Thursday, January 5, 2012

New job responsibilities

So you remember that time way back in June when I wrote about how I was asked to be trained as relief charge nurse? I ultimately told management no, because I didn't feel I was ready and I didn't want to deal with all the stuff that comes along with management type positions.

Fast forward to December, when situations again conspired to instigate the need for a relief charge nurse. The manager comes to me again to request I do relief, and in a moment of weakness I agree to it. I had a week of orientation - which really just equals three shifts - with a full-time charge nurse and then they gave me two weeks of "supervised charge," meaning I was alone in charge but one of the full-times took a patient group in the same station as me.

I'm currently in week three of supervised charge. What happened to just two weeks, you ask? I knew that I don't know much yet, but I discovered just how inadequate 2.5 years of nursing experience really is when I'm the one being asked all the questions. Boss Man subsequently gave me another two weeks.

It's been quite eye opening, to say the least. One of the unit secretaries, who has been working at the hospital almost 30 years and knows everything about everyone there, said to me last night while it was hellishly busy, "you're finding out just who doesn't know their stuff and who doesn't care to know it when you're in charge, aren't you?" And it's true. We're working with a huge amount of new grads who don't know much yet* and also with some nurses who are straight up lazy**.

I kind of imagined how much the charges had to deal with, but I never did understand the full scope of it - people calling in looking for advice, doctors calling in pissed about the number of patients getting referred to them after another doc shuts down his practice, needing to know the protocol for a rare procedure which only gets implemented four or five times a year, nurses calling to ask drug questions, deciding which ambulances go to which rooms, juggling the influx of ambulances while still bringing people back from the four hour backup in the waiting room, deciding which chest pains are legit and which chest pain complaints are bullshit and directly related to that four hour backup, personally handling patient complaints, sucking up to some complaining patients and telling other complaining patients to piss off in nice words, denying cab voucher requests, granting cab voucher requests, needling the staff to keep moving quickly to make patient throughput speed up, stepping in when staff isn't moving quickly enough, babysitting new staff during procedures they aren't familiar with, getting an obscure piece of equipment when the doc needs it, making sure xray is called to come do a portable on that newly intubated patient, knowing the story of a patient so you can tell the surgeon what's going on even when you've never laid eyes on that patient, being able to answer questions from bed coordinator when you've got no idea what the answer really is, needing to be at your desk constantly to review the tracking board and assign ambulances, needing to be walking around constantly to make sure staff is doing everything, being the contact point between the ER doc and the primary nurse in a room, being the last resort when a nurse can't get a pediatric IV, addressing a nurse doing a generally shitty job of patient care at the request of a doc, performing daily quality control tests on various devices, general upkeep of the department, tracking down a lost cardiac monitor, delegating tasks, cleaning beds when environmental is nowhere to be found, answering the phone when the secretary is somewhere else...and a thousand other things I haven't yet realized are my responsibility.

I'm overwhelmed, to say the least. I haven't once left work on time. I've cried more than once. I feel inadequate on a regular basis. Yet somehow the department hasn't imploded. A couple of docs have congratulated me on doing a swell job. No one seems too upset that I've agreed to do this. No one has laughed at me...much. I guess I'm doing alright, then. I've got one week left of scheduled charge, and then after this it's just on an as needed basis. We'll see how things go.

Sorry to talk your ears off, and sorry for the light posting recently.

* I feel a little guilty calling some of the new grads out when I myself was a new grad starting straight into the ER. I, however, had the benefit of being one of two new nurses amongst a sea of experienced nurses and I never felt alone. Now, there are so many newbies and so few experienced nurses (as evidenced by them asking me to do charge) that we've had nights where the new outnumber the old by a horrifically high ratio - whole stations are staffed by nurses with less than four months of experience. A scary scenario indeed.

**A side effect of being charge is docs coming to me and telling me things I never would have heard otherwise. We had a real sick patient the other night who was unfortunately being cared for by the laziest of nurses. The usually level-headed doc was infuriated with the substandard care and pulled me into the dictation room where he went off. I've never heard this side of him - "she's a fucking lazy, shitty nurse and I can't believe she's taking care of this patient. Do you see it? She's a fucking awful nurse, and this patient might die because of her. You need to make sure she doesn't kill him." Um, thanks for your high opinion of me? Am I really ready to see this side of you, and actually act on it?


hoodnurse said...

WOW. One, are you entirely sure we aren't working at the same hospital in a parallel universe?
Two, this post assures me that you're doing a great job, because you get involved enough to be stressed. There are charge nurses working on my shift right now who I seriously walk by who are playing words with friends while the rest of us are getting killed. It is freaking insane. The ones on days are even worse- some pretty much just sit on their asses and put nurses in dangerous situations constantly with their laziness. The charge nurses that actually give a crap and try to help are always number one in my book, regardless of experience.
Although this does make me reconsider my "I won't volunteer, but I'll do it if I'm asked" stance.

Zazzy Episodes said...

Oh my goodness, glad I'm reading this now before I graduate nursing school. Note to self, don't take a job as charge!

Anonymous said...

You are awesome! Hang on in there, and be kind to yourself. You're clearly doing brilliantly. You must be knackered though!

Solitary Diner said...

It's a wonderful thing that you care so much - you'll undoubtedly be one of the good ones.

I'm currently the resident in charge of a ward right now, and I understand the feelings of being overwhelmed. I feel like I am constantly being asked to check meds/placate families/reassess patients/review bloodwork/etc./etc. without ever having enough time to do it all.

The good thing is, it does get easier with time. There will always be exhausting and overwhelming days, but they will get easier to manage with time.

GuitarGirlRN said...

Scary, isn't it? I was never oriented to charge. I would occasionally relieve the charge nurse for an hour or less at a time--for lunch, or some such. Then that increased to four hours, then to eight. Yikes! It was always pretty difficult--especially since sometimes the charge nurse would have to triage the ambulances and worry about the resus room. Add to that the medical director of the ED screaming at you to "GET EVERYONE IN FROM THE WAITING ROOM I DON'T CARE WHERE THEY GO JUST BRING THEM IN!!!" and it got pretty stressful.

The best advice? Suck up to the good unit clerks. They always know who to call for things when you don't. ("Can you call for more stretchers? Can you call the storeroom to see if they have an 18 French PEG tube? Can you call the nursing office and tell them we have three 1:1s and no one to sit with them?") Also, utilize your nursing supervisors. When you're backed up in the ED because you're boarding patients for hours because none of the inpatient beds are clean yet, call up the nursing supervisors for those areas and complain. Call the environmental services supervisor.

Don't worry--you'll get better and more confident! You may never get to love it (I certainly don't, and I'd never do it full time), but you won't want to cry every time you have to be in charge.

Anonymous said...

Wow, thank you so much for sharing! I'm also a newer type nurse, I'll have been a nurse for 2 years in a month from now. I've been asked to do charge and I just couldn't say 'Yes'. Our charge nurses are amazing and have so much experience I was intimidated thinking that I wouldn't be good enough. I think its important to have confidence in your abilities and be realistic about what your capable of. Its so inspiring though to read what you're going through and really how to handle your stress and anxieties about your new role! You're so courageous and I commend you!! :D

Baby-Mama Runner said...

I've been a full time charge nurse for 5 months, was relief for a couple months before that. I am just hitting my 2 year mark as an RN. It is crazy that I was the best option. Sometimes I think it must have been a new girl thing... As in "Get the new girl to do it, she doesn't know any better..."
But it does get better, the scary stuff isn't quite so scary and the unexpected stuff gets easier to figure out. Hang in there. I love your blog! Makes me consider switching from Women's services to ER!

Smalltown RN said...

Charge in never an easy task. You get the privilege of doing all the dirty tasks the others don't want to do. You have to keep your finger on the pulse of the unit...know who your nurses are on staff and who is going to need support extra. It is something to be stressed(not overly) cuz that keeps you on your toes.

You hopefully still have a very long career ahead of you..and with your positive attitude you will go far. Great post!

Sandy said...

Stumbled onto your blog from the Canadian Nurse mag this month. I know that feeling of being in over your head and desperately trying to stay afloat. You have to remember to take care of yourself too because we don't want you to burn out and leave the profession. Keep up the great work!

Shrtstormtrooper said...

Thank you all for the encouragement! It is much appreciated, seriously.