Need Help w/ Charge Nurse Duties, Please

BBFRN, BSN, PhD · Nov 4, 2008

Thread moved to General Nursing Discussion forum to encourage more responses.

racing-mom4, BSN, RN · Nov 4, 2008

Each hospital is different,probably best to ask the more Sr charges at your own facility.

BinkieRN, BSN, RN · Nov 4, 2008

well, within a week i was not only doing charge, carrying a full patient assignment, but orienting bran new nurses as well. i know that the charge nurse sets the tone of the unit. but i still have yet to learn what exactly being a charge nurse truly entails. could anyone help me.
thank you in advance
jennifer

are you saying that you are doing charge, taking 6 pts and orienting all at the same time?

if the answer is yes, it's time to get out and find another job. that's totally insanity, might as well go ahead and hand over your license.

HouTx, BSN, MSN, EdD · Nov 4, 2008

Jennifer,

What type of unit are you working in? Your profile indicates Critical Care, but this is not congruent with the patient ratio you are referring to.

The role of Charge Nurse should be spelled out by your organization. If not, you need to meet with your supervisor to have it clarified. As the Charge nurse, you ARE NOT accountable for the actions of other licensed nurses. They are accountable for their own actions. You are only accountable for the unlicensed folks that you are directly supervising & delegating to.

Charge nurses frequently have to make 'management' decisions such as who gets the admission, or who gets the unpopular assignment - is this what is causing you stress? In a unit without a permanent charge position - it's very difficult to switch hats from staff to charge and exercise 'authority' over your colleagues. In order to avoid this discomfort, you may 'assign' yourself the most difficult patients.

You already know that being in charge means more work - so be sure to account for this when you make assignments. Don't take a full patient load. Give yourself some slack to make room for the charge tasks.

If your organization provides education on delegation or other charge-related responsibilities, take advantage of them.

miko014 · Nov 4, 2008

Wow, you got to orient? I didn't. I came in and my name was on the board as being in charge. They handed me the census and the pager, said good luck, and let me go.

I am in charge fairly often now, and I can say this - I HATE when they give the charge nurse a full assignmnent. I don't think they should do that EVER, on any shift. A reduced assignment, a half assignment, or no pt assignment are the way to go. At least on my unit. We have some very sick, very busy pts, and the rest of them are high turnover. It's not uncommon to go down to only having 2 pts and then going back up to 5 before the shift is over. If the charge has pts, then they can't be around to help others. Plus, they have to work with the assignments, admissions/discharges/transfers, paperwork, etc.

If you hate being in charge, talk to someone about it. If you don't get the answers you want, maybe it's time for you to look for something new. I don't think they can force you to be in charge, or at least, they shouldn't be able to.

BittyBabyGrower, MSN, RN · Nov 4, 2008

Your hospital should have guidelines for being in charge. Having been a charge nurse of a busy unit for 4 years now, I can tell you that you should NOT be orienting while in charge. Do you not have preceptors on your floor? We will take a full assignment when we need to, or at least a half an assignment when it is over the top crazy, part of the job.

Yes, you do set the tone of the unit. If you can try to stay light and remember to compliment people or tell them thank you, you will have a much better night. I have also found it beneficial to try to take things in stride...not saying I haven't had a day when I burst into tears because it was just impossible to do anything, but you will find that people respond to you as you respond to them.

It is in our nursing guidelines that once a person is oriented to charge, they can assume the postion if one of the charge nurses aren't there. Yes, we have had to force the role on a few people, because other wise there would not be anyone but the 3 core people.

jennifer79RN · Nov 9, 2008

Jennifer,
What type of unit are you working in? Your profile indicates Critical Care, but this is not congruent with the patient ratio you are referring to.

I work on a PCU Progressive care unit. It is not ICU but a step-down. So, believe it or not many of our patients are critical care patients. For example, dobutamine/dopamine/insulin/ etc drips, acute MIs, PEs, DVTs, overdoses, GI bleeds, etc. Everyone that comes to our hospital (agency/travelers/or new employees) are all outraged at out nurse to patient ratio. However the hospital has a goal of cutting the ratio down to 1:5 in Jan 09 and 1:4 by Jan 2011. A typical PCU calls for 1:4.

Jennifer

jennifer79RN · Nov 9, 2008

I am going to try and reply to everyones posts. Forgive me if I leave someone out.

To the 1st poster who mentioned "being charge,orienting, and having a full (6 pt) assignment is total insanity" I completely agree.

Here's the thing, our hospital, like most is so short staffed it has become dangerous!!!! Most of our employees have left. i stayed b/c I believed it would get better, and it did for a while. Granted there would be nights when I would be the only PCU employee but the agency and travels we had were wonderful, at least most of them were. In fact there was a time when I was the ONLY fulltime nightshift RN on our unit!! We do have several parttime RNs. Anyway, then the hospital finally did what they had to do and worked hard on getting new employees in. Of course, this means they need someone to orient these new people. Well, since there wasn't many of us actual staff that meant we all did our part and oriented. There would be nights when we would have 3 new people orienting. Luckily, everyone has a license, there are no GNs on our unit and many are seasoned nurses. So, I would take the most experianced or relieable new employee and put them with me. Doing this allowed me to give them a bit more space and I was able to do my work as well.

Suddenly, and I do mean suddenly, our administrators decided to get rid of all agency and travelers. However, not all of our staff was off orientation. So, they forced some off orientation early and made us short staffed AGAIN!! This was when I said enough is enough! and out went my resume:yeah: I am very careful not to allow my administrators to push me into something I feel I am not able to handle. I NEVER take more then 6 pts. I NEVER take patients on our unit that belongs in ICU, and I NEVER work as charge and monitor tech at the same time. All of these by the way, have been done by other charge nurses.

However, I need to get to our policies and procedures and print out duties and responsibilities of charge nurses at our hospital. I am glad that I am not alone in this situation as well as knowing I'm not alone in feeling that this is completely insane.

BTW, There are nights when our ICU will have 8 patients and only 2 nurses. Scary isn't it?! Thank goodness I don't work over there.

Thanks everyone for your responses.

Jennifer