role of charge nurse

[midwest40]

I have recently been promoted to Director of PCU, I love the position but am facing problems from staff. The 42 bed unit has been without a director for the last 6 months, there was no monitoring of what the charge nurses were doing (director of m/s was trying to supervise both floors). Orders were missed on a daily basis and we were losing the trust of doctors and patients. We have started a charge nurse report book and I have instructed charge nurses to keep track of labs, procedures, history and any other pertinent information in this book for staff and doctors. I was told this took too much time and kept them at the desk instead of on the floor. Am I wrong, or is this their job! They have been working as overpaid CNA's for the nurses for too long. Secretaries were entering orders and putting the charts away assuming nurses were going through charts regularly and signing off their own orders (doesn't work), there were no checks and balances. I am having a charge nurse meeting next week for current and aspiring charge nurses. I would welcome any thoughts, and would appreciate any resources that spell out charge nurse duties.

Thanx all

[pcumanager]

I have a similar situation in that the role duties are not clear. Do you have a list of expectations? I would find it helpful to know what other charge nurses for a progressive care unit are doing. My charge nurses also are responsible for primary telemetry monitoring.

[Shell5]

These are some of the things I do and I have seen other charge nurses do. I hope this helps:

One of the most important criteria is that the individual be honest, ethical and fair.

*Make sure your unit is covered ie; nurses, aides, clerk. If not, call supervisor.

*Might have to take patients if short staffed

*Assign patients to staff

*Make sure each nurse has a phone or beeper and that the clerk has a copy of the

assignment.

*Communicates pertinent information to the doctors on rounds (advocates for patients)

or changes in conditions or follow up that the primary nurse did so.

*Counts the narcotics

*Delegate to nurses

*May have to start IV if a nurse is busy

*Cover desk when other nurses are at dinner

*Assist with settling disputes among other employees

*Communicate pertinent infomation to the Nursing Supervisor, pharmacy, other floors,

lab

*Make sure patient census is updated

*Assist in crisis ie; code blue, rapid response.

*Deal with family complaints or call in patient relations if needed.

*Deal with narcotic discrepency count according to pharmacy policy.

*Check crash cart.

*Deal with maintenance issues.

*Assist with discharge paperwork

*Assist with checking off charts and noting orders.

*May do rounds with doctors unless dr. wants to do rounds with supervisor or

primary nurse

I'm sure there are others, but I can't think of them right now.

[RN1989]

I made up an entire charge nurse book for my staff. It included the charge nurse competency checklist, the charge nurse performance eval, and various leadership info sheets that I felt had helpful info. I put in quick reference items, p&p for special situations, patient safety, emergencies, care standards, transfusions, central lines, med administration, specifi med info, patient home med info, occurrence reporting, death/DNRs, safe harbor. I left this huge notebook at the desk for the charge nurses to reference anytime. It also had specific duties that I was looking for.

There's too much for me to try to type into a window. If you would like to know more, pm me. I could fax you some of the info that might help you.

[kimmydd]

Can you email a copy of you charge nurse competencies & leadership info? I'm working on re-defining the charge nurse role on my unit & it would be great to see what others are doing. email [email protected]

[RN1989]

Kimmy - I only have it in hard copy now since I have left the position that I did this at and did not think I would ever have need to share it. If you would like to pm me a fax number, I will be happy to fax it to you.

[classicdame, MSN, EdD]

I don't see the point of writing down all the lab and other info. If it is in the chart the charge nurse could just initial it (and the primary nurse as well). No need to take time to re-write.

Another thing: If they have been on their own for a while they have some ideas on what is needed to make the unit work. Discuss those and write them down. Then address them at each meeting (working on it, did it, can't do it because, etc). Ask for more every meeting till they learn you are on their side and respect their input.

[Katnip, RN]

If that's a phone number, you might want to remove it from the thread. This is a public forum and there's no telling who reads it. You can PM the number to the people you want to have it.

[elfmom]

Please email a copy to me-I would greatly appreciate that. I am a charge nurse on Psych Unit & struggling without any guidance from my DON & no training for the sometimes burdensome role. Again, thank-you. elfmom

[Mr Ian]

Just as a general guide on how I worked as a CN - it has a lot to do with the relationship you have with your senior and junior staff.

CN is a pivotal role in turning theory/policy into action/practice. The more or less a CN's manager does in this pivotal role - the less or more they have to do. The more or less the subordinate/junior staff do - the less or more the CN has to do.

A unit generally has a specific clinical role. The aims are usually the same - admit; assess&diagnose; plan; treat; evaluate; discharge.

I consider it the CNs role to ensure the team perform this order of things in completing whatever tasks are necessary to reach discharge.

The CN can also assist in general admin (stats/data); staff management (including Performance Appraisals & Reviews) and teaching & development (education; p&p; audit) - depending on how good they are and how their manager manages themselves and leads the team.

There's some good stuff on "leadership" that breaks the roles of any position down well - the grade usually determines the extent or level of what they can get involved in.

Intersting recent NZ article:

http://findarticles.com/p/articles/mi_hb4839/is_/ai_n29427540

In short - the more the higher managers do - the less the lower ones have to. eg: Don't tell them HOW to complete the running of the ward - just tell them the standard you expect and let them work it out. Similarly, don't take on the role of telling the junior staff what to do or what they're missing - tell the CNs and get them to tell them and single out the CNs responsiblity in the order of things.

If you want to highlight the deficits I'd suggest some simple audits that to indicate the stuff that's getting missed and establish some performance goals - eg all charts will have proper entries; -

Set your team "performance indicators" - and again, be sure not to put yourself as primary auditor/checker - make it the CNs responsiblity to report back to you at every CN meeting - let them do the 'thinking' and 'doing' to solve the issues - then tell them you'll be auditing with them on the 3 monthly mark or so to verify standards.

[Kindhearted]

Is the charge nurse free charge or taking patients?

[NRSKarenRN, BSN, RN]

each facility needs to determine how role best adapted to their needs.

resources:

a qualitative study of charge nurse competencies | medsurg nursing ...

slideshow: the charge nurse role

facility job description: ous - charge nurse

book: a charge nurse's guide: navigating the path of leadership