Have you been charge yet?

Since being off orientation, I've been in charge about 50-75% of the time. (SCARY!)

It has made me seriously consider looking for other employment, but I have GREAT staff to work with, and don't want to leave them.

Being in charge is only really bad when I am with travelers or agency nurses who don't know the floor and I have to do EVERYTHING for them. Last night we had 29 patients, 3 nurses (myself and 2 travelers) and 2 aides.

I get frustrated a LOT, and really wish I would work on "just being a nurse" somedays, but I do have to say that being thrown into this position has made me MUCH more assertive, and forced me to build good time management skills. As much as I hate it sometimes now, I know that in the long run, I'll probably be a better nurse because of it.

And besides...it's a whole $1.50/hr more...

Wow! It sounds kind of eraly for you to be a charge nurse. But what suprises me more is that you have patients as a charge nurse. At my hospital the charge nurse does not have a patient assignment, which makes it easier for the charge to lead and assist the team. However, being charge is going to build on your leadership and management skills and thats always a plus.

MelBel, do you work in LTC? Why only 3 nurses for 29 patients? That sounds like waaayyy to much to me :uhoh21:!

No, I work on a med/surg unit. According to our grid we should have had 5 nurses that night, but our facility is a little bit understaffed

I was told twice that I had to be charge in my unit, but I have refused. I don't have any trainining and I don't consider that to be safe. It would have been only me and 2 more PRN's who don't know my floor very well. So I would not have anybody to ask questions if I had any. My supervisor agreed with me. But if I get the proper training for at least one day with one of our staff RN's, I would be more than happy to do it.

I've been at my current hospital for a year now and when I had my annual review with the NM, one of my goals was to be trained to do charge. Haven't had to do it yet...but one time when I came on one night, the NM almost had me do charge...but then another nurse with more experience became charge instead. I would have refused it anyways...I don't have the training yet, and if something happens I really wouldn't know what to do. Like kiyatylese stated, if they trained me properly, I would do it..just not all the time!

On my med-oncology unit, our charge nurses are pretty experienced and there is a formal orientation & education process that nurses go through before they become charge on a shift. Most of our charges have at least 3 years experience, which really helps the floor nurses.

I've been a RN for almost 7 months now, and I'm nowhere near ready to be charge on our floor. That's perfectly fine with me right now, but if I stay on my unit for another year, I would probably be ready for that challenge. Personally, I think a nurse should have at least 1 year experience before becoming charge on their floor. I know that's unrealistic in all facilities, but it makes the most sense to me.

Not yet, but in the coming months I believe Ill be starting training. I am enjoying being a floor nurse now

Our charge nurses are awesome!!! :)

MelBel, I dont know how you managed to pull that. I am still shocked by the 29 pts and only 3RN's. Maybe I am a little spoiled because I live in California, but I dont think that's safe AT ALL. THe acuity of patients today is so much higher than what it used to be. At my facility medsurg nurses get a max of 4 pts. The patients are very sick, and some may consider them to be ICU pts in other hositals, but still, 10pts per nurse!!! Wow!! I can see why a lot of people try to run from medsurg floors.

I just cant get over this, Im really amazed. 1:10 ratio?! Im not very informed on the ratios in other states, but do you guys think its time to get a standard nurse to patient ratio in other states too? How do you manage to take care of 10 sick pts? I might be missing a piece of the puzzle here but 10 still sounds like much. Again, in my facility (teaching hospital) the med/surg pts are very sick and some consider them ICU pts, but in the community hospital I worked in 10 was unheard of too. The max I had seen was 5-6.

I always thought there was a huge number of nurses moving to California because of the pay, but the ratios might be a bigger factor. Thank God for California!

10 is a lot...our union contract is getting re-negotiated right now, and I HOPE we will get better staffing soon!

I'll tell you a little bit about my 10 patients, you will get a better idea of how it is POSSIBLE (although not easy!)

1) CVA, hx of head injury, alert, confused, ambulates unsteadily, definite fall risk, but not a whole lot of medical issues being treated...was being d/c'd to rehab in the am.

2) sepsis/anemia patient who had been on our floor about 2 weeks...IV abx, a bunch of meds, and the biggest problem being a HUGE stage IV ulcer on the sacrum with TID dressing changes. (and of course he can't roll himself)

3) GI bleed, refusing most treatment, basically just meds, assess, etc.

4) Spanish-speaking cervical injury pt, A+Ox3 (woohoo!), biggest problem being pain and language barrier

5) hospice patient w/ lymphoma, refusing all treatment (VS, etc), the pt kept saying "i just want to die, leave me alone"...hard because I wanted to provide emotional support, but no time...

6) new admit w/ acute renal failure...A+Ox3 pleasant man, just had all the admission work to do

7) A+Ox3 young woman in with dizziness of unknown origin...doing orthostatic BPs, neuro checks, but she was independent

8) GI bleed getting 2 units PRBC, 2 units FFP, had to be prepped for and go to a CT in between 2 of the units...probably the heaviest pt.

9) young man with resolved DKA, ready to go home in the am..independent

And I only took 9, and the other nurses took 10 each that night since I was in charge...

I would say the worst part of it is working with travelers because they don't know the floor and have a LOT of questions. (More questions than a nurse with 20yrs experience should be asking a nurse with 6 months if you ask me...)

Luckily I have AWESOME aides to work with on my floor (and they do all the glucose testing and blood draws), and when we are short staffed the supervisors do usually come up frequently to check on us, and defend us when admissions tries to send more patients!

In my NICU only very experienced nurses are charge nurses. We do not use LPN's or aids at all, so everyone is a RN. The charge nurse always has an assignment too.