Charge Nurse Essay

"Charge Nurse"

Charge Nurse is a registered nurse responsible for the management of a patient care unit. The primary purpose of the job of a Charge Nurse is to provide direct nursing care to the patient, and to supervise the day-to-day nursing activities performed by nursing assistants. Such supervision must be in accordance with current federal, state, and local standards, guidelines, and regulations that govern the facility, and as may be required by the DON (Director of Nursing) or Nurse Supervisor to ensure that the highest degree of quality care is maintained at all times. As a Charge Nurse, they are delegated the administrative authority, responsibility, and accountability necessary for carrying out the assigned duties.

I visited

my previous work at a skilled nursing home at San Francisco. I had work there for 10 years. As an LVN (Licensed Vocational Nurse), I was assigned to do a Charge Nurse. I was able to practice delegation, admission, skin assessment. Even though I was a Charge Nurse, the DON (Director of Nursing) would supervise me. Some of the reasons why Licensed Vocational Nurse assigned to do a Charge Nurse it's because the lack of Registered Nurse applying to the facility. And if they do hired a Registered Nurse, they don not usually stay there for several months. Newly hired Registered Nurse would leave as soon they get hospital jobs, because of better benefits and salary wise. When the management change, they wanted to appoint Registered Nurse to be in charge on the floor.
My days of following a Charge Nurse, as soon the nusrse arrived on the floor, the Charge Nurse makes a quick room-to-room check, or as they called it "Make-rounds" just to make sure that the patients they are receiving are in stable condition, make sure the call lights are within reach, and patients on tube feeding that their head of bed are elevated to prevent aspiration. After the Charge Nurse does their rounds, they will receive a report from the previous shift. Morning staff that assigned on the floor will meet for "report". The Charge Nurse I was following is working in the morning and receiving a report from the graveyard shift. The graveyard shift nurse would report if there's any appointment, any change of conditions that requires attention such as falls, infection, new admissions. The graveyard nurse will endorse if there is an order for nothing-by-mouth, diet change, medication changes, laboratory procedures such as blood samples that have been done that requires follow later for the results, any patients that are taking antibiotics. Once the report is done, the CNAs will get individual endorsement such as which patients need shower first, who requires assistance when patient ambulates, certain instructions from family members that patience needs to wear certain clothes. The Charge nurse will endorse CNAs who needs vital signs for this day, any patient that needs to be weigh, and patient that requires assistance during meals.
There are two licensed nurse on the floor, one is Medication Nurse, the other is the Charge Nurse.

Medication Nurse will pass medications, and calls pharmacy for medication refills. Usually the Medication Nurse is an LVN. The Charge Nurse will receive phone calls for new orders, laboratory results, receive information regarding admissions, and will talk to family members for any concerns. Both licensed nurse collaborate and report any changes so that everyone is on the same page. For example, if the Charge Nurse receives an order for new medications, the Charge Nurse has to tell the Medication Nurse for changes. The Charge Nurse has to input the new order in the Medication Administration Record (MAR), inform the patient (if they're mentally stable), and inform the responsible part. The Charge Nurse then writes what just occurred in the communication record. The communication record is what nurses use to write what occurred during their shifts. The DSD (Director Staff Developer), is a Registered Nurse that will review the communication report and use it on their Interdisciplinary meeting conference. The DSD is assigned for hiring new employees, does in service meeting with other staff such as continuing education for the Certified Nursing Assistants. Sometimes, all staff meeting for address concerns of each individual. The Charge Nurse does the treatment, calls the doctor for any change-of-condition of the patients, such as fever, skin conditions, etc. The Charge Nurse does the weekly skin assignment, updates the care plan if there are any changes. For example, the patient's care plan initially is for urinary tract infection, if the following nurse receives an order for antibiotics, that Charge Nurse has to update the care plan. So when other nurses comes in to check for the care plan, they will know what treatment has been done, and to know if the treatment is working or not. The care plans that are not resolved are placed in the treatment record,

once the change of condition is resolved, they are filed in patient's chart.
At the end of the shift, the Charge Nurse does the charting for change-of-condition, and Medicare insured patients. Charting for Medical insured patients are usually not done unless there is an occurrence such as change-of-condition, or patient is on antibiotic order, etc. Charting has to be patient-care related like "call light within reach" or "Aspiration precaution observed." When you chart a condition, it follows with intervention, and evaluation. Charge Nurses uses SBAR for reporting for change-of condition. Incident report is not filed in patient charting. The incident report is reviewed in interdisciplinary team meeting or individual performance evaluation to come up a plan to prevent this incidence from happening again.
What I learn from following a Charge Nurses, each have different leadership styles. Some of them does not stick to one leadership styles. It depends on the situation, if the situation is urgent like "Code Blue" the Charge Nurse is more authoritarian. If it comes to CNA's assignment problem, democratic style is more appropriate for that situation because you're addressing the concerns of individuals. Some Charge Nurse uses laissez-faire leadership style, like the Charge Nurse trust the Medication Nurse base on his or her experience working on that unit that he or she will report to the Charge Nurse for abnormal blood pressure. If I get to pick a leadership style, it would be a situational leadership style. It is a jack-of-all-trades. "The ability to diagnose, choose, and alter behavior to implement a leadership style best matched to the situation is a critical skill needed for effective leadership" (Huber, 6th edition Leadership Nursing Care Management, pg. 11). You can basically work anywhere if you developed a situational leadership. There were times when I encountered a Charge Nurse that uses authoritarian styles at all times for any situation, it demoralize the working staff on the floor. Some employees felt that intimidated and they feel that their input in care is not needed., and some of their concerns are not validated.