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

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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.