Hey guess what? You're charge tonight!

[Tait, MSN, RN]

While milling over the schedule last week my friend blurted out something that made my blood boil.

"Oh hey look, you are charge nurse next week Thursday"

What

The

Heck

I stated in slightly more colorful language as my temperature began to rise.

"Did she not think maybe she should give me a heads up on that?"

A little background:

I am a little over two years out of school. I have never held the pager for the night on our busy complex med-surg floor. I think once I did the assignment, with my friend hovering over my shoulder crossing things out, and fussing when I gave too many level 4's to one person.

Despite a long history of getting bumped up all the time in jobs to management positions, I swore to myself that I was going to take it slow with nursing. I mean, who needs to hurry into things when you are doing what you intend to do for the next ten years or so? So I had specifically stated to my previous manager (left in January after 14 years on the floor) that I didn't want to charge. That I was going to focus on certifications, maybe take the CAP (preceptor) class, but that I wasn't ready to start aiming for Level II Staff Nurse status just yet.

Well apparently my new manager didn't get the memo, and decided now was as good a time as any to throw me in the mix. When I calmly confronted her and stated my grand plan she simply stated:

"Oh you will do fine."

Not quite the point, not afraid of it, just not ready for it.

Anyway, so on and so forth.

My Night as Charge RN

Life started out as usual this fine Thursday evening. Call bells chiming, family members frantically trying to find a tech to help Grandma Ellsiebell to the commode, techs chattering on their cellphones, and me, night number four (thank you Spring Break families ) and trying to get my papers in order for the night.

Amongst the hum and drum the day charge comes over and simply states:

"I screwed up. I accidentally gave Lisa two admissions. I thought one of them was here already, but...oops"

Ok, no biggie, Lisa is a seasoned charge and can handle it. Until the phone rings:

House Sup: "Umm yeah, the ER is swamped, mind if I send your three pages up right away?"

"Actually, I have one nurse set up to take two of those admissions, could you tell me which ones you are sending first and then space the third one out about 45 minutes?"

"Sure, 31 and 47 coming up, they will call back with report in a few"

Ok, rearrange the admits, get them rolling, while starting to manage my five patient, double isolation team. No problem.

2045 rolls around, bam bam bam, three admits on the floor and another page on the beeper. ICU transfer.

After assessing the situation, the only possible course of action was to take the admit myself, putting myself at six patients. I mean, can't slam the float that is still waiting for her confused admit that was paged hours ago, and Lisa and Mimi are slammed with thier new admits.

My admit report? Ecoli, MRSA, CVA, suction. Glad I was up next.

Mid med pass on third of my current five patients...*bzzz bzzz bzzz* CP/stress test.

Assessing the situation I have this: One nurse currently admitting back to backs, a float with her new admit, Mimi with her new admit, and I with an impending isolation catastrophe on the way.

"Unfortunately we are getting slammed, and I really apologize for this, but you might have to take this admit" I stated politely to my float.

"I can't take an admit and get out of here on time, I am already going to be late as it is!" The 3p-11p float feverishly rattled off.

*sigh*

Mimi graciously agrees to take the admit as I pull meds for my heavy level 4 isolation patient with all crushed j-tube meds.

Ok 2130, and this can only get worse, two more open beds. Time to intervene.

I promptly called the house sup and stated plainly, I have two nurses who can take a patient. One who has back to back admissions just hitting the floor, and a float that leaves at eleven. Can we hold off on admits until after the new nurse gets here at eleven?

"Absolutely"

Sweet, time bought, uh oh here comes my ICU patient. Ambien/Ativan to my walkie talkie, gown change to my MRSA nares culture patient.

23:02 *bzzz bzzz bzzz* Chole

23:15 *bzzz bzzz bzzz* GI Bleed

"What do you mean we are out of linens?"

Delegate, assign, wonder when I will get to start chart checks, let alone charting! Check in on everyone.

I will save you all from the dreary finishing details of 2400-0700 as that was just a lot of paperwork, assignment making (which I did all by myself in 30 mins) and I think I fit in a cheese stick somewhere in there.

I will say it was an interesting and challenging experience, and I know I faired well as I got compliments from the evening House Sup before she left, and from the experienced charge that was on shift (that I never had to utilize) on getting the job done.

To all of you that charge, and even more to those of you who charge amongst the chaos of days, I commend you. It really is a crazy mess if just one thing slips out of place.

Tait

PS. I am going on hour 23 of being awake I have been so buzzed all day from my crazy night! Maybe it is time to rest my eyes and enjoy the next few days off!

[november17, ASN, RN]

You can't make everyone happy all the time. When I'm charge I generally put myself over first, and juggle the majority of the discharges/admits. I work my butt off but it helps the rest of the team run smoothly. Plus it keeps me busy and makes the day go by faster.

[Straydandelion]

Pat yourself on the back! You did a wonderful job of it! :)

[Thankful RN,BSN]

sounds like an average night.

[netglow, ASN, RN]

Me thinks you are gonna be asked to charge a lot now . Hard to hold on to what you really want to focus on once they find out you have "super-nurse" skills.