In order to increase the pool of charge nurses in our emergency department, our director is making charge mandatory. This has caused conflict and anxiety for many of us. Over the years when in charge, I have felt ultimately responsible. My boss and the hospital risk management nurse informed me that the charge nurse is not at any more risk of suit and that it is rare for a charge nurse to be held responsible for incidents in the department just because she is in charge. Im curious as to what other ED nurses experience. Do they rotate through the charge position, like any other assignment such as triage or trauma? Are there a select number of charge nurses? Is it common to make the charge nurse assignment mandatory?
Nancy Brent replies:
The charge position is an important one in any department, including the ED. The position takes an experienced nurse who has leadership qualities and abilities, along with interpersonal skills.
Although it is not clear exactly what your boss and the risk management nurse said to you about being in charge and liability, it is true that when one is in charge, the decisions made about patient care issues, such as delegation or who might be assigned to which ED patient, are those of the charge nurse and therefore the charge nurse is accountable for those decisions. If the decisions were made in a negligent manner, for example improper delegation or not making a decision when there was a duty to do so and a patient injury occurred, the charge nurse would be named in a suit and accountable for his or her conduct. The other ED nurses involved in the patient care incident also would be named in the suit.
To determine what other EDs are doing about fulfilling the charge position and how that occurs, you might want to check with your ED nurse colleagues in other facilities. The Emergency Nurses Association (www.ena.org) also might be a good resource.
The ENA has a wealth of information on its website concerning ED nursing practice that might help ease some of your concerns. If you click on Practice in the drop-down menu under the Practice & Research tab, you will see information available to you, such as position statements, clinical practice guidelines and tool kits.
Several position statements that might be helpful to you include: Nurse Leaders In Emergency Care (2012), Professional Liability and Risk Management (2012) and Delegation by the Emergency Room RN (2010).