Charge Nurse with patient assignment.

[RNPATL]

I really need to understand something and am asking for some help here. I need to understand how many nurses on this board function in a charge nurse role. In addition, I would also like to know how many are required to take patients in that role? Finally, when you are in charge, how many patients do you normally assign to your staff nurses as well as yourself (if you are required to have a patient assignment)?

I am really struggling with this at my present position. I function as the charge nurse, along with some of the other nurses. We rotate the charge responsibility. However, when I am in charge, it always seems like I am taking a full load. Today I was charge of the floor and had a 6 patient load. I left work this afternoon feeling terrible about the quality of care I gave my patients today and really need to understand if this is what nursing has come too.

Thanks to everyone for helping me with this issue.

[RNPATL, DNP, RN]

Wow - thanks for all the great information. It seems like taking patients and holding charge responsibility is pretty much the norm. That is truly sad! In my case, we do not get any extra pay for the added responsibilities.

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

When we are short the charge will take a full patient load. The charge nurse doesn't get pain any extra for pulling charge. Although my unit has "permanent Charge Nurse" positions.

Whatever...It's not uncommon for nights to be without a float while days has a float charge and a transport nurse...go figure?!

[webbiedebbie]

We rotate charge and yes we have a full patient load. We get a dollar something for it.

[plumrn, BSN, RN]

Let me ask you something. If you are charge, and have a full load of patients, is there someone that has to do the LPNs' patient assessments? Or is that needed by an RN only once/24 hrs? I don't see how you can do their assessments, too, if you have your own full load of pts to care for, plus all the other charge duties. (Like admission assessments, etc.)

[Chaya, ASN, RN]

I work inpatient cardiopulmonary rehab, evening shift. We usually have 32-36 patient. Ideally, during the week-day shift has 5 nurses on the floor plus a "clinical Leader" at the desk. Our shift has 4 nurses with sometimes a fifth for half the shift, and nights has two. The charge nurse takes a patient assignment for $1 extra an hour. There are only 4 units in the hospital; there is usually at least one admission nurse who floats to handle most (but not all admissions) and a couple of secretaries who float to transcribe the orders (which are later co-signed by a nurse). They are around afternoon-early eve when the need is heaviest. The staff RN's who have been there a while rotate charge according to who's there on any given night- that's less due to seniority and more a function of who's been around long enough to know how to find information, who to call when for what, and how to tweak the equipment! The charge RN makes the assignment, taking into account various limitations, like agency can't pass narcotics, LPN's can't push IV meds, anyone on light duty, etc. I see charge as a resource person but also as arbitrator, the person who anticipates the units' needs according to situations as they arise, and who follows through on any issues. When I do the assignment I divide by the number of nurses and take one less patient myself if it works out that way. Plus, I try to take acuity into consideration in making the assignments fair. I estimate I spend about one and a half hours per shift on charge duties/ putting out fires in general.

[webbiedebbie]

As charge with full assignment, we also have to do the LPN assessments. It pretty much sucks.

[nurse_robin]

I think that we all need to really think about the responsibilities of being charge nurse. I read another post on this board about someone who lost their license, and the charge nurse also losing her license because of the actions of the staff nurse working under her that day.(Both were RN's) Think about it....it's hard enough doing this job and protecting your own license, but to lose your license because of what someone else did! How can you be charge and take a full assignment when you are also responsible for everyone's actions during the shift? We need to assert ourselves and not take on more than we can handle. The BORN does not want to hear excuses when the S**T hits the fan. Become familiar with your Nurse Practice Act and learn how to protect your license. Unless of course, you don't mind flipping burgers. :uhoh21:

Give me my patients and let me go on about my business! No I don't want to be charge and if I have to cover an LVN, then she and I are a team that day and I check on her patients along with mine. I've got a good personality and know how to work well with others so I've not had a problem with LVN's feeling slighted or feeling like I'm checking behind them. I did learn the hard way though....Years ago I was working nights and the CNA that was working with me fell asleep in a patient's room and that patient fell out of the bed! I had visions for months of getting sued for this person's actions and losing my license. It then became crystal clear to me the importance of staying on top of things protecting my license at all costs!

[RNPATL, DNP, RN]

Let me ask you something. If you are charge, and have a full load of patients, is there someone that has to do the LPNs' patient assessments? Or is that needed by an RN only once/24 hrs? I don't see how you can do their assessments, too, if you have your own full load of pts to care for, plus all the other charge duties. (Like admission assessments, etc.)

Yes, generally the charge nurse is also covering the LPN's. This is a huge burden! I love the LPN's that work with me and they are terrific nurses, but policy requires that these nurses be covered by an RN and that their assessments be validated by an RN. Depending on how busy the floor is, all the RN's share in this responsibility. But, if it is really busy, the bulk of this job falls to the charge nurse.

[susanmary]

:)

[zacarias, ASN, RN]

At the large teaching hospital I work at, the charge on days and evenings has no patients unless there is an emergency or some nurse doesn't show up. Night charge has maybe two patients.

[seanymph]

When I did charge I took a full patient load, no extra pay and alot of headache. I was a new grad (with less than 2 months experience) and had even newer grads under me. A lot of nights I was crying before I ever got out of report. I always tried to split the load evenly as far as acuity and alot of times I had the higher acuity patients. This was on a med/surg. floor.

[RNPATL, DNP, RN]

Yesterday, I finally got smart and took 2 patients (while doing charge on this busy surgical unit) and then took the first 2 transfers from Surgical ICU. Regardless, I was running around the entire shift, not even having enough time to go to the bathroom or even take a 5 minute lunch. My week of charge is over and I am thankful! It was a really rough week and I am not sure I can continue doing charge with a full patient load. You really have to be super nurse because if you are not, everyone loses ... the patients and the unit.