Do your Managers and Charge nurses work on the unit?

[pilotnurse]

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.

[ZooMommyRN, ADN, RN]

Ours helps when we get swamped, and has filled in when there are holes in the schedule, I love working with ours because she attracts the oddest cases lol

[turnforthenurse, MSN, NP]

On my floor, charge takes a full assignment. When you're charge you have a lot of responsibility and I don't think they should take on a full assignment, but that is how our hospital works, I guess. Each hospital is different. We do not have management on nights but on days they do help out on the floor and at times our manager will charge.

[thelema13]

My charge during the day does not take an assignment but will help with critical pts and I've never seen my manager on the floor except the day I was hired. The charge nurse at night takes a pt assignment and I've brought it up to the manager who kind of shrugged it off. Seems to be the norm at my hospital and the night CN only takes an assignment due to being short staffed.

[Anna Flaxis, BSN, RN]

Our NM has a Mon-Fri 9-5 position and dresses in professional attire. She comes out of her office a lot to interact with staff and check in with what's going on in the unit, but her duties are mostly administrative.

Our Charge Nurses rarely take patients, as their responsibilities require them to be available for issues as they come up. The Charge Nurse desk is the hub of the unit. It's like a command center or air traffic control tower, with a bank of telemetry monitors, telephone, medic radio, electronic unit census, and desktop computer, adjacent to the ward clerk's desk and the physicians' area. The Charge Nurse is continually directing the flow of the entire unit, and in no way, shape, or form, would it be safe for patients and staff to have a Charge tied up with a patient load.

[pilotnurse]

I should clarify; I don't mean take an assignment while in charge. I mean they are dedicated charge nurses who never have a patient assignment. If they come in on an off day they are placed in a resource or float role, but never with a normal nurses assignment. We also have 5 managers, which seems like a lot for 180 employees to me. Especially since we don't ever see them. I'm not complaining about that except for the fact that there are frequent big policy changes made by charge nurses and managers that often don't work because they're being made by people not in patient care, in my opinion. It seems like it would be easier for them to just work a few shifts a month and get a feel for what really needs to change and what doesn't.

[GM2RN]

I should clarify; I don't mean take an assignment while in charge. I mean they are dedicated charge nurses who never have a patient assignment. If they come in on an off day they are placed in a resource or float role, but never with a normal nurses assignment. We also have 5 managers, which seems like a lot for 180 employees to me. Especially since we don't ever see them. I'm not complaining about that except for the fact that there are frequent big policy changes made by charge nurses and managers that often don't work because they're being made by people not in patient care, in my opinion. It seems like it would be easier for them to just work a few shifts a month and get a feel for what really needs to change and what doesn't.

I'm confused. You don't mean that you have 5 managers just in the ED do you?

[Anna Flaxis, BSN, RN]

Yes, we have dedicated CNs. Their positions are full-time, so no, they do not come in on non-charge days and work as staff nurses. CN is what they do. I'm glad, because it gives us some measure of consistency predictability in an environment that is more often than not a controlled chaos. I work with 4 different CNs because my shift is an "overlap" shift. I know how each one works and what their strengths and weaknesses are, because as a staff nurse, these things have a huge impact on me.

[Altra, BSN, RN]

I should clarify; I don't mean take an assignment while in charge. I mean they are dedicated charge nurses who never have a patient assignment. If they come in on an off day they are placed in a resource or float role, but never with a normal nurses assignment. We also have 5 managers, which seems like a lot for 180 employees to me. Especially since we don't ever see them. I'm not complaining about that except for the fact that there are frequent big policy changes made by charge nurses and managers that often don't work because they're being made by people not in patient care, in my opinion. It seems like it would be easier for them to just work a few shifts a month and get a feel for what really needs to change and what doesn't.

I'm assuming that these individuals (we have the same set up as you -- they are called Clinical Coordinators) have years of ER experience that guides them in their role as first-line dept. management. Don't discount that.

Remember too that some of these "policy changes" may come from above/outside the department -- your dept.'s management is simply given the (not optional) directive to implement these changes.

[VICEDRN, BSN, RN]

In my first er, charge was a dedicated position. In the second, it rotates. For all practical purposes, the charge nurses in both units do not take patient assignments. They may come in to do triage or get some cushy urgent care assignment but they will not take a patient care assignment in the regular er.

I personally think this is very WRONG. If you won't work this grid in this hospital then you do not really have a clue what our lives are like. It should be required of all of these folks, including educators and managers that they take an assignment. Years of experience does not mean you understand the way an assignment flows in this unit.

Heck, I have had charges tell me that they would never work an assignment after they changed the grid at my last job and you could just feel the undercurrent there, kind of like, well pay your dues, dumb new grad, it's your fault you have too many patients, pretty soon you can get off the train too and chill at the charge desk "managing throughput" if you stick around long enough. So crazy. Just take an assignment once a month and learn what life is like since we eliminated the equip tech or the vital signs tech or phleb before 10 or whatever the new gimmick is!

[al7139, ASN, RN]

Hey,

In my ER the charge nure is usually free but does help if we get "in the weeds" The ED manager only does admin stuff. We all work together so if we get slammed everyone pitches in to help, including the charge. Our charges also take assignments on the days they work when they are not charge.

Amy

[godbless-yute]

Im my ED, we have 1 mgr and about 7 clinical supervisors 2 of which only act as blow coordinator. the other 5 are strictly CS (charge), and the NEVER take an assignment, but help out with critical pts, and is usually the recorder in very trauma. Our manager never takes an assignment, but often fills in as CS to get hands on time. Surprisingly, she's very helpful.....she starts lines, puts pts on monitors, even put a pt on a bedpan for me one time. I was impressed!

[PMFB-RN, RN]

Some hospitals hire managers who have never worked in the type of unit they are managing. You have ER managers who have never been an ER nurse, or ICU managers who have worked med-surge in the past but never ICU. In that case I would prefer they stay in their little office and attend meetings.