Taking Charge Seriously

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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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Karen October 19, 2010 at 10:26 am

    I agree that responsibility and authority are needed to be effective in any leadership position including the charge nurse.

    In the institution where I work, there is much resistance to being the charge nurse by most of the staff. Ideally, the charge nurse has a slightly lighter assignment but they are still responsible for all responsibilities for that patient as well as all the responsibilities of being in charge. There is no additional compensation for being in charge nor is the charge nurse really empowered with authority. I often wondered if nursing as a whole elevated the position to include more authority, recognition and compensation – if my coworkers would be receptive to being in charge – not to mention be more effective in the role.

  2. Donald Wood ARNP October 6, 2010 at 9:16 pm

    Bravo! The wave is building that leadership training is not just for those at the C-level. I have long believed that real leadership (not health care policy formulation) should be taught from the very beginning and continued on as one progresses. A staff nurse well trained in leadership skills can better lead the patient to higher levels of health.

    Another piece of the puzzle is that when responsibility for a unit is delegated to a charge nurse, the authority to carry out those responsibilities must also be delegated. Responsibility and authority go hand in hand. To delegate one without the other is an example of poor leadership.

  3. J Lemay RN October 6, 2010 at 11:51 am

    Charge nurse is not my first choice for employment. Actually I avoid it at all cost! I was working at a small hospital in a rural area, driving hours each way to work. When I arrived, I was told the ICU had a low census and I was being floated to another floor. I dont mind floating… Its not great but its necessary.
    The assigned floor was new and I hadnt been there before. When I arrived for report, I started noticing I was the only RN. Report completed, i waited for someone to make assignments. When I asked, they said “you are in charge, its up to you”.
    I had already driven hours, slept in preparation to work and taken report. I was stuck. On an oncology unit. Only 1 of the 2 LPNs had worked the floor before. I really grumbled!!
    I contacted House supv and told them their assignment stunk. I gave myself the tour of the unit, found the crash cart, the pts and the bathroom (in that order!) Then I began assessments. Two hours later I am still assessing. 25 pts takes a while. Almost complete, I walked into a room and the pt was very still… very still! he had a pulse but wasnt breathing. I hollered out the door for someone to call a code and bring the cart.
    Finally, something I knew how to do!
    I left that job shortly after and found one with a little more ethics.

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