Tuesday was my first day being charge nurse on my very own. I was greeted with only 2 open beds, 2 patients to come from ER, and 4 patients that were so sick or busy that they needed a nurse all their own (these are called 1:1's; our usual ratio is 1 nurse to 2 patients. Typically we only have one 1:1 patient at a time, sometimes two). Not only that, but the 1:1's required special RN's... those that were specifically trained to take fresh open hearts, balloon pumps, continuous dialysis (CVVH), and take out femoral artery catheters. Not every RN is trained to do everything. For example, I do CVVH, but I don't do balloon pumps. Other RN's can do open hearts, but they don't do CVVH. It's actually really nice to have the choice... if I wanted to take open hearts and balloons, all I'd have to do is say the word and my boss would train me in a second. It just so happens that I'm not especially fond of cardiac patients, but I really like renal patients...so it is not required of me at this point to learn to do specialized cardiac stuff (although I did do fresh open hearts and balloons in Illinois, and I do take routine cardiac patients here).

Anyway, I was given the option of saying that the circumstances were beyond me and letting someone else be charge, but I opted to do it and take my lumps as they came. Right off the bat, cath lab called and said they had another patient for me and that they were coming over "now." Usually charge does not take a patient, but in this case I had to. So now it's my very first night in charge on my own with 14 patients (our usual census is 8-10), 2 coming, 4 1:1's, and now I have to admit one of my own on top of it all. At one point, it crossed my mind that I was simply too stupid/inexperienced to know if I was in over my head. :)

Yet I survived. And did a pretty good job, if I do say so myself. Luckily mine was a very easy patient, I had excellent support from other RN's who are routinely in charge, and 1 patient that was supposed to come was diverted to another floor.

Tonight was the same ... right at the beginning I had to take a patient, but I was blessed with plenty of staff at 7pm and was able to give her up and be available to give breaks to everyone else, help out, etc. There's a lot of info I've left out, but suffice it to say that we are extraordinarily busy and I am really glad and quite proud that I didn't try to back out of it. At one point, I found myself sitting there thinking, "Wow. Here I am, in this busy CCU with lots of sick patients, and it is up to *me* to keep this place running smoothly, solve problems, be a resource, make sure everyone gets to go eat dinner, make sure there is adequate staff with an appropriate skill mix, and I am doing a good job!! I honestly hadn't thought that I was capable.

Don't tell my boss, but I think I might actually like this charge thing. :-)