Feeling Overwhelmed as a Charge Nurse

Been there,done that, ASN, RN · Aug 23, 2022

I was charge nurse for many years. Usually with three patients. You need to realize that you have administrative responsibility, along with taking professional responsibility for 7 patients.

You are being used and abused. It's time to move on.

JKL33 · Aug 23, 2022

2 hours ago, Marushyne said:

On a usual night, I’m expected to be CN, take 7 patients, and orient the travelers and multi-facility nurses (internal travelers).

Take care of your patients and delegate the rest or get to it when you get to it or don't do it at all. I mean, that's what they will say when something goes wrong...that you should've used your "nursing judgment." You can use your nursing judgment right now: Anything that isn't a priority needs to be de-prioritized no matter who is going to throw a hissy fit.

Find another job ASAP.

TryingtoThriveRN, ASN, BSN · Aug 23, 2022

CN with 7 patients ?! Charge nurses are suppose to be a resource and help to their unit, typically. But being that’ tied down with your own sets of patient is too intense and on top of administrative tasks too? No, I would talk to your director about this and maybe ask to decrease the work load on yourself? If not you can always decline the position. You gotta advocate for yourself as well as your license

mmc51264, BSN, MSN, RN · Aug 24, 2022

That's beyond unsafe. We might have an occasional patient as charge. and that is only on nights/weekends. Our ratios are 4:1, occasionally 5:1 if we are short and they are floor pts (not stepdown); aides can have anywhere from 8-15. What you are describing is insanity.

kp2016 · Aug 24, 2022

That is just crazy, unsafe and completely unreasonable. Are the other units at your facility like this? Strangely I've noticed over the years some units within a hospital can be a lot worse than others. 2.5 years is plenty of time on this unit. Brush up your resume and start applying for new jobs, I'd start with talking to your travelers and float staff, they will be able to tell you exactly how the other units compare to yours.

JBMmom, MSN, NP · Aug 24, 2022

Our charge nurses have taken a full assignment on the floors for years. They try to keep the day charge RNs to four patients or less but on nights I've had as many as eight patients while being charge. A few weeks ago I was floated to our cardiology unit (I'm normally in critical care), I had six patients and then got an admission. It was me with one new grad and four travelers. I didn't know the floor, didn't know the nurses, but that didn't matter. I was a body and because of my experience I was put in charge. Ridiculous.

In the critical care unit, we are apparently budgeted for having a charge nurse out of count. However, I haven't been charge without a full patient assignment in a LONG time. And since we have many travelers and new grads, I often end up tripled with the charge assignment. Fortunately we've added a rapid response RN to the hospital, otherwise I might have three critical patients and be responsible for responding to codes. No one cares anymore, if they ever did, that the workload is sometimes unreasonable.

No Stars In My Eyes · Aug 26, 2022

Yeah, "Patient Centered Care", my patoot!

Ioreth, ADN, RN · Aug 27, 2022

I have had a similar experience being charge. I wrote about my ambivalence with being charge for the first time here: I don't want to be Charge!

Being charge with a 1/2 patient load or no patients at all isn't too bad. It can be intimidating to be the one holding the bag and managing beds. I still firmly believe that no new grad should be charge, better with at least 2 years of experience, but that is still a bit low. Even so, remember that the charge doesn't have to have the answers, they just have to know where to find someone who does.

The reality? Charge on my unit (same as unit in quoted post) has a full load. Very few charge nurses are trained before they're thrown in because the scheduled charge is called in sick. I've seen a new grad 3 weeks off orientation made charge and was stuck with it until she quit. We have enough CNAs, but they're often floated out to other floors. I've had several times where I've had to just take care of my own patients and toss out the charge chores except those I just could not ignore such as admits and narc counts. Recently I had a day where it was just me and one other nurse with 12 patients. We both had 6 on a floor where normal is 3-4. Pure chaos. I've also seen night shifts on the same unit recently where charge had up to 7 patients. I'd have a hard time doing that on this unit even without being charge.

I agree, it is really difficult to manage beds and be a resource with a full or overfull patient load.

Tweety, BSN, RN · Aug 30, 2022

Back in the "good old days" I was a charge nurse with no assignment or maybe 2 patients.

I'm not in charge every time I work, but often am. Now it's 6:1 and I let it be known that I will do no charge nurse duties under these circumstances. I will fill out a form at the beginning of the shift that lets the manager know of potential discharges, foleys and central lines, and assign beds as admissions come in, and make the night shift assignment. But that's it. I'm not stressing myself being a charge nurse with a full assignment. I'm not ugly about it, I'm reasonable and they seem to understand that it's not a good situation.

When someone comes along and asks "who is the charge nurse?", my answer is "there isn't one here right now and you should speak with either the manager, the Administrator on duty, or the nurse of the patient in question themselves". And I tell the staff "do not put my name on your white boards, put the manager's name".

I can barely handle 6:1 ratios without a lot of extra charge nurse stuff. Right now I choose to keep this job but not with unrealistic expectations. They need to meet me in the middle, because after all I accept the charge role and the pay, and not be unreasonable because I will assert myself and step away.

No Stars In My Eyes · Aug 30, 2022

I gotta tell ya, Tweety, you were the first one I thought of when I read the original post! It just sounded kind of familiar!

Lust4life, BSN · Aug 31, 2022

On 8/23/2022 at 4:44 AM, Marushyne said:

Does anyone else feel overwhelmed these days as a CN? I graduated about 2.5 years ago with no prior medical experience. I was thrown to the wolves my first night with 7 COVID patients and no aid, and that continued for about the first year until COVID slowed down. After that, I was also thrown into the role of charge with no training whatsoever (I was originally told this was only temporary as CN, but that’s not how it turned out). I feel like our managers have no concern for what happens. On a usual night, I’m expected to be CN, take 7 patients, and orient the travelers and multi-facility nurses (internal travelers). This is a “med-surg” floor that regularly sees people entirely too sick, in my opinion, for our floor (I’m talking hanging blood in the hallways while transferring patients to the ICU, intubations on the floor, and etc). We are also only scheduled two aids for 21 patients at night, so they are having to care for 10-11 patients themselves and an RN is regularly performing toileting for pt’s and etc. Does anyone else feel this way about their floor and/or managers?

Yes, sounds like the floor I once worked on. I think it comes down to doing the best you can with what you have to work with, which isn't a lot. It's probably not gonna change anytime soon, either. If you feel like you can't adequately cover your *** while taking on even more responsibility, I'd completely bow out of the CN role. Covering yourself and protecting your license has to come first these days. I especially wouldn't be orienting no travelers, with 7 pts. Do you get more pay for being CN?