The Emergency Department Charge Nurse is a registered professional nurse who is assigned specific management responsibilities by the nurse manager/director. S/he is directly responsible to the nurse manager and provides continuity of leadership. S/he is responsible for the evaluation and prioritization of activities to meet the changing unit demands on a shift-to-shift basis. The Charge Nurse has the authority, responsibility, and shift accountability for the delivery of nursing care through the use of the nursing process. The Charge Nurse accepts accountability, applies competent clinical knowledge, skills, and uses independent nursing judgment for care provided by self and by health care providers to whom care is delegated to achieve quality patient care outcomes. The Emergency Department Charge Nurse is responsible for leading the ER team in the Triage, assessing, directing, evaluation and delivery of patient care in the Emergency Department in acute and often critical situations. The Charge Nurse has adaptability to work in an environment for which the required workload may be fast-paced and stressful. 

The Charge Nurse must demonstrate the knowledge and skills necessary to provide care that is relevant to the patient(s) under their care, as well as apply principles of growth and development over the life span. The Charge Nurse also must possess the ability to assess and interpret patient data needed to identify each patient's requirements relative to his or her age-specific needs 

Essential Functions: 

•  Makes assignments for the shift taking into consideration patient needs and staff skill mix. Adjusts assignments as needed throughout the shift as patient volumes/acuity dictate.
• Functions as a resource for knowledge and clinical skills, teaching/coaching staff. Seeks out additional resources as need.
• Rounds with Physicians, communicates with primary nurse any important or relevant information. Assists with coordination of interdisciplinary team.
• Coordinates with House Supervisor on bed availability and assists with patient bed assignment based on diagnosis of the patient, as well as psycho-social needs of the patient.
• Performs ongoing monitoring of the unit, balancing and assisting with tasks to prevent staff feelings of being overwhelmed or omissions/gaps in patient care.
• Coordinates and/or assists in the completion of admissions, discharges, and transfers; assures timeliness of patient flow and accuracy in patient data collection/documentation.
• Addresses minor performance issues (behavioral, code of conduct, policy infractions); documents occurrence and resolution for Director. Discusses/updates Director regarding any major issues. Fosters a culture of accountability.
• Assists Director with focused Patient and Employee rounds using specified tools and pre-determined rounding criteria 
• Monitors to assure indicators for Core Measures, Quality Outcomes, and Patient Experience are being met (i.e. noise level in/around patient room, visitor accommodations patient centric per policy).
• Monitors unit for Joint Commission requirements and readiness as applicable.

Standard I. Assessment: The Registered   Nurse Collects Health Data.   

Rationale: GRMC nursing practice   is characterized by a high degree of autonomy and requires a broad-base of   subjective and objective data.

· Measurement Criteria

1. The priority of data collection is determined by   the patient's immediate condition or needs.

2. Pertinent data is collected by using appropriate   assessment techniques.

3. Data collection involves the patient,   significant others, health care providers, and other GRMC personnel, when   appropriate.

4. The data collection process is systematic and   ongoing.

5. Relevant data is documented in a retrievable   form.

Standard II. Diagnosis: The Registered   Nurse analyzes the assessment data in determining diagnoses.

Rationale: The Registered Nurse at   GRMC uses independent judgment and available data to formulate a nursing plan   of care.

· Measurement Criteria

1. Plans of   care are derived from assessment data.

2. Plans of care are validated with the patient,   significant others, health care providers, and records maintained by other   departments, when needed.

3. Plans of care are documented in a manner that   facilitates the determination of expected outcomes and care plan.

Standard III. Outcome Identification: The Registered Nurse identifies expected outcomes individualized   to the patient.

Rationale: The Registered Nurse at   GRMC identifies outcomes based on unique factors that affect the Registered   Nurses ability to provide services.

· Measurement Criteria

1. Outcomes are derived from the diagnoses.

2. Outcomes are documented as measurable goals.

3. Outcomes are mutually formulated with the patient and health care   providers, when possible.

4. Outcomes are realistic in relation to the patient's present ant   potential capabilities.

5. Outcomes are attainable in relation to resources available to the   patient.

6. Outcomes include a time estimate for attainment.

7. Outcomes provide direction for continuity of care.

Standard IV. Planning: The Registered   Nurse develops a care plan that prescribes interventions to attain expected   outcomes.

Rationale: Effective planning is   essential for appropriate interventions.

· Measurement Criteria

1. The plan is individualized to the   patient's condition or needs.

2. The plan is developed with the patient,   significant others, health care providers, and other GRMC personnel, when   appropriate.

3. The plan reflects current nursing practice.

4. The plan is documented.

5. The plan provides for continuity of care from   the time of entry into the healthcare system, through transfers to other   departments, to final discharge from GRMC, when appropriate. 

6. The plan provides for discharge follow-up based   on the patient's need for health care, when appropriate. 

Standard V. Implementation: The Registered   Nurse implements the interventions identified in the care plan.

Rationale: The Registered Nurse   is the most appropriate health care provider at GRMC for ensuring that   actions are taken to meet the physical, mental, and health education needs of   the patient.

· Measurement Criteria

1. Interventions are consistent with the   established care plan.

2. Interventions are implemented in a safe,   appropriate, and timely manner.

3. Interventions are documented.

Standard VI. Evaluation: The Registered   Nurse evaluates the patient's progress toward attainment of outcomes.

Rationale: The Registered Nurse at   GRMC uses the nursing process to evaluate the outcome of nursing actions,   interventions, and patient education. The Registered Nurse may alter the care   plan, expand the database, introduce new interventions, and develop patient   education activities.

· Measurement Criteria

1. Evaluation is systematic and ongoing. 

2. The patient's responses to interventions are   documented.

3. The effectiveness of interventions is evaluated   in relation to outcomes.

4. Ongoing assessment data are used to revise   diagnoses, outcomes, and the care plan, as needed.

5. Revisions in diagnoses, outcomes, and the care   plan are documented.

6. The patient, significant others, health care   providers, and other GRMC personnel are involved in the evaluation process,   when appropriate.

Standard VII. Quality of Care: The Registered   Nurse systematically evaluates the quality and effectiveness of nursing   practice.

Rationale: The Registered Nurse at   GRMC ensures that quality nursing care meets measurable community standards.

· Measurement Criteria

1. The Registered Nurse participates in   quality-of-care activities as appropriate to the individual's position,   education, and practice environment. Such activities may include the   following:

a. Identifying aspects of care important for   quality monitoring.

b. Identifying indicators used to monitor the   quality and effectiveness of nursing care.

c. Collecting data to monitor the quality and   effectiveness of nursing care, as appropriate.

d. Analyzing quality data to identify opportunities   for improving care, as appropriate.

e. Formulating recommendations to improve nursing   practice or patient outcomes.

f. Implementing activities to enhance the quality   of nursing practice. 

g. Participating in the work of interdisciplinary   teams that evaluate clinical practice or health services.

h. Developing policies and procedures to improve   the quality of care.

2. The Registered Nurse uses the results of   quality-of-care activities to initiate changes in practice, as appropriate. 

3. The Registered Nurse uses the results of   quality-of-care activities to initiate changes throughout the health care   delivery system, as appropriate.

Standard VIII. Performance Appraisal: The Registered Nurse evaluates his/her own nursing practice in   relation to professional practice standards and relevant statutes and   regulations.

Rationale: The Registered Nurse at   GRMC balances professional performance with the maintenance of safety and   quality patient outcomes.

· Measurement Criteria

1. The Registered Nurse regularly engages in   performance appraisal, identifying areas of strength as well as areas for   professional and practice development.

2. The Registered Nurse seeks constructive feedback   regarding his/her own practice.

3. The Registered Nurse takes action to achieve   goals identified during performance appraisal.

4. The Registered Nurse participates in peer review   as appropriate.

Standard IX. Education: The Registered   Nurse acquires and maintains current knowledge in nursing practice.

Rationale: The diverse health   care needs at GRMC and the need for nursing autonomy require the Registered   Nurse to engage in ongoing education.

· Measurement Criteria

1. The Registered Nurse participates   in ongoing educational activities related to clinical knowledge and   professional issues.

2.  The Registered   Nurse seeks experiences to maintain clinical skills.

3. The Registered Nurse seeks knowledge and skills   appropriate to the practice setting.

Standard X. Collegiality: The Registered   Nurse contributes to the professional development of peers, colleagues, and   others.

Rationale: The Registered Nurse at   GRMC has the responsibility and opportunity to positively influence peers,   colleagues, and others regarding health care issues, education, and practice.

· Measurement Criteria

1. The Registered Nurse shares knowledge,   skills, and information with peers, colleagues (including other GRMC   personnel), and others.

2.   The Registered Nurse provides peers with constructive feedback regarding   their practice.

3.   The Registered Nurse contributes to an environment that is conducive to the   clinical education of nursing students, as appropriate

Standard XI. Ethics: The Registered   Nurses decisions and actions on behalf of patients are determined in an   ethical manner.

Rationale: The Registered Nurse   at GRMC has an ethical commitment to the patient and the nursing profession   that must not be compromised.

· Measurement Criteria

1. The Registered Nurse practice is guided by   The Code for Licensed Practical Nurses and related ANA position statements,   such as the Patient Bill of Rights and JCAHO standards, Standards for nursing   care for the patient care unit and Nurse Practice Act.

2. The Registered Nurse maintains patient   confidentiality.

3. The Registered Nurse acts as a patient advocate.   

4. The Registered Nurse delivers care in a non   judgmental and nondiscriminatory manner that is sensitive to patient   diversity.

5. The Registered Nurse delivers care in a manner   that preserves and protects patient autonomy, dignity, and rights. 

6. The Registered Nurse seeks available resources   to help formulate ethical decisions.

Standard XII. Collaboration: The Registered   Nurse collaborates with the patient, significant others, criminal justice   system personnel, and health care providers in providing patient care.

Rationale: The Registered Nurse at   GRMC collaborates with public and private health care providers to ensure   comprehensive continuity of services.

· Measurement   Criteria

1. The Registered Nurse communicates with the   patient, significant others, GRMC personnel, and health care providers   regarding patient care and nursing's role in the provision of such care.

2. The Registered Nurse consults   with health care providers for patient care, as needed.

3. The Registered Nurse makes   referrals, including provisions for continuity of care, as needed.

Standard XIII. Resource Utilization: The Registered Nurse considers factors related to safety,   effectiveness, and cost in planning and delivering patient care.

Rationale: The Registered Nurse at   GRMC is uniquely positioned to determine the priority, availability, and   appropriateness of resources required to meet the patient's health care   needs.

· Measurement Criteria

1. The Registered Nurse evaluates factors related   to safety, effectiveness, efficiency, and cost when two or more practice   options would result in the same expected patient outcome.

2.   The Registered Nurse assigns tasks or delegates care based on the needs of   the patient and on the knowledge and skill of the provider selected.

3.   The Registered Nurse assists the patient and significant others in   identifying and securing appropriate, available services to address

Standard XIV. Training: The   Registered Nurse (Charge Nurse) will be required to train, educate, supervise   and evaluate students from outside entities or organizations with whom GRMC   has an Affiliation Agreement.

• Current New Mexico or multi-state Registered Nurse license
• BLS (AHA)
• ACLS (AHA)
• PALS (AHA)   
• GRMC approved EKG course within 3 months of hire and annually 
• Moderate Sedation Certification within 3 months from hire date
• CEN preferred
• ENPC preferred
• NRP preferred
• TNCC within 1st year or available class
• Approved de-escalation/crisis prevention training annually
• 2 years Emergency Department/critical care experience preferred