Implementing Charge Nurses on MS Floor

We are in the process of implementing a charge nurse role in our MS dept. We are a 28 bed MS/PCU/Tele. Currently the dept is run by the mgr 0800 until 1600 and then House Supers from 1600 until 0800. Have any of you done the same? How did you go about training the new charge nurses. I am most curious about making staffing and assignements.

I implemented the CRN (Charge Nurse) role on my unit about 5-6 months ago. I run a 40 bed general med-surg unit. The transition was tough because we were actually combining 2 different units into one.

The first thing was the selection of the charge nurses .... because we run 12 hour shifts I needed one charge and several relief charge nurses for the shift. I decded that only one indvidual would be recognized as the charge nurse and the other nurses would be relief and called a leader rather than charge nurse.

Once I made the selections, I called a meeting of these new charge nurses/leaders and provided them with guidelines. The guidelines were related to my expectations and how the unit needed to run. The day charges/leaders would not take patients unless the per nurse ratio exceeded 6 .... and the night charge/leaders would start the shift with 4 patients.

In the training program, we went through acuity based assignments. This is still a struggle, just so you know. But, the charges/leaders decided that the previous shift would complete the assignment for the next shift. While I was hesitant about this ... it has really worked out very well and the exchange of communication has been great. In addition, the charge from days and nights provide a full floor report to each other. This helps them and it also helps me as I generally get there earlier enough to listen to the full report. It saves me from having to run all over the floor and listen to several different tape recorders.

In addition, each charge/leader is responsible for a clinical standard. For example, the day Charge/Leader is responsible for skin assessments and ensuring that ALL patients have interventions when the are assessed at risk. This night charge/leader is responsible for fall risk assessment and intervention and restraint tracking. Both shifts work together on the central lines and general IV sites. In addition, both shift charges/leaders are resposible to round the entire floor to ensure patients are having their needs met and any problems are resolved quickly. I round everyday ... it generally takes me about 3 hours to do a complete and comprehensive round ... especially when the unit is full .... and it is very evident that the charge nurse/leader role is working great!

In the beginning, there was a lot of confusion .... people unsure of how they should do things and their level of authority. Today (almost 6 months in place) - the unit is operating very well ... the nurses are pleased and the charges/leaders are working well together. We still have our day to day problems ... but it has come a long way!

Good luck - hope it works out for you.