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Week 11. CN = charge nurse

Here's a day in the life of a charge nurse, framed within the structure of the monomyth, or the hero’s journey (saving Murdock's The Heroine's Journey for another time).

The Ordinary World: The charge nurse, an intelligent, independent and capable professional, enjoys a quiet night’s sleep in her warm bed on a late October night, the windows cracked just so, allowing the chill of winter to creep in and crisp the air in her bedroom.

The Call to Adventure: After working the day before, she had accidentally left her pager on, and as a consequence she is abruptly woken up by it before the skies were beginning to brighten, with a request for her to come in to the hospital and help manage the floor from 7am to 7pm.

(Near) Refusal of the Call: The nurse hesitates. Having worked yesterday, she knows there are several transfers, shortage in coverage due to multiple admissions and an RN calling in sick, two one-on-one safety sitters required, therefore fewer CNAs on the floor...not a formula for the smoothest day. She decides to go in anyway, since she entered the field in order to make a difference, and nobody ever said that was easy. During the brief report-off, she realizes she signed herself up for more patients and fewer staff than she bargained for. A delirious patient continuously moans aloud the name of the previous charge nurse, who is more than happy to put on his civilian jacket at this point and head down the elevator, several floors down to freedom, a short drive away from sleep at last.

Crossing the Threshold: Entering the 7am meeting means transforming the charge nurse’s day from busy to completely hectic (yet highly organized). The formula of (staff x 24 hours / # of patients) aims to come out under 9 hours, but that doesn’t always happen. On this particular day, the RNs are over ratio, and at the brief morning huddle nurses each share concerns about specific patients: low potassium, meds, psych issues, patient safety, pending transfers, discharges and admits. 

Tests, Allies, & Enemies: After checking the crash carts, some rounding, med-witnessing, checking temperatures of CAPD fluids and patient care, the nurse arrives at the 8am meeting with other charge nurses and administrators. Staffing, patient admits and transfers, ICU beds, telemetry beds, and more, are discussed. Some bantering, some disagreements about whether someone should be on a certain floor. Then the nurse must return to her floor to put out some (metaphorical) wildfires that spread while she was in the meeting.

Approach: She prioritizes matters, makes calls and talks to administrators, nurses and assistive personnel. She deals with pressing issues such as a conflict with the ambulance service. There are new admissions, people swapping schedules without informing her, and she addresses these one by one. A gaggle of physical therapists descend upon the nurse’s station all of a sudden, looking for chair alarms, paperwork, assignments, orders.

The Ordeal: Someone from housekeeping, upset, declares she is never entering a particular patient’s room again. “He showed himself to me!” Then the charge nurse is yelled at over the phone by someone from a medical facility, and the ambulance conflict also blows up in her face.  A few nurses and CNAs stop by and threaten to go home as a joke, or to bark out a critical value or Never Event just loud enough to give her a good scare.

The Reward: A job well done is the reward in and of itself. The occasional patient actually says, “Thank you.” As minor fires are put out and large ones controlled, there’s more rounding to make sure patients on the unit receive quality care.

The Road Back: At the 11am meeting, which happens again at 4pm, each doctor reports on patients of note, especially discharges and transfers. They cite PICC lines, low potassium levels, patient compliance, necessity of skilled nursing, etc. As soon as the last doctor is done, people scatter like flies. The ambulance conflict is briefly discussed, though bureaucratic repercussions are still to come. Before returning to the nurse’s station, more issues arise.

The Resurrection: If a code blue occurs, people line up out the door to take their turn at keeping someone’s heart pumping until they’re shocked back. If something blows up in one’s face or a patient/patient family complains, there must be service recovery. All this takes place while keeping an eye on patient orders, oxygen regulation, telemetry, calls to pharmacy, admits and transfers, and scheduling for the next shift.

Return with Elixir: The elixir here is metaphorical and overarching. It could be pharmacological, in the form of pain meds or lifesaving antibiotics; or spiritual, individualized to patient or personnel; or pedagogical, as student nurses in royal blue are trolling nurses’ stations looking for procedures. It might also be a well-packaged vial arriving in a time capsule via magical tubing, landing with a whoosh in a special compartment. Is that the sound of the confused patient in his room, moaning her name out loud? Either way, at the end of the day, patients were treated, lessons learned, and the charge nurse can put her feet up at home, finally get something to eat, and since she works weekends, unfortunately, that pager has to stay on, so she can do it all over again tomorrow.


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