please advise charge nurses

TrudyRN · Mar 12, 2007

I think he should ask for orientation to the Charge role. Find out just what's involved. Once he's in the know, he might find that he likes being in charge.

The best way to work Charge is to not have to take any patients himself, or maybe 1 or 2 easy ones. What does not work is to have to take anywhere near a full load + be Charge.

Tell him to quietly but firmly speak his truth and just quietly but firmly hold his ground. If he is courteous and his bosses aren't total psychopaths, I don't think they'll retaliate.

Myxel67 · Mar 12, 2007

Has he actually been offered the job--with more pay, or is he being asked to sub for regular charge on his/her days off? If he's being asked to sub, it's because the more experienced nurses are refusing. In my book, one of the more experienced nurses should be given this task.

Does he work days or nights? Dayshift charge can be a difficult job--even for an experienced nurse. On nights we didn't have an actual charge nurse until recently. The term was Resource Nurse and she also got a full pt load.

In the hospital where I first worked, a nurse couldn't even be floated to another floor until after 6 months on job.

danaheil · Mar 13, 2007

NO, he was not offered the job with more pay. He just went to work one day and the staffing office said that he would be charging now. He works the night shift, and the charge nurses at this facility are required to take full assignments as well as perform charge duties. He was also recently told that he would eventually be the only RN on the floor with either 2 LVNs or one LVN and a tech for a 16 bed orthopedic intermediate care unit or orthopedic step down unit. I don't work in a unit like this, so I don't know if this is reasonable staffing. However, it sounds as if the unit is understaffed to me. And placing a new nurse in charge of a unit that is not sufficiently staffed has a potential for undesirable outcomes for everyone involved.

annmariern · Mar 13, 2007

orientation.....its a tough job to do well. sounds like lousy staffing, he will be responsible legally for the whole unit.

CritterLover, BSN, RN · Mar 13, 2007

reasonable staffing? i'm not sure.

3 nurses and a tech for 16 patients really isn't all that bad (but not great, either).

what does "ortho stepdown" mean? is this like an icu stepdown for ortho patients? or is it fresh ortho patients?

if this is a type of icu step down for orhto patients, then no, i don't think the staffing is reasonable. icu stepdown should be 4 (maybe 5) patients per nurse, and in my experience is an rn job.

if, however, it is more of a stepdown from recovery room, caring for postop ortho patients, it might be ok.

however, it really does depend on what state you are in. in many (most?) states, lpns are limited in their ablility to give blood (often the rn has to hang it, though the lpn can monitor it), central line care, iv push meds. with post op ortho patients, there will be a lot of blood transfusions and iv push meds. it is tough to be the only rn and have to run up and down the hall hanging a bunch of tranfusions, checking off pcas, and giving ivp pain meds for those who don't have them, plus take care of a full load of patients.

so if he is going to be the only rn, working with lpns where he has to cover much of their work (depending on state law), then he really shouldn't be taking a full load.

in some states, lpns take an iv therapy course and can then do almost everything with an iv that an rn can do. that helps quite a bit.

in some units, the lpns will do some of the rns po meds (or somehow trade off tasks) to balance what the rn has to do for them.

again, it really depends on the laws of the state you are practicing in, as well as the unit culture. if everyone works great together, 1 rn, 2 lpns, and an aide could probably be a great staff for 16 post op ortho patients. especially if some of them are a few days out.

now, as for the "new" charge nurse position, he really needs to tell his supervior that he won't take on that role without orientation first.

i've been in that position before, and i've held my ground. i've insisited on orientation before being put in charge, and i've gotten it. thing is, the charge nurse is responsible for all that goes on. coworkers come to you with problems, ask you for guidance. they will chart "spoke with charge nurse." it is important to have orientation as to how the facility expects the charge nurse to deal with situaitons, and to know where the reasources/answers are.

oops, sorry, just re-read your post. no, 1rn, 1 lpn, and 1 tech is not acceptable in an acute-care setting. neither is 1 rn and 2 lpns on a post ortho floor. these patients can be heavy, and are not moblie on their own. it often takes two staff members, sometimes even three, to move them.

danaheil · Mar 13, 2007

It is more like an ICU step down for trauma pts. Occasionally a post op from the OR is admitted when space is unavailable elsewhere. Most of the admissions come from the ICU.

Gromit · Mar 13, 2007

Ugh! That sounds like a good place to leave, if you ask me. They will essentially be setting him up to fail. Bad idea to be the 'sole survivor' on that floor.

My floor made me charge once -only once. I had the bad luck of having charge for the first time, just as a new guy in bedfile (they are the ones who assign our patients their rooms, or who dictate when and where a patient is being moved to) who was cut loose for the first time on that night. Our patient acuity level is fairly high. The patient he wanted us to move out of the unit was in an oversize bed (she weighed in at about 500 lbs, had a ventilator, several iv pumps, chest tube, etc) -so after getting respiratory to spare a guy to help, and gathering the lift team to help move, and that nurse getting ready to move the patient, and the receiving room ready, we finally moved her -took us a good hour and a half (maybe closer to two hours). This is all nightshift, of course. The bedfile guy started complaining to me about how long it took (after the fact) and actually told me I was lying to him about what was involved. I kind of lost it, said some things to him over the phone that shouldn't be said out loud. Told him that I would LOVE to have him come down to my floor and repeat himself. Didn't see or hear from him for the rest of the shift. I didn't want to be charge to begin with -I was a new nurse with a little more than 6 months time under my belt. I got my wish, and though unrelated to our event, that guy quit about six months later. Guess he couldn't handle whatever pressure THEY have in bed assignments.

Hoozdo, ADN · Mar 13, 2007

My husband is a new nurse. He has been on a medsurg unit for less than 6 months. He has already been asked to assume charge nurse role, and feel unprepared to do so. He has had no training or orientation to charge. His organization is short staffed and is just looking for a warm body to fill this spot. We feel that this is unsafe to everyone involved. Can he reasonably refuse this assignment? Also worried about retaliatory actions by management. please advise. thanks,
Dana and Harlan

I would refuse if I were him. He is risking his lisence to "give them a warm body." I also wouldn't worry about retaliatory actions by management.....there are plenty of job openings for RNs.

I was put in that same position in MICU after being a new grad of only 9 months. There was no way I was going to charge with a full patient load just because nurses with >10 years experience on the unit didn't feel like doing it anymore. I told my boss he must be kidding..........I was at the bottom of the payscale new grad nurse and YOU WANT ME TO CHARGE TOO? It is not happening :nono:

tridil2000, MSN, RN · Mar 13, 2007

It is more like an ICU step down for trauma pts. Occasionally a post op from the OR is admitted when space is unavailable elsewhere. Most of the admissions come from the ICU.

he is not to take charge bc it is their way of having BOTH the rn need AND charge need covered at the same time.

there needs to be a charge nurse, and right now, that means they have to staff 2 rns. they're trying to get out of this.

Tweety, BSN, RN · Mar 13, 2007

Yes, he can refuse if he feels unprepared. I've only met one new grad nurse that has felt prepared for the role of charge/team leader, etc. Most take the position kicking and screaming and under estimate their skills. I was asked to do charge at six months and said the same thing. Sooner or later it sounds like he's working in a place where this is the RN role.

All that said, it's only been six months and he indeed might not be ready. What is the difference between charge and what he's doing now. Often it's just merely making assignments, especially if the LPNs are independent like they are here in Florida.

The staffing sounds fairly normal for night shift for that kind of unit. An RN and two LPNs is fairly decent. It might get tight if they are full and have an RN and LPN and an aide, which means 8 patients apiece for the nurses. But 8 patients apiece for night shfit for non-critical patients is the normal around here.

Bottom line of what I'm saying, he shouldn't let fear and lack of confidence rule his decision. But if he's truly not comfortable and feel he's putting himself and his patients at risk, he needs to refuse. The consequence might be he is asked to leave, or go to another shift.

gitterbug · Mar 13, 2007

Your hubby should immediately ask to speak with the HN and request CN orientation, but remind them he is a new nurse and does not want the responsibility of charge at this point in his employment. He might just back that up by looking into transfer openings. This is a warm body dump position, he will never hear about all of the good work he does and will be nailed to the wall when times are bad. Just my opinion.