Litany of Nurse Management - Old vs New

[DoGoodThenGo]

Back in the old days nursing mangement was rather a straight forward affair.

At the top one had a "Director of Nursing" who was totally responsible for the service and all nurses employed by a facility were under her direct supervision.

Next came a satellite of nursing supervisors who could either have charge of a entire facillity for a shift (house supervisors), or particular unit or units.

Finally at the lowest level were head nurses who ran individiual floors units. Seeing to day to day operations including staffing, hiring, termination (often in conjuction with supervisors and DON, though she could often get shot of a nurse or NA at least as far as her floor was concerned).

Below this were charge nurses or assistant head nurses who filled in during the head nurse's absence, and or performed some minor management/day to day running of a unit or floor.

My question is what remains of this system today and how are things in the "real world"?

From another post it seems charge nurses are often not a permanent managment position but moved about between staff nurses on a unit/floor. Much of the other functions of "head nurses" seems to have been parceled out to nursing managers who have domain over a floor or floors, unit or units.

[roser13, ASN, RN]

Homework assignment?

[rn/writer, RN]

My unit (postpartum) has a manager who answers to another manager who oversees at least seven units (connected with birth and women's health) at two different hospitals. There are several layers above this.

Charge nurse is a position that rotates among 4-6 nurses on a particular shift. Not all nurses share this role.

[DoGoodThenGo]

Homework assignment?

If only!

[RNperdiem, RN]

My hospital sounds the same as you described at the unit manager level and up. The charge nurse role has changed at my unit since we moved to a larger unit. The charge nurse now is a fairly senior staff nurse who takes their turn being in charge. That has not changed. What has changed is now charge does not take a patient assignment, but they picked up responsibilities in staffing for the upcoming shift by calling nurses off or begging staff to come in.

When the overhead pager announces a rapid response, our charge nurses go to all of those in our service. This is another new development; there was no such thing as a a rapid response at my hospital in recent years.

So yes, the charge nurse role is one that changes with the needs of the unit over time.

[happygrandma3]

Each shift has an assigned charge nurse, that nurse takes an assignment & does the staffing/scheduling for her shift - usually 4 wks at a time. The NM is busy w/a multitude of other things & fills in the staffing/scheduling part when the CN is off, but does not take an assignment.

[mappers]

We have a DON. There are two people under her whose titles I can't remember. One is over the ICUs, OR, ER, and other procedure areas, the other is over the med/surg, tele, tcu floors. They wear expensive suits and high heels, have fancy haircuts and pedicures. They seem to be into goal setting overall budgeting, strategic planning, etc.

There are Managers for each floor/unit. They also wear suits or nice clothes but where a lab coat as well. They are also usually in non-practical shoes :). She is responsible for highering/firing for the unit, budgeting and meeting unit goals.

There are Assistant Nurse Managers on each unit. On mine we have four total - two days and two nights. They are hourly, and work 12 hour shifts. They are usually the charge nurse when they work, but sometimes will have "office" days when staffing allows. They wear scrubs and white lab coats or just scrubs and nurses shoes or athletic shoes . They share tasks, like one does scheduling, one does time-keeping for payroll, one does stock ordering, etc. They also do the monthly reporting stuff - like they have to observe so many bedside shift reports and hygiene - two patient identifier things and fill out some report.

If the ANM isn't there or is "in the office" then one of the staff RNs will act as charge. We do admissions, handle bed booking, handle complaints, go to "bed huddle" where we discuss staffing for the next shift, etc. Since we are an oncology floor, the charge usually hangs any chemo if there is any to be done instead of the nurse with patients doing it. Sometimes the charge will take patients if we are really short staffed.

There is also a house supervisor. I'm not totally sure what they do. I know they oversee staffing for the whole hospital for the shifts (call in agency, run bed huddle etc.) They also oversee bed flow throughout the hospital and respond to codes and rapid responses. If it is nights or weekends, when management isn't around, they will handl issues in the house that come up...patient complaints, etc.