Lead Nurse Responbilities

mrsmsh42 · Feb 19, 2015

I'm the Charge RN at my clinic, which is part of a large university system. That being said, there was a big gap in time with no nurses in clinic, and the charge nurse before me was present for only seven months.

Basics that we are building: RN role descriptions and MA role descriptions, based on scope of practice in your state. Do you do wound care in your clinic? Who can do it? Who can pass meds and apply topicals? Who can triage patient calls? Who places orders? Who counts your Pyxis?

I do weekly Pyxis counts, monthly pharmacy inspections for outdated meds. Yearly competencies on things like EKGs, new equipment, new policies. Refreshers on giving IM and SQ meds (and can your MAs give those meds...some clinics maybe yes, some no)

Be very careful to find out WHO is ultimately responsible for your MAs, and how delegation works in your state/clinic. Even though I work in a state that allows physicians to delegate things to a medical assistant that no licensed CNA would dream of being able to do....as an employee of the university system I"m in, my MAs fall under my license. They know it, too, and my MAs are fabulous...they come and find me if they are asked to do something they're not sure if they "can" do.

You need that delegation/accountability protocol, first and foremost.

That's my suggestion.

mrsmsh42 · Feb 19, 2015

p.s. And it's a whole new ball of wax if you do procedures in your clinic. Any procedures. I work four days a week, and I work with another RN who works four days, too (Mondays she's without me; Fridays I'm without her.)

We don't do many other procedures than burn care, but when the occasional thoracentesis comes up, I'm present for it. I have strict rules about me doing the wound vacs. My providers know to find me, and if it's Monday, to find the other RN. I'm never too busy to come "assist" my MAs for an EKG. The MAs don't touch foley catheters or central lines; I do it, and I make sure that I'm never "too busy" for those things. They come get me when we have patients coming from the prison, with police escort. They come get me when a patient reports being suicidal. I'm present for the 911 calls, the low blood sugars, the chest painers that get walked by an RN over to the ER. When pulmonary lab has a patient seize, there is an RN present.

And there should be...and we actually have policies (or at least norms; we're building policies still) for all of that. We know who does what.

Depending on what your clinic does, you should protect yourself and your MA colleagues with policies for all that stuff. To protect you and them.

Ashley02 · Feb 22, 2015

Office supply ordering, medical supply ordering, and pharmacy ordering monthly. Check outdated supplies and meds monthly. Monitor the biohazard waste pick up and call to arrange when that is needed (we're on a will call basis). Monitor provider orders, imaging studies, did the pt have those done, where?, do we have results. Manage referrals, who did we refer the patients to, have they been scheduled, did we receive referral notes back. Weekly auditing of charts, are encounters locked, coded, etc. Keep track of my high risk patients for disease management. Work with the wellness coordinator to arrange outreach and different activities for the patients (disease management). Monthly bulletin boards, outreach programs, etc. Lab review daily. Follow up phone calls to patients from the previous day's provider visits.

Ann.E · Mar 6, 2015

Thanks for the great responses! I have been doing weekly checks of expired meds and also trying to get expired supplies out of our store room (which is bigger task than I thought it would be). I am trying to let providers know that I am available to do maintenance things such as flushing porta-caths or doing wound care, but it's a slow process. I am slowly developing a weekly and monthly checklist and I have already done several staff trainings on topics such as injections or foot exams. Thanks for the input though, you guys gave me some great ideas for other things I can be doing as well :)

Becca_Anne · Mar 7, 2015

I'm the lead RN at our clinic which is part of a larger organization with multiple clinics. I am the only floor RN at that site, we also have a RN case manager who manages our more complex patients. I am responsible for training MA's and checking them off on their skils such as administration of medication, vaccines, foot exams, EKG's, PFT's, ensuring morning huddle takes place, reviewing incoming lab results and radiology, assisting providers with any in visit needs such as patient education, IM medication administration (which can also be delegated to trained MA's who have been signed off by me), all IV or foley catheters, emergency cart/AED/Birth kit monthly inventory and testing, scrubbing all charts on my own schedule and seeing patients for triage and nurse visits, management of coumadin patients, wound care (which can be delegated for smaller less involved dressings), Triage calls and calls to patients about their lab results or other aspects of their care. I attend meetings at other clinics and coordinate accross sites with the other lead RN"s. We are trying to transition floor nursing into more of a case management role so my role is evolving. I also support my MA's with any and all clinical questions they have and am responsible to step in as their teacher if they need to be taught new skills such as EKG's or PFT's. We do not do a lot of complex procedures at my site but the provider is responsible to train their MA for those specific needs. I am available as backup for them to step in as needed.Congrats on your new role and I hope things have been going well for you!