What is a charge nurse?
The charge nurse (or unit coordinator, as we officially call it) is a role where you are responsible for the assignments of the nurses to patients, the influx and outflow of patients from a unit, and the main contact for all things that go on in the unit during your shift. I work in a busy outpatient area so there are lots of comings and goings.
In some ways, it is the management of the bin-packing problem in real life. A little translation for all you computer people out there.
The computer people will also know that the bin-packing problem is NP-complete, meaning it is impossible to solve optimally real time. Nevertheless, life is full of such problems and we have to work within them.
Patients come to us in a pseudo-random fashion with different needs and requirements. We have to put them in a room with a nurse assignment, get them ready for procedure (which is a variable task), and recover them (which is also variable). We have capacities - number of rooms, number of nurses, number of techs, etc. The labs that we supply and receive patients from has a different capacity than we have - they get patients in and out faster than we do. They have fewer rooms, though.
So the task involves the simple numbers game as well as various heuristics - how long do we think we'll have to recover, how much of a prep do we have to do, how many patients does each nurse have, what time of day is it, and more. Experience helps with anticipating how things will go.
Another responsibility of the charge nurse is to keep everyone happy (as much as possible). By "happy" I mean that their needs are met. The doctors, your staff, your peer organizations, your manager, the housekeepers (who clean up the rooms between patients), and indirectly, the patients, all demand attention from the charge nurse. Naturally personalities come into play! Additionally, everyone sees the charge nurse's role a little differently depending on the needs they have. Everyone expects their needs to be served exclusively. Yeah, no kidding.
My Experience in the Charge Nurse Role
Personally, I liked the challenge. It touches on those industrial engineering urges I had years ago in undergraduate college - I took one IE/CS course and I thought it was kinda cool. Optimization problems. Efficiency. Math. Neat-o. It's like playing Tetris in real life.
The personality dimension of the job is my challenge. Like I said, everyone sees the charge nurse's actions from their own perspective and prejudice, and not everyone is self-aware enough to consider, even for a moment, that maybe there are other forces that resulted in a particular decision. Some people will assume that "you hate them." Or "you're out to get them." Or you're just looking for a chance to "screw them over" or tell them how "dumb they are," and how much "smarter/ cooler/ powerful you are." Some people will conclude that you're incompetent. Then they react to you angrily. Or, they play the two-faced game in which they act all nice to you, but bitch about it behind your back to their peers. I think that's a typical female tactic, although...I've seen the male doctors do that crap, too. Instead of their peers, they complain to the manager.
These things are, in fact, their own problems, and everyone has a moment now and again. Yet, I am sensitive to this - I try so hard to be fair and equitable... but sometimes, the situation is just difficult. I am a highly conscientious person, and to be perceived as careless or spiteful is vexing!
To be completely honest, of course I have my own problems too which I try to put aside. I am human and prone to react to similar (perceived) assaults on the self.
The nurse that was rehired a few months ago (whom I posted about) knows just how to push my buttons. Last week when I was charge nurse for the first time, she did it. As charge nurse, you really can't just avoid someone, like a floor nurse can, and in trying to act as the charge nurse, I apparently got "in her stuff" too much. Then, two days ago she was also on staff when I was charge nurse. I tried a different strategy - staying out of her stuff, only touching base when necessary. That seemed to work...we'll see if that's a viable tactic in the future. I might need to get some feedback or do some reading on how to deal with difficult people in a management position.
I did like the problem, the communication, the juggling. It was scary and exhilarating when things got really busy mid afternoon yesterday. With practice, I think I'll be able to keep my cool better. Each day I worked as charge nurse, I got a little bit better and I would anticipate that trend to continue.
Future
I wonder if I could create a simulation program to develop a schedule and assignments. I see a number of factors I could encode or represent statistically. For example, the flow of patients through our unit seems to be a true random distribution, not evenly distributed at all. I wonder if there are other distributions that could model behaviors on our unit. I see such a program as a management assistance tool - like initial assignments and a reference as the day progresses.
Eh, just a thought. I'll see if this problem bugs me enough to give it a try.
Maybe this is my million dollar idea???
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