Posts Tagged ‘charge nurse’


Confused About the Charge Nurse Role? You’re Not Alone

February 3, 2011

Charge nurses—as is often the case, there’s the ideal and the reality. Consider a recent blog post at the nursing blog At Your Cervix, which expresses some honest reservations about acting as a charge nurse—both about the challenges involved, and the lack of compensation for the added duties. Here’s an excerpt:

I’m really not so sure about this charge nurse thing. I was told when I arrived on a recent shift that I was to be in charge. I think I’ve done charge (maybe?) three times. Those times were only because there was no one available who did charge, and I was the most likely choice to do it. I haven’t been trained or oriented to do charge. It was kind of a “toss her in there and do it” situation.

If you read the entire post, you’ll learn that this blogger isn’t so sure she wants to take this role on again anytime soon. As it happens, AJN published a CE article back in September of last year (our clinical editor, Christine Moffa, wrote this post about it at the time) on an initiative which took place at the highly respected New York-Presbyterian Hospital/Weill Cornell Medical Center. Its goal was to figure out this charge nurse thing in a more systematic and sensible way.

Like so many roles in so many professions, there may be multiple versions of the same job, depending on where you work. This can be a good thing, since complex work within a complex system is difficult to reproduce by formula (hence the limitations of certain uses of “workflow mapping” done by outside consultants), but it can also be a huge problem, as the facts noted by this blogger suggest.

Our September 2010 article, “An Evidence-Based Approach to Taking Charge,” is part of our Cultivating Quality series, which looks at specific evidence-based initiatives and sees how they worked. The article about charge nurses describes the role confusion and other issues the medical center hoped to address by the initiative; gives a research overview; and addresses, in particular, the selection, preparation, and duties of charge nurses. Here’s a brief excerpt:

Our medical center doesn’t have a permanent charge nurse model; rather, charge nurses are assigned on a rotating basis. Until this initiative, the role wasn’t voluntary; all staff nurses were expected to assume the position if the need arose. The majority of staff new to the charge nurse position said they didn’t have a clear understanding of the expectations for the role. Some units had their own charge nurse descriptions; other units had none. Orientation to the role was inconsistent and unstructured. The vice president of patient care services responded to these concerns and identified a project leader who coordinated a task force to determine issues and develop strategies to address them. The goals, as established by the task force, were to

* provide role clarity.

* clearly define responsibilities and core competencies.

* provide a formalized orientation.

* develop a standardized hand-off report.

Is it possible to anticipate every problem? No, probably not. But there’s a lot more that can be done to make everyone’s life easier, and the role far more helpful—and less stressful. We hope you’ll read the article, and let us know your own experiences in this role.—JM, senior editor/blog editor

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Taking Charge Seriously

October 6, 2010

By Christine Moffa, MS, RN clinical editor      

Most hospitals have charge nurses, although how they’re selected and what they do varies not only between hospitals but often between units in the same hospital. For instance, the first time I was in the role of charge nurse it was because none of the usual suspects were working that day! And my manager’s parting words were, “Looks like you’re getting baptized with fire. Good luck.” Thanks to the work of a quality improvement team, the nurses at New York-Presbyterian/Weill Cornell Medical Center in New York City won’t have to go through what I did.

This month’s Cultivating Quality column, An Evidence-Based Approach to  Taking Charge, “describes the planning, implementation, and evaluation of a charge nurse initiative in a large academic medical center.” After reviewing the literature and identifying issues through the use of focus groups, members signed up for different quality improvement teams to develop solutions and action plans.

            The following are some of the changes implemented by the teams:

  • The development of charge nurse core competencies and a definition of the role to be used hospital wide.
  • A standardized hand-off report to be used between charge nurses going off and on shift.
  • An orientation workshop using interactive case scenarios.

See the full article for a list of the charge nurse core competencies as well as an example of a case study used during the interactive workshop. Here’s a breakdown of the charge nurse role and its responsibilities:

Let us know your experience. How are charge nurses selected at your facility? Is there consistency in the responsibilities given to charge nurses between units or shifts—for example, do they take a patient assignment or not? And are they given any special training or support from management?

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