ED Charge Nurses?

[NurseBee22, BSN, RN]

I am currently a back up charge in the ED, we get about 2 shifts a month (lately more due to sick leaves). The way we run things are the main charges have 2 of 3 shifts as charge and one shift on the floor so they don't "lose their skills". One CRN is returning from leave and is refusing to be on the floor as a staff nurse and she basically "stole" my back up charge shifts because we create the schedule and can change anyone's shifts so she moved me to staff and her to charge... reason being is she can't handle it on the floor anymore because it's too stressful.  

Do your charges only do charge or do they switch between staff? Additionally how can you trust someone to be a leader when they themselves can't even handle it on the floor. I don't feel comfortable with someone who can't handle a basic two ED patient load telling me to take 4 or 5. You should lead by example. All the other charges will also put each other on "easier" spots like fast track. If your in charge, have you lost your skills or do you still participate on the floor. And if you're in the ED on the floor what do you look for in a charge? I see both worlds equally now but am feeling disdain towards the "main" charges for how incompetent they are on the floor.

Looking to see what other EDs do. 

 

[Closed Account 12345]

You said she can't handle a "basic two ED patient load." When I worked ED, I consistently had four to six patients.  Does your ED have a low census and good staffing, or why would she only have two patients at a time when staffing? That would be an ED game changer; nurses truly could treat everyone like they're at the Hilton. That doesn't really have anything to do with your question. I'm just curious!

My other thought is that a good ED charge nurse doesn't need scheduled staffing shifts to maintain clinical skills. A good ED charge nurse should be regularly jumping in to help nurses and interact with patients when leadership duties allow. One doesn't need their own assigned patient load to go throw in a second IV on a trauma patient, help catch triage up, settle a stable ambulance patient while the assigned nurse is dealing with an MI next door, round on patients, etc. 

You're describing a unit politics/culture problem. Someone with a me me me attitude is a hard leader to follow.  With that said, ED charge isn't an easy role. The charges assigning each other to fast track may be less about favoritism and more about giving their peers a much needed mental break.  I can see both sides there.

Let management know you've enjoyed your relief charge shifts, and ask what you can do to continue picking them up. (Do this without talking down about the other charge or fairness of the situation.)

And remember, just because someone is assigned to a charge role doesn't mean they're personally a competent super star bedside nurse. *Should* they be? Yes, but that's not always how the cookie crumbles. In fact, it's frequently not. Lacking clinical skills among your charge nurses probably doesn't have much to do with the way their shifts are scheduled. 

[NurseBee22, BSN, RN]

No LOL! We get 3-5 patients. I'm saying this person cannot handle 2 "typical" ED patients. We are a very very busy trauma center. Why does no one else on staff get a mental break? I see this from both sides. Charge is hard in a different way than staff. But staff is still hard. We have unsafe staffing and high volumes. There is the reason there is back ups. So they aren't doing it full time. I just can't follow a leader who forgot how to manage the floor. I would have to disagree with you, I think everyone in a leadership position should have time on the floor. You can't be a leader of a group of people doing a job you yourself can't do. That's my main gripe I guess. And other staff can see that too. That they are a burden on the unit when they are staff because they forgot how to manage and prioritize a patient load.

[Closed Account 12345]

3 hours ago, NurseBee22 said:

I would have to disagree with you, I think everyone in a leadership position should have time on the floor. You can't be a leader of a group of people doing a job you yourself can't do.

Oh no, I agree with you! I just feel like an engaged ER charge nurse gets plenty of time on the floor without being scheduled  as a staff nurse. 

That sure makes better sense about your 2 patients statement. I was thinking you work in the world's happiest ER. Reading comprehension fail on my end! ?

Nurses are so frequently appointed to the charge role based on seniority, unit politics, or popularity. The real considerations should be clinical competence and leadership ability. A good charge should be a clinical resource to staff, not a clinical mess... but alas. 

[Emergent, RN]

Some people consider the charge nurse position as a license to kick back. They are hopeless cases...?