New to Charge

[nursemike, ASN, RN]

I was reading the thread on the "mini swat team," and it reminded me of some things I've been trying to figure out in my own situation, but I don't want to derail that thread. My situation is that I've started doing charge from time to time, and for reasons not entirely clear to me, I'd like to do it well. So far, I've been pretty lucky. Our off-shift supervisors know I'm new, and they've worked hard to keep me out of staffing, so far. Free charge is supposed to be our norm, but a lot of times it doesn't happen. Even out of staffing, I'm busy all the time, which I don't mind, except that I know part of the reason I'm busy is inefficiency. I'm sure I'll get better, over time, with things like staffing. My bigger concern is where and how to give my fellow nurses the support they need. Again, I'm lucky to have worked with some good examples, and I'm trying to follow their leads. But it occurs to me that

I've had some pretty helpful feedback from allnurses, and I ought to use this resource.

So, to anyone who cares: what do you look for from your CN? If you are a CN, do you have any tips?

I'm not so much concerned about people whining about their assignments, but I would appreciate advice when someone is clearly swamped. I make assignments for days, and try to make them balanced. The day charge does the same for nights, usually pretty well, but we're both assigning people we don't regularly work with, so there's an element of guesswork as to who can handle what.

My bigger concern, though, is the unexpected stuff. Had a newbie nurse with a patient desatting, last time I was in charge, so I was backing her up. I think we both did okay, although it occured to me as I was leaving, that morning, that I didn't know what the ultimate outcome was. It looked like he might be having an MI, but it could have been a purely respiratory issue. I think I'd have probably noticed if a code was called, but once all the proper resources (RT, the doctor, appropriate tests) were in place, I went back to my paperwork. I think that was okay, although I should probably have followed up a little better.

Well, anyway, any input will be appreciated.

[cardiacmadeline, RN]

I have been doing charge for about the last year. I know one of the biggest things my fellow coworkers look for in their charge nurse is someone who will help them out. So I always try to make sure I ask everyone (including CNA's) if they need help throughout the shift. After I get report, I always look at everyone's assignment so I can kind of guess who is going to be busy and will probably need a little help. When I do have to give people admissions, I try to help them get caught up before their admit does come. When people are getting post-ops, I try to pop into the room to help get the patient settled, and then I also know how the patient is doing too. I also like to give the nurses a heads up that they are up for the next admission. I have found that staffing is probably the most challenging part of charge. With budgets tight, it can be tricky sometimes. That is why it is important to know what is going on in the hospital (if other floors have beds or not, is ER busy?), because you have to know the hospital dynamics in order to staff properly sometimes (do you staff on grid or over grid for possible admits?) As far as your concern for the unexcepted stuff, I think that is why it is important to know the patients on the floor and what the assisnments are. You can't anticipate everything. I think in the situation you described, it sounds like you helped her out and the appropriate people were in with the patient. As long as you remain available if she would need any further help, I think you did fine. Yes, following up is a good idea, but that is partly the nurses responsibility also to let the charge nurse know what is going on with their patients. Anyways, gotta go to work. Just remember, stay friendly, helpful and approachable!

[catshowlady]

When I am swamped, I am sometimes too overwhelmed to even realize what I need help with. Also, when I was a newer nurse, I felt like I had to do it all in order to prove myself. In these situations, I found it really helpful for my charge nurse to find something to help with, and then tell me that s/he is doing it. In other words, don't ask to help, just do it and tell me about it.

[foxc1121]

Hurray for you charge nurse!!!

In time, it will get easier as you get comfortable in your position. I will tell you this - a word of advice. DO NOT tell a nurse to be a patient advocate and call the MD and dismiss the nurse and her concerns. I already know that. If I am coming to you it is because I cannot resolve the situation and need your input. Do not make me feel that I am overwhelmed and cannot handle my responsibilities, just because I ask you a question, opinion, help..... whatever - you will create animosity and have resentfull nurses.

I can only speak for myself. Really truly look at patient assignments. Night shift acuity is different from day shift acuity - I say this because during the night shift do they feed their patients? NO. Do they deal with family members? No (visiting hours are most likely over at that point) . Listen to your nurses, besides being a patient advocate, you need to be a nurses advocate. When a nurse is speaking to you - do not - if you can avoid it - dismiss her/him and make them feel as if their voice is not important. Case in point....My charge nurse asked me what was going on with transferring my patient to rehab. Social services was not responding to my calls regarding patient pick up....etc. Patient's husband did not want her to go to rehab, I was in the process of calling the MDs already...My charge nurse dismissed me and said "just be a patient advocate and handle the situation".

Now, this was one of my closest friends that was charge that day - to be dismissed in such a manner was disrespectful and inappropriate to me and I walked away feeling disrespected. I understand as charge you are responsible for the entire floor and your time is limited, however, treat your nurses with respect. Do NOT speak to them in the way that I was spoken to.

I guess the bottom line is respect....trust your nurses that they are doing the best that they can do...praise them, because you are in charge that day and chances are they have not heard praise in a long time. Please, please learn to field as many MD phone calls that you can. No nurse likes to be called when she is doing a dressing change, pushing an IV med, etc to speak to an MD about an admission that she/he knows nothing about yet. It only makes you and your floor look incompentent.

Thats it in a nutshell...treat your nurses with respect..help when you can, and never, ever say to management that this nurse is overwhelmed and she needs help all the time....not fair - look at the assigment, ask your nurses questions. Can this patient walk?, can they feed themselves? So many times I have no answers and need to discover things for myself.

[KneKno]

I like to arrive early and review assignments with the off-going charge, sometimes a few tweaks are needed (more experienced nurses next to newer nurses, open beds to regular staff, etc) to make my life easier. Then, I try to preassign where any expected admissions will go (anyone still in OR?), and decide where the first more stable and the first less stable admits will go. Through the shift--help with new admits, assist with any unstable patients (if it's a newer nurse, I try not to take over, just guide), then help with any care--pills, baths; then paperwork (reviewing orders, posting rhythm strips). If a nurse has a "good" assignment, I might ask them to help out with some of the above.

I usually have an assignment, so I try to take 2 of the more stable patients, those that will probably not transfer out but won't need me in their rooms most of the shift. And always remember: "If you want to hear God laugh, just tell Him your plans."

[nursemike, ASN, RN]

Hurray for you charge nurse!!!

In time, it will get easier as you get comfortable in your position. I will tell you this - a word of advice. DO NOT tell a nurse to be a patient advocate and call the MD and dismiss the nurse and her concerns. I already know that. If I am coming to you it is because I cannot resolve the situation and need your input. Do not make me feel that I am overwhelmed and cannot handle my responsibilities, just because I ask you a question, opinion, help..... whatever - you will create animosity and have resentfull nurses.

Thanks. Sorry about the experiences you described. That will not be happening on my unit. For one thing, we rotate charge. I'm in charge this weekend, but next weekend someone else will be, and I'll just be a staff nurse.

So, at the very least, it would pay me to respect the other nurses who do charge, since they'll be my charge, next time. More to the point, my peers don't eat their young, but they do have teeth.

One thing I've learned is that I have to prioritize between "my" work and helping others. When I'm doing the assignments for the next shift, I usually can't leave it to go start an IV for someone, so I ask them to ask another nurse, or if it isn't too pressing, it may keep until the next shift. Of course, if the pt has IV meds due, or is at risk for seizures, the IV becomes more urgent. But we have a pretty strong team, and everybody works together. One of the benefits of coming to allnurses and reading some of the rant threads is that it makes me realize how lucky I am.

As far as being dismissive, I've had it pretty well drilled into me that when I'm in charge, every pt on the floor is my pt. If a newer nurse is overwhelmed, my license is at stake, too. Besides, even the newer nurses are good nurses, and I may need their help, myself, sometime. (One of the prouder moments of my nursing career was the first time my mentor came to me for my opinion on one of her patients. Not that I could tell her anything she didn't know, but I can see how a second set of eyes can sometimes be helpful. Still, wow! And while I often joke that she used to be my role model, until I realized how much work that was, the truth is, she's still my role model.)

So I will, definitely heed your advice, along with the other advice I've gotten.

But now I have to go get a shower, so I can get to work and whip these slackers into shape.

[foxc1121]

We rotate charge at my facility too. And I still say hurray for you, you have a great attitude...I want to work with you@!!!