HELP - I need to interview a charge nurse!!

[Cilantrophobe]

i originally posted this in the oncology section (where i am doing clinicals), but haven't received a response yet.

for my nursing management course i need to interview a charge nurse (preferably oncology, but any specialty will suffice). if you can answer these questions here or in a pm i would really appreciate it. thanks in advance!

interview a charge nurse about what factors she or he uses to make the assignments for a shift.

1. what are key issues?

2. what routine tasks does this rn delegate to others (lpns, rns, uaps)? after she or he delegates the assignments then what is for the rn as an assignment?

i know the questions are a little vague, but please feel free to elaborate as to how making assignments on an oncology unit works well and/or doesn't work well.

[jjensen]

Key issues to me are that I don't give the RN's a bad assigment; meaning 3 of the 4 are discharges (Leaving them open for all the admissions). I also try to keep the rooms close together so the nurses are not running from one hall to the other... I try to look at acuity of the patients and if they are going to be getting blood, chemo etc. because they are very time consuming... I also look at who has a student nurse for the day or who is orientating because they need a little lesser load too...

2. We don't have any LPN's or such. We have CNA's and they do vitals and chems and help with what is needed, so our RN's are essentially responsible for all the other things that the patient needs...

It never fails that I get somebody upset or someone is not happy with the assignment. I had to get thick skin and have told other RN's that they cannot really complain until the are a charge RN and have to make assigments... I do put lots of effort into who I assign to what RN. I believe that continuity of care is essential and that is one of my main priorities when doing assigments...

Hope this helped a bit...

[Cilantrophobe]

That does help.

You said the CNA's do "chems" what is that?

[April, RN, BSN, RN]

That does help.

You said the CNA's do "chems" what is that?

Chemistries... a.k.a. blood draws.

[canesdukegirl, BSN, RN]

i originally posted this in the oncology section (where i am doing clinicals), but haven't received a response yet.

for my nursing management course i need to interview a charge nurse (preferably oncology, but any specialty will suffice). if you can answer these questions here or in a pm i would really appreciate it. thanks in advance!

interview a charge nurse about what factors she or he uses to make the assignments for a shift.

let me preface my answers with sharing that i am charge in an or. i know you requested onc, but my experience on the onc floor did not involve charge.

1. what are key issues?

my key issues when making assignments are first which staff i have available to be able to handle working mostly independently and efficiently with the surgeon in the room. for example, i would not assign a general surgery nurse to an orthopaedic surgeon doing a total joint. experience and comfort level of the nurse is key. i would also have to take into consideration the experience and the comfort level of the surgeon in which i am assigning staff. some surgeons get really nervous when they see a new face, and they are then distracted subconsciously by making sure that the things that he needs will not only be available to him, but that the nurse understands what he needs, how it works, and knows where to find it. i do not see this behavior with the senior surgeons, but mostly with the new attendings.

2. what routine tasks does this rn delegate to others (lpns, rns, uaps)? after she or he delegates the assignments then what is for the rn as an assignment?

this is sort of a broad question, and with my specialized work place, i am unable to answer this in a way that would help your assignment. however, i can allude to what i would do if i worked on a med/surg floor. traditionally, the charge would ask the uaps to get the rooms ready for new admits, take vitals when they get to the floor, and generally get the pt settled in. of course, the rns must take report from the previous shift and begin the course of patient care and all that entails.

i know the questions are a little vague, but please feel free to elaborate as to how making assignments on an oncology unit works well and/or doesn't work well.

when i worked on the onc floor, the charge would task the uap with taking vitals, changing beds, doing bed baths, recording i&os, and reporting any findings to the nurse that needs attention. if a pt is getting chemo, the nurse of course has to record vitals and watch for any untoward reactions. sometimes the patients have requests such as a fan, ice, cool cloths, etc in order to make them more comfortable. i would assign an na to look after these requests. i would assign my most senior nurses to administer chemo.

i hope this helps you out a bit. i am sorry that i was not able to give you a more clear picture of what i would do as an onc charge.

[canesdukegirl, BSN, RN]

It never fails that I get somebody upset or someone is not happy with the assignment. I had to get thick skin and have told other RN's that they cannot really complain until the are a charge RN and have to make assigments... I do put lots of effort into who I assign to what RN. I believe that continuity of care is essential and that is one of my main priorities when doing assigments...

Hope this helped a bit...

Yes, someone always has a complaint, thinks that they are taking on a more heavy load, believes that they are being shafted in some way, shape or form. Never fails. I think that a lot of staff think that charge nurses wield this magic wand and all can be righted from the charge desk....not so! We have to deal with assigning the appropriate level of experience coupled with the acuity of the patient in order to ensure a safe working environment and the best patient outcome. This all must be done with the staff that are available, considering call outs. It is a hairy proposition sometimes, and staff do not understand how difficult this can be. I always try my best to consider every facet of the situation, i.e., has this nurse had a very difficult week already, have they been on call, do they have a student assigned to them, have they had a ton of admissions, etc. There is so much to consider. It is difficult for the staff to see the big picture sometimes, and they are not expected to. It is the charge nurse's duty to consider the big picture, and to be as fair as possible. Typically, there is much thought given to assignments. It is wonderful when it all comes together!

[Cilantrophobe]

Thank you for your responses!

[Cilantrophobe]

Sorry but if anybody can still elaborate I would greatly appreciate it.

I need more for question #2. After the charge nurse delegates tasks/assignments what does the charge nurse do? I'm assuming it's probably quite a bit, but a general idea is good enough for me!

[KneKno]

I'm a night shift ICU charge. After assignemnts are made, I take care of my patient's! My load is usually a little lighter than the average, and I serve as a resource for the rest of the staff as needed. I assign new admits to beds, help anyone that's busier than the rest or make a point of asking a less busy RN to help them, round with any early or late MDs, and respond to codes/rapid responses. I also do some auditing, mostly real time--is everything required documented for restrained pts, have "time outs" for bedside procedures been properly done and documented. I even get to watch a few staff every month go in and out of rooms, auditing for handwashing and pt identification. Day shift charge has a 50/50 chance of having patients. Mostly do the same kinds of activities, they round with more MDs, keep the flow of pts moving, and deal with more family issues, just cause theres more visitors during the day.

I'm friends with the onc charges, they pretty much do the same. They don't respond to codes unless it's on their unit, and their audits are more complicated with chemo documentation.

From what I understand, RN's don't "delegate" to each other, delegation only applies to less trained staff--I can delegate a task (walk a pt) to a UAP, but I "assign" another RN the same task.

[canesdukegirl, BSN, RN]

Sorry but if anybody can still elaborate I would greatly appreciate it.

I need more for question #2. After the charge nurse delegates tasks/assignments what does the charge nurse do? I'm assuming it's probably quite a bit, but a general idea is good enough for me!

Oh, sorry. I totally misunderstood the question. I thought you were asking what the RNs do when done delegating tasks to UAPs. The charge nurse's primary role is to make sure that the unit runs smoothly, that the staff have a readily available leader to go to with questions and concerns regarding either patient care or what particular policy is in place for a specific problem. The charge nurse is mainly tasked with being the "communication guru" so to speak. For example, the house supervisor calls the unit, speaks to the charge about which beds are available, discusses potential admits/discharges, gets updates regarding the unit census, and what the staffing levels are for the day. The charge nurse also facilitates getting needed equipment, fixing broken equipment, handles any problems with pharmacy, transportation for patients, and of course staffing issues. When the phone rings and the secretary does not have an answer, the charge nurse must then deal with the problem at hand. There are several reports (such as patient acuity reports and pharmacy reconciliation reports) that the charge must also make sure are completed. The charge must also ensure that all of the code equipment is in working order and that the code cart is stocked appropriately. Sometimes the charge also has patients, and must deal with patient care along with these additional responsibilities. The charge makes sure that the staff have breaks and lunches/dinners and must also take on additional patient duties if a nurse gets too many/additional new admits.