Er Charge Nurses

[neneRN, BSN, RN]

I want to hear the different ways charge nursing is handled in ERs. Where I'm at, the charge nurse sits at her own desk to watch all monitors, handle EMS calls, take admission orders, answer phones, and basically be in one spot so all staff and doctors can easily find for whatever problems/concerns arise. This works well for the most part, but my frustration is that, as charge nurse, I am tied to that desk..I can't get up and help staff, I can't walk around to find open rooms, etc. But I don't think all ERs do it this way? If your charge nurse doesn't have to stay at a desk, how does it work? Specifically, who answers EMS calls, takes orders, watches monitors...if I make the suggestion to make the charge nurse more mobile, then I would like to have ideas of how it could work!

[911RN]

As a Charge Nurse, I am responsible for making assignments at the beginning of the shift, and assigning patients to the staff. I do have a desk beside the central monitors. Admission orders come to me and I put in requests to the bed placement nurse. Usually the pt's nurse takes admission orders from the PMD, or the ER doc will write basic admit orders to get the pt to a room, with the floor nurses taking the rest of the orders. Ambulance calls come over the MICU phone and anyone with MICU certification can answer them and assign rooms. If a critical pt, or a trauma is coming I am alerted to let the MD know. I handle pt concerns and complaints, coordinate transfers. We do have someone to take orders for direct admits, except on the weekends. We are provided a portable phone and a pager so we can leave the desk and assist the nurses. Some days it is very difficult to get away from the desk.

[russ11]

Every staff person in all our departments carry a phone... doctor, nurse, tech, patient rep, translater, admissions staff because our department is huge and busiest in the state. We have a monitor tech who takes all EMS calls, watches the monitors and runs the EKG's. The CN is very mobile...monitors department,expedites bed assignments, flexes staff, assigns rooms, and handles problems. Pts. primary nurse takes orders or if tied up any any available nurse can do it as charts are computerized and all info (meds, allergies, hx, treatment) is available to everyone. Over the CN we have a shift supervisor that coordinates all 4 areas of Emergency Medicine ..we have an adult ER and trauma area , Fastrack, Peds ER, and and observation unit.

[neneRN, BSN, RN]

russ11-sounds like your ER charge functions more in the way I would like to see our hospital use them-I like the idea of a monitor tech for EMS calls- does the tech then call the charge to place EMS pts?

[russ11]

Yes...if CN phone is busy the Trauma nurse or SS can place patients.

[MomNRN, BSN, RN]

We have a smaller, Level II hospital - only 13 beds.

Our charge RN's handle bed assignments, assist other staff as needed, handles any crises, make sure dept functions smoothly, and on and on. There is no sitting at a desk. We also do pt care and just run faster to get it all done.

Our system needs reworked as well.

[DST2RN]

Our E.R. charge nurses are divided into 4 color coded zones they each have a zone , they pretty much assign tasks handle issues with patients take complaints and until I started workin at a hospital thought all death notifications were made by MD'S to many movies I guess but at our E.R. it's the charge nurses job to do the death notes and speak to the family in a special room we have set up for that. They aren't really centrally located they are all over the E.R. and carry a house phone with them. There first task on shift is to set up the code blue team and code yellow team prior to start of shift I see them do this very first thing when they get in find out who's workin and make a team and notify each member in pass down. I feel sorry for ours they never eat or get to rest in 12 1/2 hours.

[CritterLover, BSN, RN]

the cn doesn't sit behind a desk where i work either.

well, at least they arn't supposed to, though we do have a few that do their best not to budge from behind that computer all night.

we are a fairly small er, 16 beds in the main side, that can be flexed up to 23 (including hall beds) if needed and we have the staff.

we have monitors, but it isn't anyones responsibility to watch them. we keep the alarms set, and if someone is alarming, whoever hears it needs to check it out. the er is small enough that you can hear the alarm almost anywhere in the unit (this is also how any icu i've ever worked in is set up. i've never had a monitor tech in icu. nurses watch their own monitors, and help each other out).

any nurse (or physician) can take an ambulance call. we let the cn know about it, but they don't have to be the one answering it.

when an ambulance patient comes in, it tends to be the cn that assigns a room. if it is an obvious triage candidate, i'll make that call and send them to triage. if i have an open room, i'll tell them they can have my room. if there is only one room left, then i'll tell them where they have to go. but if there are options, i leave it up to the cn. (don't want to irritate any of my coworkers by putting a patient in their room).

as for taking doctor's orders, unless we have a holdover, we don't take orders from docs over the phone. the er docs do that, and then write the decided-upon orders.

our cn not only runs around helping us out, they often have a patient assignment of their own (we're a bit short staffed right now).

i can see where it would be necessary to have someone dedicated to watching the monitors if the er was huge, but even then it would seem as though it should be a monitor tech, not the charge nurse. that seems to be a waste of resources..

[NicoleRN07, RN]

In my ED, as CN, I make assignments at the beginning of the shift. As for my other duties.....I DO NOT sit at the desk. I help out where I am needed. It is the primary nurses responsibility to take admitting orders, and we all answer EMS calls and watch the monitors. On some occassions, I have to take an assignment, and most times after 11pm....I am also the triage nurse. I also handle complaints and any other situation that may occur that needs my attention, including transfers, moderate sedation, and codes within the hospital (usually I assign 2 nurses and a tech to respond to codes). It is a team effort to provide excellent care!!