Another thread here today got me thinking. On a scale of 0 to 10, with 0 being totally unimportant and 10 being absolutely essential, how important is it for a charge nurse to be able to run a code? Are there other leadership qualities that are more important?
The reason I ask is that I was recently at my ACLS refresher. One of the charge nurses from a 40 bed inpatient telemetry unit was in my group. This nurse should not have passed the ACLS refresher, IMO. He or she struggled every step of the way, and had it been a real code, I would have feared for this patient.
Now, I'm not saying that *I* could run a code seamlessly. There is a huge difference between a classroom environment and the real deal. But, I am not a charge nurse.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I would rate it as "0". Not important at all. It's not a charge nurses roll to run codes, at least not in any of the hospitals I have ever worked in.
They should know the initial steps to preform until the code team arrives, though, like how to call the code and to start CPR, fetch the crash cart. After the code team arrives the charge nurses roll (role)should be to be available to fetch things or make phone calls, or maybe take part in the code as directed by the code team leader, usually this means CPR or recording. Otherwise they should stay out of the way.
ACLS used to be hard and people used to fail it all the time. Now they want everybody to have it, even med-surg nurses and it has been dumbed down to to the point of being meaningless.
I am concerned if this person is the resource person her peers look to for advice and guidance...
It really depends on the facility but the importance is up there......at least a 8. Hopefully a Rapid Response has been called and the code is to get additional personel. On a telelmetry unit one would think the charge nurse would be able to follow through the ABC's of a code or at least direct people. In some LTAC's (long term acute care) they have ICU units with vents drips and PA lines and they are supposed to have a doc on call at least to come in for emergencies....if they have an ICU they need to be in house (although not always enforced).
All nurses should know CPR and AED's but a charge nurse on a telemetry floor should be the team leader until the code team arrives.....at least in theory.......
I agree that ACLS has been "dumbed down".....or over simplified that the competency after passing is not the same.
It depends on the hospital, how quickly the code team will be there, etc, etc... Where I worked before, I would rate it about a 2. Recognize a deadly rhythm, call the code, check a pulse, have someone start CPR, get the crash cart, get the pads on... Maybe give the first drug/shock if indicated. Either way, the floor RNs/charge should not need to actually "run" the code.
At my first job as an RN, they wanted each floor nurse to be telemetry (though no necessarily ACLS) trained and be able to start CPR and analyze the rhythm/shock using the AED.
As the person that stated a charge nurse should be able to run or at least know what to do in a code in the other thread the OP is referring to, I'm glad to see many of my peers on this forum agree that it is an essential skill. A charge nurse should be a resource for the nurses working on the unit. The charge nurse does not have to know everything, but enough to know what she/he does not know and to support the staff.
In my unit we run ours codes. We do not call a code blue, and we do not have a RRT in the hospital. Events usually go like this: nurse recognises the event, calls for someone to get the crash cart --> we starte coding as the secretary or someone else pages the resident rotating that month and calls the charge nurse. The resident may or may not come immediately but usually they do and we continue.
I work in a busy ICU and all our charge nurses have over 10 years of experience and are very smart and capable. A lot of times the junior residents look to us to know what to do, so it is very crutial that we have knowledgable people working the unit. Most especially those in charge. I understand this might not be how things work in other units, so I know why some people might feel comfortable being in charge with only 2.5 months of experience as an RN (since probably its the norm at their hospital).
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As the person that stated a charge nurse should be able to run or at least know what to do in a code in the other thread the OP is referring to, I'm glad to see many of my peers on this forum agree that it is an essential skill. A charge nurse should be a resource for the nurses working on the unit. The charge nurse does not have to know everything, but enough to know what she/he does not know and to support the staff.
In my unit we run ours codes. We do not call a code blue, and we do not have a RRT in the hospital. Events usually go like this: nurse recognises the event, calls for someone to get the crash cart --> we starte coding as the secretary or someone else pages the resident rotating that month and calls the charge nurse. The resident may or may not come immediately but usually they do and we continue.
I work in a busy ICU and all our charge nurses have over 10 years of experience and are very smart and capable. A lot of times the junior residents look to us to know what to do, so it is very crutial that we have knowledgable people working the unit. Most especially those in charge. I understand this might not be how things work in other units, so I know why some people might feel comfortable being in charge with only 2.5 months of experience as an RN (since probably its the norm at their hospital).
*** I take it for granted that an experienced ICU RN can handel any role in any code situation. We don't call codes in our ICUs either, nor to they call RRT. My comments were in relation to a tele floor where the OP works.
I think it is important 10/10 that the charge nurse is able to handle the initial steps if there is a code, call the code overhead, get the crash cart, get the bed positioned, try to make sure there are multiple iv accesses, fluids.
Does it depend on where you work? I work in med surg in a huge teaching hospital. Most of the nurses on the floor are NOT ACLS certified. Charge role is often assigned randomly. If a code where to be called in about 2 minutes the room would be filled with about 20 MDs all ACLS certified and the code team.
Another thread here today got me thinking. On a scale of 0 to 10, with 0 being totally unimportant and 10 being absolutely essential, how important is it for a charge nurse to be able to run a code? Are there other leadership qualities that are more important?
The reason I ask is that I was recently at my ACLS refresher. One of the charge nurses from a 40 bed inpatient telemetry unit was in my group. This nurse should not have passed the ACLS refresher, IMO. He or she struggled every step of the way, and had it been a real code, I would have feared for this patient.
Now, I'm not saying that *I* could run a code seamlessly. There is a huge difference between a classroom environment and the real deal. But, I am not a charge nurse.
What say you?
I think it's more interesting that the nurse's gender is indistinguishable. That's uncusual. Unfortunately it's quite common for people to get ACLS without the ability to be marginally helpful, let alone manage a code.
In a recent PALS course, the instructor started with "Don't worry. You are all going to pass."
Apparently these courses used to be hard and intimidating, so many would not take them. In my experience many come unprepeared, and the course is dumbed down for them. More certifications, lower quality.
A better question is whether anybody who holds an ACLS cert should a least have a reasonable shot at running a code.
And yes- A charge nurse n a 40 bed unit with ACLS certification should be able to manage a code.
Does it depend on where you work? I work in med surg in a huge teaching hospital. Most of the nurses on the floor are NOT ACLS certified. Charge role is often assigned randomly. If a code where to be called in about 2 minutes the room would be filled with about 20 MDs all ACLS certified and the code team.
2 minutes is a long time. But in our unit we would def be able to position the bed, get the crash cart, start cpr, etc before than. I really wish we always had an experienced charge nurse or experienced nurse around but we don't. Some times it is to the point where someone with 2 years med surg experience is a verteran.
Specializes in Telemetry, ICU/CCU, Specials, CM/DM.
*** I take it for granted that an experienced ICU RN can handel any role in any code situation. We don't call codes in our ICUs either, nor to they call RRT. My comments were in relation to a tele floor where the OP works.
Even on the ICU/CCUs that I worked on, we always called the codes so the ER doc and RRT would respond. If it was an impending problem that had not gotten to the point of a code yet, we always just called the ER doc for intubation if needed or informed the attending or specialist. I have actually worked with ICU nurses that had no clue where or what things were in the crash cart though, which was very sad. Sometimes, they had been there longer than I. That is another reason that I always made sure that I was familiar with the procedures.
Heck I just re-upped my BLS, some nurses fumbled severly even with the CPR practice, and then were still working on the written test, or were being educated on things they got wrong by the instructors after I left ?! These were nurses with many years experience. This is basic response folks.
...and some of us can't get a break for a hospital job. :anbd:
It could be that he/she struggled because it was a class and not the real thing. I've gone through a class with a nurse who has been an lpn for over 30 years and the way she acted and responded to questions and during mock code would make you think it was time to retire. But in actual codes she is totally different. In fact, she will tell the doctor what they need to do. There is something about having to perform in front of people in those acls classes that some people cannot handle. I would think (and hope) that the charge nurse has made it this far for a reason.
I work nights on a tele floor at a 350 bed hospital. A few weeks ago we had the craziest night I've ever seen. Two code blues, a code stroke, a RRT, and a trauma roll up to the ED all within an hour. Spread out over different floors, of course...if all those happened in one night on my floor I'd still be gibbering in the corner!
So, yeah, a charge should be able to theoretically run a code if necessary...on tele floors and up at least, since our med-surg nurses aren't ACLS certified. Even at that, by the time the code team shows up, basics should all be done...CPR, suction, NS up and running, pads on, etc...no matter what floor or area you're talking about.
IMHO, no one should be thrust into the charge role without significant experience under their belt. My facility requires a year as a RN, which I don't think is anywhere near enough time to be comfortable dealing with emergent situations, b/c there's just not been a chance to get enough experience. Minimum should be participating in several code blues and code strokes if you're talking the acute care side of things. There's nothing worse than the blind leading the blind until the calvary arrives.
Esme12, ASN, BSN, RN
20,908 Posts
I am concerned if this person is the resource person her peers look to for advice and guidance...
It really depends on the facility but the importance is up there......at least a 8. Hopefully a Rapid Response has been called and the code is to get additional personel. On a telelmetry unit one would think the charge nurse would be able to follow through the ABC's of a code or at least direct people. In some LTAC's (long term acute care) they have ICU units with vents drips and PA lines and they are supposed to have a doc on call at least to come in for emergencies....if they have an ICU they need to be in house (although not always enforced).
All nurses should know CPR and AED's but a charge nurse on a telemetry floor should be the team leader until the code team arrives.....at least in theory.......
I agree that ACLS has been "dumbed down".....or over simplified that the competency after passing is not the same.