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Well, Sunday was a big day. It was my 43rd birthday, and also my first night as Designated Charge Nurse. Of course, I've been a relief charge nurse for a couple years now, and I've basically been doing the job full time -- as relief -- since the last DCN stepped down.

Despite my experience, relief charge nurse expectations are lower. Your job is to keep the ship from hitting icebergs until the captain sobers up. I tried not to intervene in management or personnel problems unless things threatened to descend to physical violence (it happens).

The last DCN stepped down because it was not a rewarding experience. Emergency room nursing is brutal, fast and filled with moments of instant gratification. People come in sick and most of the time make them better or keep them from dying. That's cool.

Being charge on the other hand is a lot like herding cats -- only some of the cats are drunk, high on meth, vomiting, incontinent of bowel and bladder -- and that's just the nurses. Seriously, you spend a lot of time in a logistical nightmare of managing limited resources. You have to smooth over conflicts, break rules, make rules and otherwise be the calm adult amid the chaos.

The night we found out our fearless charge was stepping down, about 10 people came to me and asked if I was going to apply. Now there are three reasons that 10 people ask you to do a job:

  1. Because they think you are the best person for the job
  2. Because they think you can do the job and at least not screw it up worse than other people and ...
  3. Because they think you are the only person stupid enough to do a job that no sane person wants.
Regardless, I was the only person who applied -- as far as I could tell. I still had to go through the interview process, where I impressed even myself with my managerial gobblygook. 

The hardest part for me is staying in the chair when I want to be jumping in a caring for patients. Or, as one unit secretary put it ..." you need to fly the plane, not get up and serve drinks."

I think I'm  a pretty good nurse, but being a good nurse does not make one a good charge nurse. It is a completely different job and I may be a perfect example of the Peter Principle which states  "in a hierarchy every employee tends to rise to his level of incompetence." Good engineers get promoted to become lousy managers, for example. 

Every job I've had, I've quickly been foist into the roll of being in charge. So, maybe I'm a lousy nurse but I'll be a good charge nurse. If I start feeling confident, I'll remind myself of the Dunning-Kruger Effect -- which posits that the most incompetent people don't know their are incompetent. Per Wikipedia:

"Actual competence may weaken self-confidence, as competent individuals may falsely assume that others have an equivalent understanding. As Kruger and Dunning conclude, "the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others"

So how did my first night go? Well, Sunday night was fine, but Saturday was crazy with a full department all night long and the staff stretched thin. At one point we had three ICU level patients in the department and two conscious sedations at the same time. I got my lunch at 4:30 AM, but everybody got their lunch and I didn't have to mandatory anyone. 

I also felt incompetent, which thanks to Dunning-Kruger, I'll take as a good thing.

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