Published Jul 28, 2002
Here is a question for all you experienced nurses. When you are charge nurse on your unit what do your duties become? Are you responsible for admissions, new nurses, CNA's, and the next day's staffing? Are you required to take a full patient load while trying to accomplish this? What is the pay diff?
I have been out of school for exactly one year. For the last four months I have been charge nurse every shift I work. My floor is poorly staffed and we have more travelers than regular staff. On an average night I have to field questions from four other nurses (many answers I don't know myself), place admissions, monitor the CNA's and deal with staffing issues for the day shift...all while handling my own patient load and admissions of my own. When is enough enough? This is not what I got into nursing for!
I am extremely frustrated with this situation. I spoke with my director who basically told me there was no one else to be charge so I was out of luck. I am continually drving home after my shift feeling like I completely ignored my own patients to do paperwork and deal with other people's patients.
I need some advice before I talk to my director again. Am I being unreasonable? Do I have the right to refuse to be the charge nurse?
Thanks to everyone for listening, please tell me if I am being a baby!
Generally speaking I have found being a charge nurse is not worth the money or headache. Your concerns are legitimate. I've been in the same position. If results are not obtained through the nurse manager, I'd look for a new job. If you truely like the job, then try working through your union or Employee Relations Committee. Even though I'm a seasoned nurse, if the incentive and feasibility of being a charge nurse is not there, I would choose not to do it.
Good luck, my friend. Not all jobs cause the same amount of distress.
i would avoid being a charge nurse like it was a bad disease. we get paid no more for it and you become responsible for everything getting done. i got elected to be charge . as my manager put it because i am very stong clinically and always make sure things get done on my shift. to me it has been like a punishment
First let me say this: YOU HAVE THE RIGHT TO REFUSE ANYTHING THAT MAY PLACE YOUR RN LICENSE IN JEOPARDY!! By doing so, you DO run the risk of losing your job, BUT better a "lost job" than a "confiscated nursing license by the BON" because you failed to exercise sound judgment in what you could or couldn't safely handle on the unit in which you are employed.
Nurses need to put their foot down about what is SAFE for them and their patients, and what is not. There is nothing to fear but fear itself, and no one has ever been courageous without being in the midst of a fearful situation, so why are you putting up with that drama?
If you are only complaining about what should not be kosher for any nurse to do on his/her job, BUT still accepting the crap that the Admin. deals you each shift, the REAL message that you...and thousands of nurses like you....are sending to the "Powers That Be" is: "No...I do NOT like having to deal with this crap, but I AM WILLING to deal with it BECAUSE I need...a paycheck to survive.., etc... And it is in the NEED for a nurse to survive that Admin has you by the collar and choking the chain as tight as they can around nurses necks like yours.
This might sound harsh......but it is EVER so TRUE! REALITY sucks!!! It doesn't get any more real than this, hon. Life is a SINK OR SWIM deal.....and it sounds like you are "sinking fast". Want to save yourself? What's stopping you? Take a stand, stand for what you believe is right to do, and leave the mess for the Admin to clean up as they always CAN find another nurse who they can beat up on. STOP the abuse, and find yourself better employment. :kiss :)
I avoid charging like the plague. It is NOT worth the measly differential or headache. And to me, a new nurse out of school HAS NO PLACE charging a unit. But I know it is done; I was forced into it at the rural hospital where I worked right out of school. I did not begin to feel "qualified" to take on such a huge liability. Therefore, I vehemently disagree w/1st year nurses charging. They just don't have the experience to take on such a HUGE responsibility!
At our facility, 7-3 and 3-11 Charge nurses do not take patients. They do on 11-7, but I believe have a slightly lower amt of pts. All charge nurses are expected to be the resource person for the rest of the staff, make assignments, call MDs, take off orders or check them after done by ward clerk. Call the appropriate places when there is a code, a death , notify the supervisor that meds are needed from the night cupboard to cover new pts or new orders, mediate disputes by staff, etc. and NO, it is not worth the measley 30 cents an hour extra they pay, which is why I won't do it. I, too, was thrown into a Charge position the first few months out of school, with about a 2 day orientation! :rolleyes:
Did it for almost 8 years before major burnout threatened what little sanity I had left:confused: Now I work the floor, but refuse to do Charge.
Yes,you can refuse to do charge and no you shouldn't take a full pt load-you should be doing team nursing so the aides are working with the nurses so you can get that responsibility off your shoulders. If you like your job,spend some time at home thinking about how you can distribute the load -Let other nurses make calls to the docs,take off their own orders or whatever way you can figurem to delegate some of the work.You are probably good at organizing is why you have been chosen to do charge-Delegate!
The role of Charge Nurse varies where I work... but here is how *I* handle it:
I do have to field a few extra phone calls with admitting to place patients. However, each RN is responsible for their own patients and CNA (generally we're 2 RNs and 1 CNA, so we share). I don't let ANYONE dump on me... I do my job and I expect everyone else to do theirs. There are, of course, those days where you are forced into playing referee when personalities clash... but I'm pretty straight forward about that... and those I work with know my decisions are based on objective, not subjective reasoning.
We have a floor where the Charge takes no patients... rounds with the doctors and SUPPOSEDLY goes through charts pulling orders and noting them when completed... the times I've worked there, Charge doesn't seem to do squat. Makes me thankful I'm self sufficient and will speak up if I'm in a jam and bellow loudly if I'm not getting the help I deserve. :)
Originally posted by patadney Delegate! EXACTLY!!!!Peace:)
Thanks for the support! I am meeting with the coordinator on Monday to discuss some of these issues...hopefully it will go smoothly.
Cheerfuldoer-you exactly right. We let ourselves get dumped on to avaid conflict, I guess I need to rethink how I agree to take on responsibility.
I'll keep you posted!
All the advise is excellent, I do have some more to add. I don't take admit's when in charge, unless my assignment is the lowest of acuity, which yours SHOULD be, and there are no other alternatives.
Second, you will be called on often, so barter.... I'll start that difficult IV for you, please do ...... for my patient while I'm with yours. This keeps you ahead and prevents those who like to pass off work on to others... they catch on quick.
Third, travelers can supervise the LPN or NA. Assign the NA's to the other nures and intervene only when needed. ex. the nurse assigned to the NA complains to you they aren't answering call bells. Instead of you tackling the issue... ask the RN what have they done about it. If nothing suggest they discuss the rationale with the aide and ask the aid for ideas to improve the situation... not just delegate. Then follow up and give positive reinforcements for their efforts,,, " You handled that well by listening to ....." or when it didn't turn out favorably you still can say "You tried very hard to handle a tough situation, do you have any ideas how we can approach it differently?" This way you did not remove the authority to handle the situation and looked for a team approach to continue to work on it.
When it is TRUELY unsafe, contact your chain of command IMMEDIATELY for assistance. This is a fine line you will learn with experience... some days you have to hold a group meeting and state "OK, tonight will be very tough for us, if we work together as a team we'll get through this together". Start tough shifts off on this positive approach instead of allowing griping and bickering to begin, this negativity is a productivity KILLER when you need it the least!
Finally be a role model.... which is the toughest thing to do when you want to sit and complain.. which I'm sure you have every right to... but if you get down to work with a positive approach... it will catch on just the same as negativity will.
Keep us informed on how it goes, but please go into your meeting with some ideas on how to solve the problem... you are in the best position to do so. Nursing improvements must come from nurses... the managers have the knowlege and authority to make it happen.
Nurse Ratched, RN
Bellehill - all I can say is you're getting screwed. What kind of hell do they operate that at 8 months out of school you were the most senior and experienced person they had to put in charge every day? (And I am not being unkind or questioning your skills in any way, but you yourself know this is ridiculous on its face.) If you quit tomorrow, who would be the next most senior person? Some poor new grad fresh off orientation?
Where I work, charge carries the same patient load as everyone else. I try and divide the patients as equally as possible so no one gets slammed, myself included. I am responsible for rounds, coordinating breaks, assigning beds and distributing new admissions (of which I usually take the first when charging) and making sure all those stupid little daily checkoff things are checked off.
I do not orient new staff while charging. Fortunately on my unit I am only relief for the regular charge nurse, and there are other people qualified to charge as well. I don't believe I can do justice to the orientee when dealing with all the miscellaneous crap that goes with charging.
Next shift's or next day's staffing is not my responsibility, altho I keep the house supervisor abreast of changes in our census so she can staff accordingly.
For this we get a $2.00/hr increase when charging.
I've never seen the charge-as-desk-nurse role in action, and feel like it would bother me to have someone else doing my charts. Call me controlling, but I need to know for myself that stuff was done.
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