Charge nurse and take patients?!!!

Five&Two Will Do · Apr 18, 2011

Well I just got a job making good money. At my new hospital I'm on a med surge floor. The rn has a pt load and does charge at the same time. Where I worked before, the charge nurse did not take pts. So i have been learning how to have a pt load. Well that is enough by itself. So how in the world do you have a pt load and do charge duties at the same time?? It seems impossible?

On the telemetry unit that I used to work on, we became greatly understaffed for 8 months. Before that the charge nurse never took patients, but it became very necessary. When I would do charge, I would take 3 or four patients. I made sure they were not the most acute obviously and weren't getting blood or other infusions that required close monitoring. It helps me to make a checklist for all of the charge duties to make sure that I do not forget anything when I am that busy. Hang in there you will get some made time management and multitasking abilities. You will work circles aroiund everyone else! :yeah:

ANH_RN · Apr 18, 2011

Hah, I had never heard of charge nurses NOT having a full pt load until someone mentioned it a few months ago. At our hospital, on our floor, we each take 4-5 starting out. A bad night we'll end up with 6 pts. Charge nurse usually starts off with 4 sometimes 5 and will even get an admission. It's very taxing on them, especially day shift. Day shift nurses will end up with a full load AND they're in charge of doing tele checks, staffing, the crash cart, and (now for example) they are doing 'audits' as well.

I would love it if the charge nurse did not take any pts because then they could actually help you if you were in need of some assistance (especially with codes, rapid actions, etc)...

wooh, BSN, RN · Apr 18, 2011

At old job, would have full load (7-9) and be charge. When they kept putting me with all the new grads because I was apparently the only one nice to them, I found another job.

Next job, was charge straight off orientation with a full load. Came to days, was regularly charge with a full load.

Transferred to another floor where I've refused to do charge and am much happier. Our charges always have a small load at night and on weekends, sometimes weekdays, sometimes a full load whether day or night.

Katie5 · Apr 18, 2011

I really believe that charge nurses (when possible) should not have any patient load. They can man the phones and run the other jobs plus be a resource to the other nurses when needed.

BluegrassRN · Apr 18, 2011

On our unit (Medical floor, average census in the low 20s) our charges take patients. Honestly, there isn't enough to keep us busy if we *don't* take pts. We dont' have that big of a floor. We have physician order entry, so there are no charts to note. Likewise, we have electronic MARs, so no chart checks during the night. We have a hospital admit nurse and IV therapy until 10pm, so typically everyone is settled down and finished with nightly tasks before they need to take over those responsiblities. We have a unit secretary until 9-10 at night, so once again, no need for someone to be covering the phones. Nurses interact with the physicians directly, not through the charge. The staff does know that they need to keep the charge nurse aprised of any potentially unstable situations.

We take the same number of patients as the floor nurses, but generally the ones that require the least time (though not necessarily less acute; in fact, our charge nurses are also the most experienced, so we often take the more medically complex patients). For example, it's unusual for a charge nurse to have pts that are up with max assist of two, or who are incontinent of B/B and need turned and changed every two hours. You don't want to give a charge a pt that will tie her up for 20 minutes at a time every hour or two, you want her more available than that. However, it's not uncommon or unacceptable for me to take a 50 year old with atypical, acute pneumonia and hypoxia. I'll take an admit, but not after 4am, because the admission process interferes with my ability to lend aid in the event something happens in the am rounds, as well as my ability to get staffing assignments for the oncoming shift completed in a timely manner.

I oversee a staff 3-5 nurses and 1-2 aides on my shift. We get anywhere from 3-10 admits a night, depending on the night. I don't have a problem doing my charge duties with a full patient load. I'm available for questions and assistance when needed.

Katie5 · Apr 18, 2011

On our unit (Medical floor, average census in the low 20s) our charges take patients. Honestly, there isn't enough to keep us busy if we *don't* take pts. We dont' have that big of a floor. I oversee a staff 3-5 nurses and 1-2 aides on my shift. We get anywhere from 3-10 admits a night, depending on the night. I don't have a problem doing my charge duties with a full patient load. I'm available for questions and assistance when needed.

This is on your floor. Very great. But not all others run this way.

Besides I wouldn't want to come get you in a patient's room, if I needed a question answered. I like the quick availability. Perhaps that's just me. Different opinions, I guess.

JoMark06 · Apr 18, 2011

At my hospital I have been floated to another unit so they could have a "free floating" charge nurse. I didn't feel it was fair to my floor to take from our staffing where our charge nurse was taking patients to give them a free floating charge. On my floor (I work on a very busy cardio/thoracic stepdown unit), day shift charge starts the day with only 2-3 patients because they round with the docs in the morning, plus manage transfers and admissions. Night shift starts the night with 3 and often takes an admission at some point during the night. Our ratio is 4:1 but if staffing is bad, we can take 5:1.

BluegrassRN · Apr 18, 2011

This is on your floor. Very great. But not all others run this way.
Besides I wouldn't want to come get you in a patient's room, if I needed a question answered. I like the quick availability. Perhaps that's just me. Different opinions, I guess.

We call carry minicells, my nurses just call the charge nurse phone if they have a question or need me.

I agree, for some floors this model would not work. That's why I provided the details of our unit. I know in our ICU and stepdown, the charges either do not take pts or take a reduced number, depending on the needs of the floor. In our ED, charges never take pts. Surgical floor is the same as ours, with charges taking a full load.

My point was, there are floors on which it is totally appropriate for a charge nurse to take pts. It works fine on our floor. At one point maybe a decade ago, we trialed the charges not taking pts and instead doing admits, noting orders, etc. Everyone (including the charges themselves) complained that the charges didn't have enough to do, and so we went back to the charges taking a load of "easier" pts.

MJJFan1, BSN, RN · Apr 18, 2011

I think it all depends on the unit and resources that you have available. For example at my last job, the charge nurse took no patients but the charge very well could have. The computer charting system we had required the physicians input their own orders so there was no need to sign off on them as the unit secretary requested any labs, notified PT, RT what have you. It got to be very aggravating watching her play on AT&T with her phone bills and such as we are all drowning. Well she would take report for you but I didn't like that Cuz I had questions of my own that I'd like to have asked. IMO it just depends on the unit and your available resources.

nursejoed · Apr 18, 2011

In general on most floors, a full pt assignment is MORE than enough. To be expected to take on other duties is insane. Hosp. admin will hang you out to dry if something happens to one of the charges nurse's patients while they are fighting with the ICU about making a bed for a transfer...

steelcityrn, RN · Apr 18, 2011

Probably should have been told that upfront. Making good money can come at a hefty price today.