Head Nurse

Tweety, BSN, RN · Jul 17, 2007

Many places allow ADN's to be Nurse Managers (the expression "head nurse" is no longer used), just depends on where you are. Here our managers all have BSNs. I worked at a place where all the managers had Masters.

Sometimes it's just a matter of the right place and the right time, but experience in nursing and proven leadership usually takes several years. There's no cut and dry answer to your question.

Charge nuses are in charge of the particular shift they are on. But the Nurse Manager is in charge of the entire unit (and perhaps other units) and they are not the same thing.

TheCommuter, BSN, RN · Jul 17, 2007

I think that the requirements for becoming a nurse manager are more lenient in LTCFs (long term care facilities). At my workplace, the DON (director of nursing) is an RN with a BSN degree. The three ADONs (assistant directors of nursing) are all LVNs with diploma educations and a few years of floor experience. Heck, one of our ADONs barely became licensed as an LVN less than 3 years ago, and she became a nurse manager only 3 months after becoming a nurse...

So, it all depends on the type of facility, the geographic area, the demand for nurse managers in your area, and the scope of practice.

Xbox Live Addict · Jul 17, 2007

In most LTC facilities in OK, the ADON is an LPN, and most DONs I have known were diploma or Associate RNs. However, I believe that HCR ManorCare only accepts RNs as ADONs; that has been my experience with them in this area.

Assisted Living facilities will take LPNs as DONs and administrators, since they are generally private pay and not subject to the Medicare/Medicaid rules which in OK state an RN must be physically present in the building 8 hours a day. I guess the obligatory RN supervision for these facilities (per the OK NPA) comes at the corporate level.

Daytonite, BSN, RN · Jul 18, 2007

no, a head nurse is not the same as a charge nurse. a head nurse is a nurse management position. a head nurse is responsible for the budget and management of one or more nursing units. it is a middle management position in some hospitals. the facility will determine what educational level they require for this position. it can range anywhere from an adn to a master's degree. what i have mostly seen is that at least a bsn and several years experience as a staff nurse is the basic pre-requisite for this kind of position. head nurses are responsible for the 24-hour staffing of their units, the hiring of their nursing staff, budget accountability for their unit, handling patient and staff complaints related to their unit, and making sure all kinds of other things are being done to keep the unit in running order. you do the yearly evaluations of your unit employees. you also do any disciplining for any wrongdoing that is done by your employees. a head nurse is what you might commonly call a boss. when i was a head nurse i was required to attend weekly nursing management meetings as well as be a member of a number of hospital committees. every other tuesday morning i sat with other head nurses reconciling my employee's time cards to assure they were correct before turning them in to payroll so the staff paychecks would be ready on friday. guess who gets to hear the first complaints if a paycheck is wrong? you. we also had to be house supervisors if one the off shift nursing supervisors got sick or called off work. people usually get this position because they want it and because the opportunity presents itself. advancement to this level of work is dependent on your talent as a leader, desire for the job, your previous experience and the facility requirements for the job. beyond that, i guess a lot of it depends on luck and opportunity.

i got my chance at it because the head nurse on the medical unit i was working quit and there was no one else who wanted the position for months. the don knew i had several years of experience as a house supervisor in another hospital, my leadership ability was noticed and i was approached to "try it out" temporarily. i found it extremely more stressful than any staff nursing job. i couldn't believe some of the horrid situations some of the staff nurses got themselves into with patients that required discipline and sometimes being fired. over a one-year period i had to fire 6 nurses for serious errors they made in their practice. one involved the failure to call a code blue on a dying patient. these were not decisions i made independently, but were made by the director of nursing and human resources. i was just the messenger that got to deliver the bad news. the flip side of being short staffed was that i often had to work as a staff nurse as well because there was no one else or there would have been rn staff working alone for 32 patients with only one or two lpns or cnas. in all good conscience i couldn't let that happen. after a year, the job wore me out. if i had my choice, i would rather be a nursing supervisor or a charge nurse. for those jobs you clock in, do your 8 or 12 hours and clock out and go home.

a charge nurse is a clinical staff nurse position where you have some supervision accountability over the other staff nurses you work with. you report directly to the head nurse or house nursing supervisor. in many places a charge nurse still takes on the responsibility of doing some direct patient care as well as assigning the patients to the nursing staff on duty.