Is this the End of the Charge Nurse as We Know It?

12 Jun

Mat Keller headshot
By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

It is with growing concern that MNA has received reports of increasingly ineffective charge nurse utilization in our hospitals.  If you’ve been in nursing for more than a few years, you’ve seen the trend yourself: charge nurses have quickly gone from having no patient assignment, to having a few admits or discharges as needed, to always having half of an assignment, to always having a full assignment… to having two floors?

This alarming new trend is to assign the nurse variously described as a given unit’s “resource,” “foreperson,” and “air-traffic controller” to two units at once. This disastrous model stretches already thin nurse staffing even thinner while eliminating an essential resource for both routine and emergency nursing care. Furthermore, it requires the charge nurse to be in two places at once while making safe, accurate, and timely staff assignments without knowing half the staff being assigning.

When a hospital requires a charge nurse to take on a full patient load, or to be in two places at once, that hospital is putting its bottom line ahead of patient safety. This is dangerous for both the hospital and the charge nurse. In fact,  many experienced nurses are now turning down charge nurse assignments due to their unwillingness to take on the legal risk such unsafe assignments entail.

Charge nurses are essential tools to ensure the right nurse is assigned to the right patient, to help navigate crisis situations, and to ensure care that would otherwise be missed is performed. As one researcher put it, the role of a charge nurse is a “skillful balancing act.” But how can one perform a skillful balancing act on two floors at once?

Is this the end of the charge nurse as we know it? Maybe. It’s up to nurses to stand strong together: do not accept unsafe charge nurse assignments. Do not enable your facility to cut corners and put patients at risk. Do not perform your skillful balancing act with a full patient load on two floors at once. Our patients deserve better.

9 Responses to “Is this the End of the Charge Nurse as We Know It?”

  1. Karen June 12, 2015 at 12:19 pm #

    As one of the nurses frequently required to work charge on 2 units – I know beyond a shadow of a doubt how unsafe it is. But I also know that positions are posted and overtime hours are available for anyone who asks. If we don’t have the bodies to fill the spots – what are we supposed to do? It’s all well and good to “refuse an unsafe assignment” but there are truly times (a lot recently) that there just isn’t a body available. Then what?

    • Mathew Keller RN JD, Regulatory and Policy Nursing Specialist June 12, 2015 at 12:32 pm #

      Not an easy situation to be in, Karen– I would agree that you’ve gotta do what’s best for the patients, which in the scenario you described probably means taking on that additional unit as charge (so long as it’s not enabling the facility to make such assignments a matter of course rather than a rare exception!)

    • Lori June 12, 2015 at 1:06 pm #

      Makes one wonder why new grads still can’t get jobs in med/surg. Seems a new grad would be better than not, to help with staffing in general. And, the “slowness” in hiring amazes me, sometimes.

      • Bonnie Martin June 13, 2015 at 9:39 am #

        As was said it’s all about the bottom line!

  2. David Cheesebrow, MAPA, MN,RN June 12, 2015 at 3:06 pm #

    I have worked as charge in ICU and ED units. The charge nurse is not only responsible for the functioning of the assigned units which includes issues with nursing staff, medical staff, lab or x-ray, families, as well as assigning critical levels to report to staffing and assigning the on-coming staff to patient assignments. How can you do that between two units? The working position descriptions and responsibilities did not match the written position description and for the few cents an hour difference, it was always worth the risk to other staff/patients, their families and to yourself. This is a poorly thought out idea that fails to identify or accept the true problem- inadequate staffing for the criticality of today’s hospitalized patients.

  3. Bernadine (Bunny) Engeldorf June 12, 2015 at 3:14 pm #

    I agree with the well written commentary, It is a struggle! Most recently a new nurse struggled with some practice issues and was told she needs to ask the charge for help. She stated “How can I do that when they have a full assignment (five patients) and are just as busy as I am?” The role seems to be less mentoring, teaching and coaching and more of a balancing act around crisis intervention. Lets find a way to support our patients and nurses safely. Might require pushback on our part, stand up for safe staffing!
    Bunny Engeldorf, RN
    Chair MNA Practice and Education Commission

  4. edinnola1 June 14, 2015 at 4:51 pm #

    My first night as a full time Charge nurse I was given 2-39 bed units and a 26 bed unit. That’s right, 3 units. Fortunately, nothing serious happened that night.This wasn’t an every shift occurrence, but it happened infrequently when staffing was short. That practice has now stopped, but occasionally a charge will get two units. I had a four hour orientation shift prior to taking over. At times I felt I was a preceptor to 4-5 nurses. Some instances my senior nurse on the floor had no more than 2.5 years experience.
    Being a charge at for a whole extra dollar an hour (some places $2) isn’t worth the headache at times. You’re the first to be blamed if something goes wrong, and the last to be thanked when there are no issues or you solve whatever gives array during the shift.

  5. Diane Scott June 24, 2015 at 3:23 pm #

    Mr. Keller is exactly right. Staffing decisions are driven by administrators’ desire for increased profits.

    • Diane Scott July 16, 2015 at 12:46 pm #

      What if charge nurses work 0600-1800/1800-0600 on a unit and they have patients; however, the staff nurses work 0700-1900? This means, for example, the night charge would handoff their patients to the day charge that comes at 0600, then the day charge still needs to get report on all patients on the unit and make the assignments for the day. What if this happens on a huge med/surg floor with 50+ beds! I wonder how the charge nurse coming on duty manages to see the patients they are responsible for from 0600-0700? It will not get done. Then maybe, the charge will handoff one of those patients to a nurse coming on at 0700 – but really knows nothing about them – cause hasn’t seen those patients ….this has concern for safe staffing written all over it.

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