How to handle this charge nurse dilemma

[Billy_Ruben]

I'm charge on my unit at night. Been a nurse for almost 2.5 years and there are other nurses who are far more experienced than myself that I work with. Some were asked to be charge but declined, one in particular isn't considered because of her attitude and demeanor. I get great feedback from my peers and manager that I'm doing well in my role. I feel like I'm coming along fine and I'm definitely learning along the way.

Ive run into a situation more than a few times where I feel almost like some of the more experienced nurses are using my position to...thinking about how to put this...I guess, not do something they know they maybe should or buffer themselves from consequences. For instance, they'll ask about a lab and say, "I don't really need to call, do I? It can wait until the morning can't it?" I'm thinking well that depends on a bunch of factors. I know they know the answer. I know they know to look back at trends. To evaluate symptoms, watch the telemetry, whatever. I get the feeling they want me to answer for them so that if something doesn't go smashingly well (the doctor pitches a fit for a 4 am call or the doctor pitches a fit for waitin til the am) they can just say, "well, my charge nurse told me to do xyz."

I know there's plenty of sincere questions being asked. I don't mind those at all. Am I being paranoid? I really feel like I'm a decent judge of when someone is really asking for true help or when what I've described above is going on. I'm not sure how to handle it when people are doin this. I don't want to blow someone off and feel like it's my responsibility to field all questions but I don't like this feeling of my position being taken advantage of.

Thoughts?

[firstinfamily, RN]

As a charge nurse, when another nurse has notified you of some abnormal finding, she/he is making you aware. To me, the nurse who is directly caring for the patient should be the one to call, however, usually during the night shift, that nurse is suppose to make the charge nurse aware before any calls are made. If you feel they should call and they do not, then you could actually be held as accountable as they are. If they ask you whether they should call or not then ask them, "what do you think?" Find out what their thinking process is before you judge. It could be they have experience with this particular MD and don't want to be the one to wake him etc. However, if the pt continues to decline and the MD was not notified at the very beginning of an abnormal finding, then he can throw the responsibility back at the nurse and the charge nurse. Yes, they most likely are testing you, but, you have said that for the most part you know you are doing your job, so my suggestion would be to throw it back at them and ask them what they think. See what their thought process is. If they say they are not going to call, then as the charge nurse it is your responsibility to call the MD. It does not matter whether the MD wants to be called or not, it does not matter if he gets mad, he is the MD and if a patient is having problems of any sort, he needs to know. If he is never notified, then how can he do anything about it??? Put your brave face on. Just because they are more experienced does not mean they are better nurses. If anything, they should understand the importance of notifying the MD. IF you continue to have these issues I would discuss it with your manager and ask her what she expects you to do. You do not have to mention names. Your manager must feel you are a dependable and responsible nurse to put you in charge. Don't let them intimidate you!!!!

[jadelpn, LPN, EMT-B]

Throw it back at them. "what do YOU think you should do?"

Then ask your manager for direction, as there should be a policy--and most facilities MD's need to be notified of abnormal labs within a time frame. If there is charge meetings, I would see (and something you can discuss with your manager) if the evening charge (or applicable, day charge) can notify MD when they are rounding "there's an H&H on your patient at 3am, are we to call you with any abnormal results, or are you going to discuss this case with the hospitalist in house?"

If a practitioner has a patient that is critical and/or unstable, then they need to be notified for further orders. Should they kick and scream then perhaps they need an alternate plan. And only once would they kick and scream, then I would be the first one to say "what is your alternate plan going forward?"

Best wishes, and always discuss this with your manager for direction if the direction is unclear.