I don't want to be Charge!

The title says it all, but I'll unpack.

I've worked at my first job in nursing for just shy of 2 years, 1 year nights and most of the past year days. It has been a ROUGH past year, as I'm seeing everyone is experiencing. I made it through my first year of nursing constantly feeling like I wasn't keeping up, but I've found my groove. I'm still running ragged, but now I recognize that our hospital-wide acuity has increased, folks are delaying hospital services and coming in much sicker than before. Our unit has increased in physical size with a move to a different floor, but we have not increased staffing to match and we can't retain the staff we have. I don't know any different, but generally floating to other floors is a relief, and float pool says our floor is particularly rough due to patient population being minimally mobile and prone to falls, and little to no CNAs.  We are severely understaffed with nurses too, but who isn't? However when I go to other floors and have the same number of patients, I don't feel as exhausted at the end of the day. I know my manager is trying to hire nurses and CNAs, but there's not been enough applicants, and we still bleed staff faster than we can get more.

Few people are trained to be charge nurse, and most often a nurse will be thrown into the charge rotation because the scheduled charge called off and someone had to cover. Well, you survived once, so now you're it. The worst case of this was with a new grad RN with only 3 weeks off orientation (back when we were a much smaller unit).  She did OK, but she eventually left because she was stressed all the time from being charge most of the time while still learning to be an effective and efficient RN. Recently I had to be charge on a day without CNA coverage and I had a more than full load myself with all other nurses having a 1.75 load. It was pretty awful, but fortunately one of the regular charges (a nurse that has been a nurse a little shorter time than me) came in for the last few hours to help me wrap up paperwork and set assignments. 

My manager took some time to train me for charge and the plan was that I would be ready if that happened again. Now one of our full-time day shift charges just quit and I'm terrified that I'm going to be charge every time I work. My manager knows I don't want to be charge, but I don't know who else can do it. For the day shift, there is only one other RN with more experience than me (but less time on this unit and hospital), and the rest are all less experienced and frankly ill-suited for this role. There's a few PRN nurses with more experience, but being PRN means they can't be charge under our pay structure. The experienced full-time RN has charge experience, but doesn't want it any more than I do.

I know I'm a competent RN, but the situation of our staffing and the accuity has made everything so much harder. I frequently have trouble keeping up with charting because I'm doing all the CNA work for total care patients and my load is usually 1.5 to 1.75 of the staffing ratio on our staffing grid.

But I'm not ready to be charge. I don't have the breadth of experience to be charge. I generally know what to do or who to call in an emergency, but that is according to my experience of 2 years. For more complicated things that aren't a clear emergency, I really don't know that I can be a resource for the rest of the nurses. I'm also worried about the patients I have as charge. Generally we give charge the "easy" patients, but I've seen those go downhill fast too, and sometimes there's just no "easy" patients. Our charges also consistently take a full load, while everyone else takes a more than full load. 

I'm not done with my BSN (took the COVID year off and had some delays getting back into the program due to the long break), and I wanted to finish that before moving on to a new job. I do like my work, but I know that it isn't what I want to do forever. The unit I want to go, Oncology, is occasionally hiring, but not as often and not the ideal shifts/FTE for me. My manager is fully aware that this unit is not my forever home and supports my growth towards my preferred nursing goals. I think she even knows that I may leave if she overextends me as charge. And in truth, I am already looking.

We had an open round table with upper management yesterday and I attended after a particularly difficult day. I brought up my concerns of new grads being charge and  all the other nurses at the table from various units chimed in about how dangerous this is and how much faster these new nurses burn out and leave the hospital or nursing all together. The upper management rep reworded the suggestion to "consider not putting new grads in charge position until they are several weeks off orientation". I stopped her and said "No, my suggestion is to not put new nurses in the charge position until they have years of experience, not weeks or months. Ideally these nurses should have 3 years of experience." The suit pursed her lips and didn't amend her notes. This really bothers me. I don't care if this is the way it is done. It isn't safe. I don't care that they don't have the staff. It isn't safe. They should work more on retaining our experienced nurses, not burning out the new nurses, and providing fair pay all around. Finding nurses is their job, not mine, but I am tired of being put into unsafe situations and being told it is normal.

Ugh. I wrote another book, and as usual I'm not looking for any specific answers. Mostly I just want reactions from those that have been there. 

[brandy1017, ASN, RN]

The problem isn't you being Charge, rather the working conditions and short staffing.  I would be looking for another job ASAP and probably with a different hospital system.  You are not a new grad, you have two years experience so you should be able to find another job without any problem. 

I don't think things will get better if you stay.  Management does have options such as travelers or agency to get enough nurses, but that cost money.  So they choose to overwork you and make excuses to get away with it!  Listen to their actions, not what they say and get out of there! 

[BSN-to-MSN, ADN, BSN, RN]

Refuse. Say no on the spot.

They tried to put me as charge a couple of times, no warning,  just bam, show up for the shift and there it is, my name in the charge row. I said no, you can't make me. I know how it works,  first no patients,  then the abuse starts. 

Tell her from a certain date, you will not accept being charge. Does it say in the job description to do the job of multiple people for one pay? She can manage the bedboard herself.

[PollywogNP, ADN, BSN, MSN, LPN, NP]

RN-to- BSN said:

Refuse. Say no on the spot.

They tried to put me as charge a couple of times, no warning,  just bam, show up for the shift and there it is, my name in the charge row. I said no, you can't make me. I know how it works,  first no patients,  then the abuse starts. 

This happened to me also. The day charge (who was a new grad with a little over 1 year experience & was made charge since no one else applied) tried to say that: "all you have to do is make the assignments" Nope that is not all there is to being charge. Plus it was telemetry & there were 2 RNs that had not even taken basic EKG class let alone get ACLS cert. Nope not gonna cover them that are too lazy to get their asses to EKG class. Not taking the fall when they fail to call doctor for serious EKG changes. The first time the house supervisor was the "charge ", second time this brand new grad agreed to be charge. First time refusing the day charge stated I could be reported to BON! But could not figure out what the reason would be. Told her go ahead, try it. Asked her if she'd ever read nurse practice act? Said not my fault that I'm one of the most experienced nurses but if I wanted to be charge I would have applied for the job. End of story.

[LibraNurse27, BSN, RN]

RN-to- BSN said:

I'd rather wash hospital windows under the "other duties assigned". Outside. LOL.

LOL! Some days I feel I'd rather wash windows than work on the floor. My former manager told me I'd never be charge, because I'm a little too "spicy" with my communication if I need to advocate. I think she was afraid I would push back on upper management when they tried to dump on us, because of some strongly worded letters I sent regarding unsafe staffing causing falls. I sleep better knowing I did the right thing for my patients than knowing I made my manager happy by keeping my mouth shut.

When I left I offered to stay per diem but my manager seems to have lost the paperwork. Although I was a good nurse, well liked by MDs and patients, never made a significant error, and was the only nurse on the floor that spoke Spanish, it wasn't enough. I learned not to do a job in search of praise from management or recognition from your organization. Everyone is replaceable. So if you find a better job, take it and run! You don't owe anything to a hospital that likely doesn't appreciate you. 

[PollywogNP, ADN, BSN, MSN, LPN, NP]

18 hours ago, Been there,done that said:

If any one wants to refuse charge duties, they need to review their job description. Many have the statement "and other duties as assigned." That means you are stuck with charge.

Correct! I had over 15 years experience at the time including 3 years active duty Navy nurse, deployed on hospital ship. I understood my job description well. This was also the hospital where I was asked if I accepted my assignment before report had been given and the “assignment “ had room numbers under nurse name. Room numbers. Not even pt names! My reply” after you give me report then I might be able to “ accept “ the assignment. The reply? “ You have to accept now or it’s patient abandonment.” Nope. Not how that works. Duh! Same people were clueless about responsibility of charge nurse.

[bluescrubs, ADN, ASN, RN]

New grads just off orientation and being charge?!?! Things like this is what makes people leave. I left staff nursing to do travel. If I am bending over backwards with 6 patients, 3 of which are totals and no CNA then I need to see that reflected in my check. One thing I think Covid has made many nurses realize is that these hospitals and management do not care about us. If they continue to have such high turnover they are going to hire more agency and travel nurses. I would not recommend anyone do bedside if its not through agency or travel because it just isn't worth it. The hospital assignment that I am doing now is paying $850 bonus for nurses to come in. Hospitals spend so much money on bonuses to come in and agency nurses, if they just hired enough staff and had enough resources they wouldn't have to look elsewhere and they would be able to keep staff for more than a few months or when the new grad hits the one year mark. I know you said you are looking but honestly right now most hospitals are like this. I do not believe charge should take an assignment or a full assignment at that. The charge should be there to hold the new grads hands, be a resource when **** hits the fan, help with admissions or discharges when the nurses are overwhelmed, take a patient that might be too critical, etc.  

[Ioreth, ADN, RN]

Thank you all for the responses. Most of the responses in person that I've gotten is from experienced nurses that say "that's the way everyone becomes charge, it sucks, carry on". Or from nurses just as new or newer than me that think this responsibility is an "honor" and shows that management trusts me. That may be, but it's also an honor I'd rather wait another year to have. I know I'm better off now than being thrown into it sooner, but for all the reasons I wrote about earlier, it is just less safe and contributes to early burnout. 

4 minutes ago, LibraNurse27 said:

Are you in Med/Surg? We called a lot of rapid responses because we were all new and didn't know what to do when pts went toward ICU status. Not good, but it did show admin that the unit wasn't safe... =/

I have noticed that brand new nurses don't want to call a rapid because they want to show that they can handle it. Late newish nurses like me tend to call the most rapids because we tend to recognize a situation beyond our ability to fix but we don't know what to do about it.

We are a weird floor. We used to be considered intermediate care level, but have recently been moved under the med/surg umbrella, which may be better and worse at once. However, we've seen patient acuity go up everywhere in this hospital. It is a unique floor with a very specific patient population. I don't think there is anything like it anywhere else, so to go into more detail would be to state exactly where I work. We do take a lot of general med/surg overflow as well. Transfering to ICU and intermediate care is problematic in my hospital due to lack of beds in both areas, so we tend to hold onto patients beyond our acuity level far longer than is safe. 

[LovingLife123]

I don't think 2 years is too new to be charge.  What I have a problem with is you taking an assignment while charge.  Instead of saying to administration charge should have 3 years experience, it needed to be charge shouldn't have an assignment.  How do you manage bed flow and be charge?

It sounds unsafe and I'd be looking elsewhere to be honest.

[Ioreth, ADN, RN]

2 hours ago, JKL33 said:

If I were put into a charge situation like what you are describing, even with plenty of staff and charge experience, I would limit my sense of responsibility to 1) my patient assignment 2) assistance to other RNs if a patient was not doing well/acute condition change 3) essential house-keeping duties that are generally part of the CN role, like making out shift assignments, etc.

I would not take responsibility for other housekeeping tasks or for supervising patient care by other RNs who have a license just as I do; if they are allowed to independently work the area then they should be able to take basic care of patients. If they're in stages that still require oversight then it is your employer's responsibility to actually provide adequate oversight. Claiming that overseeing beginner nurses is the responsibility of a charge nurse who has a full assignment is just not a legitimate thing and I would tell them exactly that. I do not take on responsibility that rightfully belongs to someone else. It has always really bugged me when nurses literally run themselves ragged and appear to actually believe their sense of self-worth is completely tied up trying to perform these magic tricks that administration demands. I've seen people freaking out because they couldn't find time to do things like some of the audits CNs get assigned or didn't complete CN call-backs. My firm belief is if these things are so crucial then pony up the resources.

There are other resources--especially admin and the house supervisor, who all should be called upon routinely when nurses are struggling due to understaffing. Plus nowadays some people seem to have forgotten that the nurses can and should be consulting with the relevant providers if they have concerns about their patients' conditions.

Very good points. Right now there is very little support from charge to the rest of the floor staff and mostly because they also have a full assignment. I try to keep my charge nurse in the loop as far as changing patient status, but often they can't do a thing to help other nurses or be the resource they need to be. Some of the newer charge nurses try and run their pants off, but most of the experienced charges are just exhausted and have had to let it all go. It really is every man for themselves most of the time. 
On other floors it is expected that RNs will relay needs to charge and the charge will call physicians as needed, bundling calls as much as possible. On my floor, if an RN needs something then they make the call, but it stresses out our physicians and PAs because they get call after call after call from various RNs. Charge is supposed to hold the other nurse's phones for lunch breaks. That doesn't happen either. Charge is supposed to briefly take an RN's patients if they have to accompany a patient elsewhere in the hospital, that also doesn't happen, and those cares and meds are just missed while the RN is off unit. I know that variations of this is happening everwhere, but on my unit it is really a Wild West atmosphere.

I had a patient going downhill fast yesterday (I thought we were going to lose her at one point), another with a critical test result to relay to a physician, and 3 other patients having explosive diarrhea and 1 CNA that wasn't able to keep up with everything. I really needed to step away from the sh*ts and call a couple of physicians, but I couldn't, so care was delayed. In desperation, I asked my charge for specific help and she refused saying that she had a discharge to do. I ended up having to let my phone ring a few times because my hands were covered in poop or I was on the phone with the physician (after far too long delay) and calls ended up going to my charge. She chewed me out saying that these busy mornings were a test to see how I handle stress and that I was failing. She said I can't handle being charge if I can't answer my phone. I'm sure this experience added to my fear of being charge once I found out another charge was quitting.

This was so frustrating because I don't want her job. Also, I know that she failed me that day and I think she knew it, but took out frustration on me with the annoyance of calls going to her. I was drowning, I let her know, she let me drown, then she told me it was my own fault. This is one of many things I'm afraid of, but I know it is inevitable. 

Regarding oversight of new nurses. Ain't no one on this unit have time for that. And it is unfortunate because we're pulling new nurses off orientation before they're ready regardless of how that orientation went. And we have a LOT of grass-green new nurses. However, I do agree that it isn't my job to be their momma. They have their own license and I don't need to pull theirs under mine.

[Ioreth, ADN, RN]

7 minutes ago, JBMmom said:

Our hospital hasn't had charge nurses without an assignment in years. For the past few months they have tried to leave the ICU charge at large as a unit and house resource. I am charge about 9/10 of the shifts I work, I think I've been at large four times in the past six months. However, our manager frequently tells the upper management people how she supports and ensures that our charge is at large for a resource. Ha. 

That was another thing that every nurse present at that roundtable asked: Take charge out of staff, ie. no patient assignments for charge. In our ICU, the charge nurse is also the Rapid Response leader, and I have had a rapid response that was not resolved where the ICU charge had to run back ICU due to an emergency there. It is a problem for every single unit in this hospital.

[Ioreth, ADN, RN]

1 hour ago, JKL33 said:

As an aside, I know every place is different but this is a program I have never gone along with and never would. I don't feel that reporting patient conditions to a peer who happens to be filling the charge nurse role that day meets the obligations of my licensure. Plus I'm specific in what I report and how I convey my concerns. Wouldn't use the grapevine method unless some unusual situation/emergency. If the providers are getting too many calls there are other things that can help mitigate that, but I'm not leaving it up to the hospital to dictate that I won't speak to a provider about my patient when I think it's necessary.

Truly I agree with you. It is weird to float and see this done elsewhere. I try to ask around if anyone else needs to talk to Dr. H when I make a call.

1 hour ago, JKL33 said:

Would start making an exit plan if this is how things usually roll there.

With so few CNAs, yes this is frequent. After a very long wait, we finally got approval for 2 CNAs during day shift, but this just doesn't happen with the staffing. Most days we get 1 CNA, but we've been having 0 more often lately because so many are being pulled to be sitters. 

I don't want this to seem like I'm above CNA work. I will happily wipe butts, bathe patients, take vitals (I prefer to get my own first set), and blood sugars. But when something comes up that requires RN intervention, then I need my CNAs to cover the toileting so I can address those things. That's what was so frustrating about this situation. I had a patient I knew would fall if I didn't toilet him promptly and another that was compliant but had serious skin breakdown that I didn't want to worsen. The vast majority of our patients are not able to move independently. One more CNA on the floor during this moment would have helped. 

Yeah, this does stink, and it is probably contributing to staff exodus.

1 hour ago, JKL33 said:

She's a piece of work. That's BS.

She and I generally don't get along, and that's her usual response to someone asking for help. She is very good about moving patients out and in, but not so much about supporting the staff.

1 hour ago, JKL33 said:

Honestly you can't expect anything from a charge nurse that has a full assignment. That's not fair. And I wouldn't put myself in a situation to be charge in a setting like that, either. What you are describing sounds like a circus and also dangerous.

Again, I do agree. I am trying to keep in perspective that I don't know what else was going on in the unit, with staffing, what was on the bed board for admits, etc. But still... her response was that she couldn't help me toilet a patient or hold my staff phone while I called a physician was because she was busy with a discharge. I can only think of 1 discharge in the past 2 years of nursing that was that urgent and couldn't wait long enough for a phone call. But yesterday was a circus, it was particularly bad yesterday, but most days aren't a whole lot better. I don't want to get too stuck on yesterday. It was presented as an example of the unit, and I think my particular frustrations with the events took over.

And days like that do color my perception of the charge role. It is rough right now with my own patients, and even though I'll have a "lighter load" (really just down to our on paper staffing grid patient load), I know this will be going on around me. The paperwork doesn't bother me. Meh. Some of it is unfamiliar but learnable. Bed management is unfamiliar but I can learn. What is worrisome is keeping up with the circus while managing my own patients. 

[Ioreth, ADN, RN]

14 hours ago, Been there,done that said:

Stop beating yourself up.

I wasn't aware that I was beating myself up until you pointed it out. I am blaming myself for lack of experience, but I see now that experience isn't the problem. I've been observing the difficulty the charge nurses are having on my unit and I don't want to be put in that situation. You're right, I think I would be fine IF we had something approaching safe staffing levels, including charge out of staff.

11 hours ago, Jedrnurse said:

Not that it makes a difference in how difficult a full assignment + charge is, but are you at least paid for that extra work?

$1/hour differential for being charge. No, they don't take into account having a patient assignment. It is so not worth an extra $12 per day.

11 hours ago, Jedrnurse said:

Some of the things you mentioned that charge nurses do should be handled by the nurse manager. 

This is the first nursing job I've had, so I don't know any different, but some of the float pool nurses that have 20+ years on them have said this too.

5 hours ago, LibraNurse27 said:

Is it possible you can ask for no charge if no one wants to do it? If everyone refuses they can't force you. 

I've never heard of no one being charge, and I don't know how that would work on this unit with surgeries rolling in so fast. Someone will have to manage that bed board. Unfortunately I can't straight up refuse because it is in my job description that I must do it if requested. Same wording for all staff nurses.

I did watch a few times where the charge attempted to refuse transfers to the floor due to obscenely unsafe staffing levels. This went nowhere. House supervisor came in to have a talk with the charge RN and those patients rolled in and were put wherever transport wanted to put them. They just handed charts out to the nearest nurse and said "house sup said this one is yours".

5 hours ago, LibraNurse27 said:

They threatened us but we have a strong union plus if they fired anyone they literally wouldn't have enough staff! 

We don't have nurse unions in my state. But honestly, I think I am pretty much unfireable due to the lack of staff. However, I don't want to test that assumption. I do have a tendency to speak my mind about safety issues, regardless of who may be listening.

5 hours ago, LibraNurse27 said:

Do you have a clerk or you also have to answer phone calls? We had no clerk so we had to do our own calls to the doctor. 

Nope, never had a unit clerk either. I think every other unit in this hospital has a unit clerk/secretary at least for day shift. I can't imagine handing over physician calls to a unit clerk. As stated above, I'd rather do my own physician calls regarding my own patients. However, having a clerk to handle some of the other calls would help immensely.

I'm realizing that the charge nurse in my units are being asked to do 5 jobs: charge, floor nurse, CNA, assistant manager, and unit clerk. No wonder I am overwhelmed looking at it!

By my count, 7 people in this thread have encouraged me to continue the job search. My senior year clinical instructor is a float nurse and encouraged me to look elsewhere. Another fantastic float nurse who is a clinical instructor at 2 local nursing schools encouraged me to look elsewhere. The first thing I usually hear from float nurses when they look around my unit is "this is unsafe". On her way out, the charge that is leaving told me to get out now. I think I'm seeing the writing on the wall. 

I hate job search.