Charge Nurse Assignment After a Call-Out

Start by recognizing that the unit is short one RN and that "do the best you can" is not a staffing plan. The charge nurse should not carry a full RN assignment; if a partial assignment is unavoidable, it should be the most stable patients, with another RN covering high-risk medications and assessments.

A safe plan:

• RN A: the heparin infusion and telemetry patient, plus other stable patients. Heparin requires RN assessment, aPTT monitoring, and rapid response to bleeding. This RN should not also take the postoperative PCA patient.
• RN B: the postoperative day 0 patient with PCA and drain, plus stable patients. This RN needs to perform frequent assessments, manage pain, and monitor the drain.
• Charge nurse/RN C: no full assignment; cover admissions, medication double-checks, and breaks. Take 2–3 stable patients only if absolutely necessary, and hand off the heparin patient if a crisis occurs.
• LPN: stable patients with oral and subcutaneous medications and dressing changes after RN initial assessment. The LPN should not take the heparin infusion, the PCA patient, or the first assessment of a new admission.
• UAP 1: vital signs, glucose, intake/output, and ADL support for the C. difficile patient with strict contact precautions.
• UAP 2: fall-prevention rounding for the patient with dementia, plus vital signs and ADLs for stable patients.

Escalate to the house supervisor for a float RN or agency nurse and document the unsafe staffing concern.

Delegation must match scope of practice, patient stability, and the nurse's ability to supervise.

Can delegate to the LPN: administering oral and subcutaneous medications to stable patients, performing dressing changes after the RN has completed the initial assessment, reinforcing teaching that the RN has already started, and collecting routine data. The LPN cannot perform the initial assessment, develop the care plan, administer blood, or manage the heparin infusion if that is restricted by state practice or hospital policy.

Can delegate to the UAP: vital signs, blood glucose, intake/output, weights, ADLs, positioning, and fall-prevention rounding. The UAP can report a change but cannot interpret it or decide whether it is urgent.

Cannot delegate: the initial assessment, the postoperative assessment, PCA management and monitoring, heparin titration, evaluation of teaching, and any clinical judgment about deterioration. The charge nurse remains accountable for the assignment and must check in with the LPN and UAP at defined intervals. The high fall-risk patient needs frequent rounding and possibly a bed alarm; the UAP can carry out the rounding, but the RN must assess injury risk and restraint use.

To the house supervisor: "We are one RN short, and I cannot safely cover a heparin infusion, a postoperative PCA patient, and a new admission with the current skill mix. I need a float RN or agency nurse now, or I need you to authorize closing beds or transferring a patient. The LPN cannot take the heparin or PCA patient, and the UAP cannot perform assessments. I am assigning the charge nurse without a full assignment, but that leaves admissions and break coverage exposed. This is a staffing concern I am documenting."

Documentation should be factual: the planned staffing, the call-out, the patients' acuity, the assignments made, the specific tasks that could not be covered, the time the supervisor was notified, and the supervisor's response. Avoid vague phrases like "unsafe staffing" without specifics. State the potential harm, such as delayed heparin monitoring or missed fall precautions.

Use the chain of command if the supervisor does not act. At the end of shift, complete an staffing event report if policy requires it. The goal is not to threaten the supervisor but to create a record that supports system change and protects patients.