What does "charge nurse" mean to you?

[notjustanurse]

At my facility (which is very small) it seems to mean very different things to different people. I am one of several charge nurses on our small med-surg unit. I work with both RNs and LPNs, as well as PCAs. Our unit manager has encouraged the charge nurses to stop taking a full load of patients, and scale back to just one or two patients so we can be more available to oversee the floor. So, on my shifts I take usually one patient unless we are slammed, and I do all of the discharges and admissions. This is a ton of paperwork since we have not converted to computer charting yet. I start or resite any IV's, do initial and onging patient assessments, and do all of the end of shift chart checks. I was recently approached by one of the other charge nurses who asked me to stop doing all of those "extra" things because it was putting pressure on the other charge nurses to do them as well as several of the other nurses work with different charge nurses. My manager seems to think I am doing fine, so I plan to continue as I have, but it got me to thinking, what does a charge nurse typically do?

Thanks for any and all input.

[kesr]

You're doing GREAT! Pfooey on other nurses complaining you are making them look bad~of all the reasons to change what you do, that is the worst!

[PatricksRNMommy]

I am a full-time mid-shift (2-10) charge nurse on a PCU/Tele floor and usually do not take patients unless someone calls out/goes home sick or all the nurses have a very high acuity patients and are unable to take an admission/post-op/transfer. I am responsible for bed placement, assignments, staffing, rounding on the patients on my floor, dealing with patient/family/MD/nurse/other department issues, staffing, getting report from the nurses, counting the narc cabinet, checking the code cart, reveiwing performance evals and corrective actions, paperwork (acuity sheets, chart reveiws, etc.). I serve as a wound care resource, IV resource, and help with admissions and discharges as much as possible. During the day (7-3) there are 2 charge nurses with similar duties who both report off to me before the leave. The night shift charge nurses do have a full patient load, although I assign them less patients and try to give them an assignment that will allow them as much extra time as possible to complete the charge nurse duties...

[ObtundedRN, BSN, RN]

On my unit, the charge nurse doesn't take any patients unless we are short a nurse and can't cover the assignment. Our charge nurse makes the patient assignments for the shift, they handle lots of administrative tasks, chart audits, they have a meeting once a shift with the a nursing administrator where all the charge nurses in the hospital come together to give counts on how many patients are ordered transfers/discharges, and any patient's that are expected to have an order for transfer/discharge soon. This gives bed management some ability to plan ahead. So all of this is going on in the background to help us do our jobs easier. And of course the charge nurse is always available to help us out with our patients. This comes in very handy when I have a patient that is going down and I'm busy in the room doing interventions or beside procedures, my charge nurse is able to help with my other patient.

[sistasoul]

My charge nurse makes the assignments, takes a full patient load including admits and discharges, attends to codes, rapid responses, and is a resource person. She also must make walking rounds at the beginning of her shift to all patient rooms with the off going charge nurse. If we have patients on tele she is also responsible for those patients whose nurses are not trained to read the strips. Poor lady.

I would like my charge nurse to be available to help out the nurses more on the floor. I know the charge nurse is so busy most of the time that she just cannot help us is we are drowning.

[HollyHobby]

The role of charge nurse varies according to your facility.

I "grew up" at a hospital where the charge nurse carried a tremendous amount of responsibility. I functioned in that role for several years and received exactly one dollar per hour extra for it. In addition to taking a full patient load, I was responsible for staffing, receiving the brunt of the verbal abuse from doctors and visitors, and (most importantly) I was responsible for every single patient on the unit. If a nurse made an error, I was in trouble too... even though I had my own two or three vented and very unstable patients to manage.

I was expected to know everything that was going on with ALL 24 extremely critical patients. While giving report to the oncoming charge, if I did not know the exact current rate of one pt's levophed drip, or the exact current vent settings of another, or which multiplier Nurse Suzie was currently using to calculate her insulin drip, I was s***. I really had to know every detail about every patient: every lab value, whether or not the patient had been bathed, who the emergency contact is. I had to follow up on every lab value to be sure the doctor was called and appropriate orders were implemented.

In that role, it really was like every patient was MY patient, and I was delegating their care to nurses working under me. If those nurses screwed up, they were not to blame; I was.

All of this while caring for my own patient load, triaging the unit several times per night to make room for fresh traumas, and of course being the code nurse for the entire hospital.

Where I work now, I am usually assigned the charge role. I don't get paid a dime for it. I get a full assignment or a slightly lighter one. I do go around and get a formal report on all the patients on the unit once each night; I make mini-rounds throughout the night so I know basically what's going on, who needs extra help, etc. I make the staffing decisions for our shift and make patient assignments for the next shift. I'm a resource so other people can come to me for help or advice, but really we are all resources for each other. Otherwise, though, every nurse is responsible for her own practice.

It's much more democratic. Although I'm technically "in charge", my fellow nurses have the right (and the responsibility) to freely make suggestions. It's more of a collaboration than a dictatorship. I do have the right to put my foot down and demand the other nurses do what I say, but I can't imagine having to do so. We all just work together to get it done.

I have a greater sense of responsibility (than my non-charge neighbor) in the sense that it's my job to make things run smoothly, but I am not intimately responsible for every intervention/med/treatment of every patient on the floor.

Basically what I'm saying is that each hospital and even each unit within each hospital will have different expectations of the charge nurse role. It's important for you to know exactly what is expected of you as charge nurse. If you go above and beyond those expectations, you deserve an award and hugs all around. :)