In accordance with the Code of Ethics for Nurses, the intent of this statement is to provide guidelines for registered nurses assuming the role of charge nurse. ONA recognizes that the role of the charge nurse may vary with the area of practice and facility policy; however, the registered nurse’s role must be consistent with professional standards as developed by the nursing profession, the scope of practice defined in the Law, and the rules of the Board of Nursing.
Charge nurses are registered nurses who are responsible for the operation of the nursing unit over a specific time period. The charge nurse must have a strong foundation of clinical knowledge and skills on which to base judgments and make decisions, organizing abilities to direct nursing tasks and operations, and interpersonal skills to facilitate communication and the work of others.
The charge nurse accepts the responsibility for, and is accountable for, his/her own nursing practice. The charge nurse also seeks out and pursues opportunities for learning and assumes responsibility for his/her own self-development. Registered nurses must be knowledgeable and skillful in performing the charge nurse role.
A registered nurse who assumes the role of charge nurse also assumes the responsibility inherent to the role. Three fundamental responsibilities for charge nurses include planning, coordinating, and evaluating unit nursing activities.
The charge nurse identifies the procedures, processes, and patient care to be accomplished during the work period, as well as the resources that will be required to safely carry out the work of the unit.
The charge nurse distributes the work of the unit in a manner that makes the best use of available resources, both personnel and material, and which take into account the knowledge, skills, and abilities of those persons who will be integral to the patient care process. The charge nurse provides ongoing coordination of work and resources as necessary to meet changing requirements in the work environment.
On an ongoing basis, the charge nurse evaluates individual and collective outcomes of the patient care provided during their shift, compares patient care delivery to accepted standards, adjusts assignment of resources as necessary, and reports changing needs and outcomes to the health care staff.
Because the charge nurse observes and weighs patient care delivery and outcomes as provided by coworkers, the charge nurse may be asked to contribute observations to individual employee evaluations, suggest competency evaluations, or to advise and educate fellow staff. These functions of the charge nurse should not, however, be constructed as supervisory in the sense of exercising control regarding employment decisions. The charge nurse is accountable for overall operation of an assigned unit during a specific time period, but is not solely or personally responsible for the selection or discharge of employees of the health care facility.
Functions and Competencies of the Charge Nurse
- Coordination of activities, e.g., collaborating with physicians, other departments, consulting with other nurses.
- Awareness of legal aspects of nursing and applies this knowledge when making staff assignments.
- Awareness of institution policies and procedures related to nursing service.
- Interprets organizational chart, and uses the institution’s organizational structure effectively.
- Identifies the priorities for patient care management.
- Knows the responsibilities of all nursing staff members and utilizes this knowledge when preparing assignments for staff members.
- Utilizes the talents of all members of the nursing staff.
- Solves problems or avoids potential ones by making appropriate assignments of staff to patients.
- Demonstrates leadership through clinical practice and teaching.
- Delegates unit and patient responsibilities to nursing staff members according to each staff member’s education, training and availability and in accordance with 4723-13 of the Ohio Administrative Code (OAC).
- Recognizes leadership styles and selects the appropriate leadership style for given situation.
- Applies decision-making theory and the scientific method to solve patient care problems.
- Educates nursing staff and students utilizing formal and informal venues, including peer consultation, mentorship, preceptor programs, unit conferences, case studies, patient rounds, and in-service programs.
- Applies communication theories and techniques in negotiating with patients, families and other staff members to accomplish the nursing care plan.
- Initiates and completes the designated forms required by administration in the delivery of patient care.
- Observes performance of nursing personnel and shares this information with the nursing manager.
- Monitors the quality of patient care being delivered by other nursing staff members.
- Checks the completeness and accuracy of patient care plans routinely, and continually updates and revises these plans as changes occur in the patient’s condition.
- Contrasts and evaluates the patient’s behavior and/or condition with the physical, psychosocial and spiritual goals stated in the nursing care plan.
- Assists with the establishment of criteria for patient care to be utilized in a total quality improvement program.
- Checks equipment to determine if it is functioning properly.
- Checks the environment for patient safety.
- Audits the patient’s medical record to determine that all orders have been carried out, that laboratory tests are posted, delivered nursing care is documented, and patient progress or lack of progress is described.
- Implements measures to correct inadequacies noted in the quality of patient care administered on the unit.
The Nursing Department within the employing agency is responsible for developing written policies and procedures relative to the registered nurse working in a charge nurse role. These policies should reflect the scope of nursing practice, as well as established professional standards. Policies and procedures do not release nurses from accountability for their own actions.
References for the Scope of Practice for the registered nurse: