Question for Charge Nurses

[mom4josh]

this is for all of you charge nurses out there.

in our facility, the charge nurses have been told that we can be held responsible for orders that we sign off but the primary nurse does not carry out. there is one relatively new nurse (new on our unit only... worked in er for 30+ years) who habitually leaves orders undone that the oncoming shift finds and has to do, often more than a couple things. she always says "i didn't see that one." so far, it hasn't been anything life-threatening, but i fear that one of these days it will be and the charge nurse will be punished for the other nurse's mistake simply because the charge signed off the orders.

my questions to you are:

1 - do you as charge nurse take patients or just run the unit?

2 - do you sign off orders for the entire unit or just your patients?

2 - have you ever had problems because you signed off an order that the primary nurse did not carry out?

any comments or suggestions would be appreciated!

[Kymmi]

Its just like any other order you'd sign off. Lets say you sign off a order and the next shift doesnt follow thru with it...thats not your responsibility as long as the orders were done correctly by you. Make sure if it is a medication that it shows up on the EMAR (or whatever med system you use), labs are entered in the system, treatments are put where they are supposed to be put in order to assure they get done. Dont sign orders off until you are sure that they are all completed and ready for follow thru. If it is something that needs done asap or stat then tell the responsible nurse because she might not get to that chart for awhile since she knows you are signing off the orders. At shift change we do a 12 hour chart check with the oncoming nurse and review all orders written that shift with each other to make sure the orders appear on the EMAR, labs are entered correctly..etc etc...that way if any order should have been done by the nurse that is giving report the nurse that is coming on will know it up front and decide if they are going to do it or make the nurse that's leaving do what they should have done ( for example : if a med was ordered stat 6 hours ago and never given then the oncoming nurse would know it wasnt done and me personally would make the previous nurse carry out that order since it is now so overdue). The problem I find alot of the times is the nurses assume that the pharmacy entered the med in the computer system or the unit clerk entered the labs in the computer and the nurse doesnt check to be sure that it was done and sign off the orders only to discover that pharmacy didnt enter the med or entered it wrong but because the nurse signed off the order then they are held accountable for any missed orders because their signature on the signed chart states that the orders are done and done correctly.

[jen123321]

Maybe different for me, but personally I don't like when anyone signs off my orders b/c then I don't really know what's going on...I have to go back through the chart and look at them anyway so I'd rather just do it myself. I work in an ICU though so it's imperative that I really know what is going on.

[miko014]

I'm not a charge nurse, but I can answer your questions.

1. Charge for days RARELY takes pts - Evenings sometimes take them - Nights always has a full assignment (6-8 depending on the night).

2. Nobody signs off our orders. Unit clerk takes them off, enters things in the computer, scans to pharmacy, etc., then signs them off, meaning that they are done with them. Then they set them on a different rack for the nurse to sign off. If it's an order for, say, a chem 7, and it doesn't have a number next to it (the order number that the computer assigned to it), then we know it wasn't done. We don't sign off any meds until they show up in the computer. Nobody else signs off other nurses orders - that is a good way for something to be missed!

3. Yes, once, but I wasn't the charge nurse. There was an order written at 3:15 for a stat dulcolax supp for a pt. Dayshift nurse is there till 3:30 (I usually get out of report around 3:20-3:30). She signed off the order but forgot to tell me about it, and she didn't give the med. I didn't find that until 10:30pm, and that was an accident (the page was no longer flagged since it had been signed off already, and our one-time orders for meds that are in our pyxis don't show up in the "to do" list). Luckily it was only a suppository! But if she wasn't going to carry out that order, she never should have signed it off.