives so much more flexibility when things get crazy with admits or crashing patients.

In the ER I'd worked in, it depended on the time of day whether the charge nurse would take an assignment or not. Usually it was only during the usual slow times in the early, early morning.

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Specializes in Medical Surgical.

In our hospital, I believe everywhere in our hospital, the "charge" was just the designated senior nurse. He or she had as many patients as everyone else, and actually usually the sickest. Also was responsible for making assignments, picking up her share of new admits, giving the LPN's pushes, blood, etc. And because of the out-in-the-hall SBAR, the charge really didn't even know what was going on with the floor, since all you ever heard about was your own patient. Terrible system. The nurse managers never, ever, ever, did any patient care. They would have been ostracized by the other managers if they did. I saw one once get begged by a floor nurse to just sit in on a blood transfusion because she had patients crumping. The manager pulled away from her and said she had to go to the cafeteria to serve ice cream for a "social". Uh-huh.

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med surg- charge always has pts. manager never takes pts

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