New grad hired as charge nurse

[mdenton]

So a little background first. I graduated with a BSN in May of 2018 and passed the NCLEX-RN in late July. I also have recently moved the Philadelphia and it is near impossible to find a job as a new grad. I applied to probably 100 jobs and got very few responses. Nearly every job I applied to turned me down because I did not have a minimum of one year of RN experience. I finally got hired as an RN in a nursing home and the facility was really nice. Patients seemed happy, staff seemed happy and it seemed like a pretty good place to start my career. They offered me a position working 7p-7a and I accepted. I had two days of classroom orientation and then get 5 days of orientation with a preceptor on the floor. I was a little skeptical about the short orientation but thought that I could handle it. There are about 24-60 patients on each floor. I was under the impression that there were 2 RNs on every floor and the patient loads were split up that way. However I have come to realize that there is 1 RN and 1 LPN and a few CNAs. I worked my second orientation shift last night and my preceptor was asking me about charge nurse stuff and asking how I was feeling about it. That was when I realized they hired me as a charge nurse. Nobody even told me that that is what I was hired as. So far the patient load and meds/treatents is totally doable but I dont know if I can safely be responsible for my patients as well as responsible for what everyone else is doing on the floor. Just feeling really defeated at the moment because I have been job searching for months and FINALLY get an offer but I truly don't feel like the risk to my license is worth it. Maybe I am wrong but I do not think it is safe for a new grad to work as a charge nurse. Any thoughts/advice would be greatly appreciated. Thanks!

[mdenton]

Also dug through the paperwork that I was given and sure enough there is a schedule that I have to sign after orientation stating "I agree to work as a charge nurse on the following days" etc etc etc so it definitely is not a mistake that they hired me as one

[pro-student]

Unfortunately, this is pretty common in LTC. It really depends on the people you work with. I've worked with LPNs who have been nurses longer than I've been alive and could nurse circles around most RNs. It is a risk but if you work with good people, probably a negligible risk. It's certainly not an ideal first job. Only you know your own skills and knowledge base. If there is support in the building, good people to work with, and you have strong skills and aren't afraid to ask for help when you need it, you could make it work.

[cleback]

Although I wasn't specifically hired for charge, I was placed in charge my first day off orientation and told by my manager she wanted me in charge there on out. This was inpatient psych. The reason was we utilized so many floats and travel staff that I was often the only regular staff rn there. It sucked. I often just had to ask other more seasoned nurses what to do. Sometimes it came down to I just didn't know what I didn't know. And I'm thankful nothing too wrong came of my mistakes.

Anyway, it's not ideal but what can you do if you need the job for experience/bill paying. Just make sure you utilize the more seasoned staff there or on call. Hopefully, your manager expects this too.

[applesxoranges, BSN, RN]

The RNs are usually charge RNs in the LTC or so I thought.

[Lisacar130]

Pretty impressive that you say the patients and staff seem happy.

While this isn't an ideal scenario for you I say try it out. Ask for lots of help from the experienced nurses and other staff. Call your manager at home if you have to, if something weird happens and you don't feel right about advise given by staff.

[NurseCard, ADN]

What you described sounds completely normal for most nursing homes.

It actually sounds like you've found a good one.

As long as your CNA's are doing their jobs properly and keeping the

residents clean, fed comfortable.. and you have a good, reliable

LPN... you should be fine. Make sure to make the MD aware of

any changes to your residents. Listen to your gut.. if anything seems

wrong, let the provider (MD, APRN, PA, etc..) know. Document,

document, DOCUMENT any skin changes and what you did; any

new wounds, etc..

Nursing home work is super tough and I personally just can't

do it anymore... but again it seems you've found youself in a

decent facility. Good luck!

[fsudmbRN, ASN]

Any RN... especially one working a night shift... is in a supervisor/charge capacity. ESPCIALLY NIGHT! I have worked in long term care for over 7 of my 10 years of nursing. I worked as house supervisor on the weekends right out of nursing school, as I was the only RN on that weekend. I have also been the night supervisor. As the weekend house, I was in charge of the whole building: Admissions, discharges, family and patient issues and concerns, etc. As night charge, I was in charge of FAR less. I had to make sure that medications were discharged and that was basically it from outside of my "normal nurse" duties. I did occasionally have to pronounce someone if they died in the facility. If we ran a code, I was in charge. If we needed to send someone out, I helped. But for the most part, it was all something that I would have done no matter what. (if I was an LPN, I would have still been in charge of the CNA and able to write them up for sleeping during work hours.) For the most part, facilities only hire a few RN's.... RN's cost more. It is a very common practice in LTC. You can do it....

[Been there,done that, ASN, RN]

What is the job description of charge nurse duties?

[Lemon Bars]

I was just in the same position as you; new grad RN/BSN, accepted my first nurse job at a rehab/SNF. I wouldn't worry so much about the charge nurse status because I don't think there are many emergencies and complex issues compared to a hospital. I was thankful that there was another RN on the other side of the building who was experienced and available to me if need be.

My issue was that I was not able to handle the 23 patients assigned to me. I could not pass that many medications safely within the appropriate time. Also, I was doing charting on patients whom I did not really have time to observe and familiarize myself with. Thank goodness the residents were medically stable and no one died.

During the interview, I had asked to be place on the rehab side of the facility, but they put me on the SNF side instead. There was no time to do thorough physical assessments, read patients' charts, or do anything except pass meds and click through the charting as fast as you can. You might have a better experience but I think LTC is a terrible way to start an RN career. It's embarrassing, but I ended up resigning at the end of my orientation, to protect the patients and to protect my RN license.

[JBudd, MSN]

Just don't throw your weight around as the "boss". Ask the nurses who have been there how assignments are usually made, if there are any especially heavy patients that should be rotated around the staff, how they get through med passes on time, etc.

I worked LTC many years ago, I had to start morning meds at 0630 to finish by 1000, when it was time to turn around and start the noon meds. We made sure to go in the same order, so the ones who got the same meds during the day would have a decent gap of time between doses. There were other RNs, but I was the first "BSN" they'd ever hired, including the DON & ADON.

[Penelope_Pitstop, BSN, RN]

Just don't throw your weight around as the "boss". Ask the nurses who have been there how assignments are usually made, if there are any especially heavy patients that should be rotated around the staff, how they get through med passes on time, etc.

Awesome advice here.

Also, if and when you decide to pursue employment elsewhere in the future, remember that having charge nurse on your resume will only help you, not hinder you.