No charge nurse

pebbles, BSN, RN · Sep 17, 2002

When this happened at my hospital, it was a disaster. Consequently, the chief of surgery got involved and the unit was allowed to have one more nurse on day shift, so the ratio of pt to nurse was less. Then, we found we needed someone to do rounds with the doctors and act as an overall communication liason bewteen nurses and other staff as well as to help keep track fo long term and discharge planning. So they took the extra nurse off teh day shift, and we now have a CRN with no pt assignment on day shift who also helps on the ward. So we have come full circle.

CRN does the pt assignment - clerks are NOT qualified to do that as they do not understand the acuity and needs of each pt, and have never had to balance a nurses workload.

Good luck - I hope it works better at your hospital than at mine. We had unsafe situations daily, and all the staff were burnt out.

cindyln · Sep 17, 2002

A unit clerk making assignments??? Now that is something I would not go for at all!!!

perkines · Sep 17, 2002

Our house supervisor will now have to go to each nurse to get a report also instead of one charge which will also waste more time. We only have two lpns on staff for days, but there are quite a few on nights as of now our charges take care of the work that is out their scope of the job-- not sure what the plan will be for them. I am on the transition committe and we are going to be implimenting in Jan--of course one of the busiest times of the year for us. By the way our med unit is combined with peds so we take care of every age except newborns. Thanks for replies

MollyMo · Sep 17, 2002

I personally don't think your situation will last, if it ever starts. Once the supervisor realizes how time consuming getting individual reports will be, they'll probably raise a stink about it. And a unit clerk is not qualified to make out assignments. This isn't a slur against them. I used to be one. I know that they are important but that is beyond the scope of their practice. When we want changes or if we have a problem with a management decision, we let the docs know and let them know how it will impact patient care. They are very quick to get on the phone to management and administration on our behalf.

flowerchild · Sep 17, 2002

I agree, it won't work the way you described. And a unit clerk IS NOT QUALIFIED to make assignments for the nurses! No way! When the UC makes the assignment I would think that makes her in charge, at least for that task. Seems there are some legal issues here. I worked in a situation where the Super received report from each individual nurse, but it was not verbal. We passed around a clipboard that had forms on it to write our report, then the super would pick them up and give report to the oncoming super. Worked OK for us at the time but we still had a charge nurse and many times the charge would take the verbal reports with the clipboard in hand and write things down for the super. The report that is given to the super is different from the one you would give to an oncoming nurse. It is not as concise and only gives an overview of the pts status. Good luck! I see problems with this plan! Who's going to know when an order is written? Who's going to make all those calls to the Docs? Who's going to keep everything organized and fair? Taking care of all those patients without a charge would leave you little time for all those tasks done by the charge nurse now.

prn nurse · Sep 17, 2002

The unit clerk is not qualified to be the tele tech either.

Some hospitals want to put inexperienced people in the telemetry monitors' chair and simultaneously charge the patient an outrageous fee for "being on telemetry."

Some assume the tele technology interprets the data, but that is not necessarily true. Lots of things happen with rates and rhythms that the computer doesn't pick up.

I agree with MollyMo... it may never start. Lots of options get bandied about at the management level that never take place.

I hope for your sake it falls through. Its' only based on bottom line..... more profits.

nimbex, RN · Sep 18, 2002

Hell, if the clerk has the knowledge base to make assignments... let her manage mine.... Since she knows so much... she can update the docs, make rounds, make the laundry list of needs during rounds and take the orders off at the same time...

SUPER CLERK!!! I hear piggly wiggly is hiring!, no wait, the hospital clerk is over qualified... she supervises the RN's since she begins the shift by delegating ASSIGNMENTS!

Good God.... THE WHEEL IS ROUND PEOPLE.... let's stop trying to reinvent it... round still equals a circle!

Some one pick me up off the ground please... geeze!

perkines · Sep 18, 2002

We are still throwing ideas back and forth. Watching tele is a for sure for unit clerk unless the hospital can't get staff for the position. They are running with thoughts of having a charge with a small (light) team. I see a future of lots of bickering amongst co-workers. My main concern is the lack of somebody who is "boss" and resource person on the floor. Who has worked were there is not a charge nurse? How did it work out?

Genista, BSN, RN · Sep 18, 2002

In 1998 I worked at a small hospital where we had no charge nurse. The way it worked was the nurses took turns making out the assignments. Basically, whoever arrived to work first that day made the assignment out. Of course, we tried to give people their same assignment whenever possible. As far as having no charge nurse on the med/surg floor, we made due with our house supervisor as back up for any questions. The way we decided who would get the first admit was by taking turns. Usually we wrote down 1st, 2nd, 3rd admit on the assignment sheet. It was a bummer when you had a bad night & were up for an admit anyway. It was my first nursing position and I knew no other way. This was an 82 bed hospital, so on the small side. Our house sup (RN) would come when paged or return our call. But even so, it was a hard place to work. We took off our own orders. We tried to help eachother out as best we could. I stayed 1 year to get my experience in, then moved to a 225 bed hospital which had Lead RNs.

I think hospitals are stupid to eliminate Lead position. Where I work now, the Lead helps oversee & coordinate care. They help with order entry & noting orders. They make calls to doc or other depts for the extremely busy nurses, and help out with various tasks.They do bed control.And I would like to add that my floor has had a mass exodus of RNs, too, due to burnout. It has been so bad in the 3 yrs I've been there, that now "management" has come up with creative new ideas to "make it work." Want to guess what some of their brilliant ideas are?!!!! Yep, you guessed it...eliminate the Lead RN position. Another idea they had was to give us one more nurse aid and then let the nurses have 1-2 more patients a piece! :( It infuriates me that these are their "solutions." We have given them OUR ideas to solve the problem. We have come in to work on days off to help reorganize and brainstorm creative ideas to make our floor more organized.

When I started at this current hospital, the Lead RN didn't have an assignment.They were able to help start IVs, help with admits, and basically a godsend to us on the floor. Over time, managemnt has reorganized our floor in an attempt to make it "better" and one of the changes was that Lead RNs now take an assignment of 2 patients. That's all fine, but keep in mind that's time taken away from other things like noting orders & helping out on the floor. Our renal patients (we are the renal floor too) are extremely high acuity with MRSA/VRE often, brittle diabetics, complex wound care, 3 pages of meds, etc, etc. Taking 2 patients and being Lead is really detracting from the Lead role, in my opinion.

What it all boils down to is they aren't willing to pay for the staff that is needed to run the floor safely. I'm sooooo tired of managment's excuses! In fact, we have gone thru 3 nurse managers in 3 years (one of them we all loved) and three nurse educators. I've lost count of how many valuable veteran RN (with 20+ years experience) we've lost to other floors & settings.

Now there is another mass exodus...about 8 of us are leaving, myself included. I am actively seeking transfer to another floor (one where they are keeping their Lead RNs).

Of course, they try and tell us about new meetings & ideas to make it better...but we don't like their ideas. They are only making it worse by eliminating the charge nurse position. Next thing you know, our nurse aids will be gone too. As it is, I feel I am expected to do EVERYTHING.

Good luck to you & your coworkers

live4today, RN · Sep 19, 2002

I have worked at places that did not have a charge nurse....and I worked at one hospital whose head nurse was fired....and she wasn't replaced during the entire travel nurse assignment I was on there (which was 3 months). :eek:

On the units I've worked without charge nurses....the RNs rotated as Lead RN who would make out the patient assignments....including having to take equal measure of patients herself.

By your hospital eliminating your charge nurse only means they are looking at it from their own selfish money hungry perspective. They want to utilize all available resources (human bodies) as they can to the fullest capacity possible. :nurse:

midwestRN · Sep 19, 2002

In the old days on med floor, we had a charge for every 22 pts, they changed it to a charge for every 66 pts about 4 years ago. Pt ratio is 5 or 6 to 1 on day shift. The nearest RN is expected to help out the LPN. Our hospital has closed some needed beds because they can't staff the unit. I know they can only see $, but the answers are not in shorter and shorter staffing. Their answer to retaining nurses was a bonus. Mine was $275.00. I've worked there for 5 years. They could have kept their money and just given me some QUALIFIED help.