Off the Charts

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