Checklist
Charge Nurse Checklist
Being charge nurse means you're the first one people look to when something goes sideways. This checklist keeps you ahead of the shift — covering handoff, assignment, midshift adjustments, and overflow management. Check it. Use it. Adjust it to your unit.
1
Pre-Shift / Handoff
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Review census and staffing gridKnow your ratio before the board is set. Flag any gaps now.
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Read outgoing charge's notesCritical values, pending consults, family dynamics, any patient who's circled. Grab the full picture before you step on the floor.
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Verify bed capacityED board, pending transfers, PACU arrivals. Know what's walking in before it walks in.
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Check equipment statusIV pumps, telemetry, PCA pumps. Know what's broken or missing before your nurses find out at the bedside.
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Confirm float pool / agency coverageKnow who's unfamiliar with the unit. Adjust assignments accordingly — don't put them on your sickest patients.
2
Assignment & Huddle
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Set assignments before bedside roundsPair experienced nurses with high-acuity patients. Pair newer staff with assignments that build skills without creating risk.
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Hold a 5-minute standupCritical values overnight, any pending procedures, any patient concerns, overflow plan. Write it where the team can see it.
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Identify your "watch" patientsAny patient who could deteriorate, any family that's volatile, any task that's time-sensitive. These get checked hourly, minimum.
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Confirm midshift coverage planIf someone calls out, where does the overflow go? Know the answer before you need it.
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Brief new arrivals on unit normsWhere the supplies are, how to contact you, escalation process. Every person who walks onto your unit needs this information.
3
Midshift Oversight
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Walk the floor every 2 hoursSee your nurses. See your patients. Interruptions can wait — visibility is the job.
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Re-assess acuity midshiftAdmissions happen. Patients crash. If census or acuity changes, re-balance assignments immediately — don't wait for the problem to land on one nurse.
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Manage interruptions ruthlesslyEvery "can I just ask you something" has a cost. Batch your availability — be reachable on purpose, not at the mercy of whoever speaks first.
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Update the board every admission and dischargeAn outdated board creates miscommunication that compounds all shift. Treat it like a living document.
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Check in with overwhelmed nurses proactivelyDon't wait for them to ask for help. If you see someone falling behind, move resources before the gap becomes a patient safety issue.
4
End of Shift
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Complete a structured handoffName the "watch" patients explicitly. State what's pending, what could decompensate, and what's already been handled. Give the oncoming charge the full picture.
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Document unit issues for the next shiftEquipment failures, staffing holes, patient concerns. Write it where it'll be seen — don't assume verbal communication is enough.
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Flag anything that needs manager awarenessDon't let a problem sit unreported because "it worked out." If it almost went wrong, that's still a reportable event.
Adapt This to Your Unit
This checklist is the skeleton. Your version should reflect your unit's specific risks — ICU adds vents and drips, L&D adds fetal monitor checks, ED adds boarding patients. Write it down so you don't have to improvise at 0300.