New93 role standards, now public
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Role standards

Nursing

Charge nurse

What an experienced registered nurse must be able to do to run a shift on a busy inpatient unit: match patients to nurses who can safely care for them, keep the unit flowing, and be the point where a worried nurse's concern turns into action. Drawn from the Clinical Nurse Leader certification blueprint, the US certification built around point-of-care unit leadership, and grounded in TeamSTEPPS and the national delegation guidelines.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
4
Sources
3
Version
1

Built from Commission on Nurse Certification, American Association of Colleges of Nursing, Agency for Healthcare Research and Quality, National Council of State Boards of Nursing and American Nurses Association. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent charge nurse does on day one, dimension by dimension.

Clinical skills

  • Answers a nurse's concern, or their own observation, that a patient is deteriorating by going to the patient, triggering the right escalation now, and freeing the staff the response needs.
  • Orders competing demands across the whole unit by clinical risk, so the patient who cannot wait is reached first and nothing else is lost.

Workflow and tools

  • Makes and remakes assignments so every patient has a nurse with the competence and capacity to care for them, and escalates when the unit cannot be made safe.
  • Keeps patients moving through the unit - admissions, transfers and discharges - without letting throughput pressure override any one patient's safety.

Patient communication

  • Responds to a patient's or family's complaint about their care by listening, acknowledging honestly, fixing what can be fixed, and coming back as promised.
  • Holds a high-stakes conversation with a patient or family honestly and calmly, without false reassurance, stepping outside their role, or withdrawing from it.

Compliance and safety

  • Acts as the first escalation point for staff: takes a concern seriously, carries it up the chain of command until someone with authority acts, and closes the loop with the nurse who raised it.
  • After an error or near miss on the shift, makes the patient safe, makes sure the event is disclosed and reported through the safety system, and treats the staff involved fairly.

Role knowledge

  • Assigns and delegates across RNs, LPN/VNs and assistive personnel within each person's scope and demonstrated competence, and supervises the work so that accountability stays where it belongs.
  • Works across professions on behalf of the unit, settling disagreements about a patient by looking at the facts together and escalating what cannot be settled.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • When a nurse reports, or they see for themselves, signs that a patient is acutely deteriorating, tells the nurse to recheck later, wait for rounds or a score to trigger, or handle it alone, instead of going to the patient and escalating now.

    A charge nurse who waves off a worried nurse turns one person's early warning into nobody's, and failure to rescue a deteriorating patient is one of the commonest preventable causes of death in hospital.

  • Discourages or stops a staff member from calling the rapid response team or a provider about a patient they are worried about, or lets an unresolved escalation drop without going up the chain of command.

    Staff escalate through the charge nurse. If the charge nurse is where escalation stops, the patient loses every safeguard above the bedside, and the staff learn not to speak up.

  • Assigns a patient to a nurse who has not shown the competence that patient needs - a float or new nurse given a titrated infusion, a monitored rhythm they cannot interpret, or an unstable post-operative patient - without direct support, because there is nobody else.

    An assignment is a promise that someone able to care for the patient is caring for them. Making it without the competence behind it is how an unrecognised change or a titration error reaches the patient.

  • Delegates to an LPN/VN or nursing assistant work that needs RN assessment or judgment or lies outside their scope - the admission assessment of an unstable patient, IV push medication, first-time teaching - or treats delegated work as no longer an RN's responsibility.

    Work delegated beyond scope is work done without the preparation or legal authority it needs, and the unstable patient is the one who most needs an RN's judgment.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not prescribe, change medical orders, or tell a nurse to give a medication outside the order.Escalates to the provider, and above the provider through the chain of command when the order is unsafe.
  • Does not hire, discipline or dismiss staff; those are the manager's decisions.Removes an impaired or unsafe staff member from patient care at once under policy, secures the patients, and reports to the manager and house supervisor.
  • Does not tell a patient or family a diagnosis, prognosis or result before the provider has.Answers honestly within their role, arranges the provider conversation, and stays present for it where they can.
  • Does not run a unit that cannot be staffed safely without telling anyone, and does not close the unit to admissions on their own authority. Staffing law differs by state; California, for example, sets minimum nurse-to-patient ratios in regulation.Escalates to the house supervisor or administrator on call early, follows the state's staffing rules and the organisation's staffing-concern process, and documents it.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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