Rocks in My Shoes: 3 Obstacles ED Charge Nurses Face [PART 1 of 3]

EDITOR'S NOTE: Special thanks to Greg Brown, MN, RN, for writing today's blog post. You can connect with him on LinkedIn. 

It’s no secret that Emergency Department nurses wear many hats, but as Charge Nurses we have additional demands beyond those of our colleagues. When walking into the charge role, we are gifted not only with the responsibility, but also the privilege to lead a staff for the next 12 hours.

No matter what happens over those 12 hours, there are always two outcomes: The shift will get better, or it will end. I, for one, relish the challenge of being a charge nurse in a busy ED. I get to flex my problem solving, prioritizing, and critical thinking skills in a broader scope that affects my organization as a whole entity.

That being said, when things start to go sideways, the challenge can become overwhelming and exhausting, and the only thing we can do is to make the best decisions we can at that moment. Sometimes we win, and sometimes we fall on our faces. But that is the beauty of leading an ED. We are surrounded by allies, who all rally behind each other and pick each other up. Our successes and failures are shared, and as a Charge Nurse, we get to lead, well … the charge!

Furthermore, approaching situations and tough issues with positivity or at least neutral responses can have a direct impact on the team’s perception of the shift. As a Charge Nurse, I chose to work nights exclusively. That meant fewer resources, more issues, and newer nurses. When my frustrations were palpable, it would have a direct impact on the morale of the department. After all, I was the most senior leader among my peers, and when the captain is frustrated, the proverbial ship is at a greater risk of plunging down and sinking into the briny deep!

Here is the first of the “rocks in my shoes” that I face when leading my ED team, and how I work around the issue to present a positive front to my team.

OBSTACLE # 1:  Lack of Staffing Resources for the ED

In nursing school I was told, “ED nurses are good at everything, but are masters of none.” I tend to disagree with that statement. We are good at controlling chaos … that is our specialty after all. Most of our patients arrive with a “chief complaint,” we have no diagnosis, no clinical data, no care plan, nothing. When that patient hits the door, we assess one thing right off the top: how much time does this patient have between now and eternal slumber?

Now, throw in a patient load of 4+ patients per nurse, all of whom need assessment, interventions, and care based off a chief complaint and appearance, and we become masters of prioritizing our patients. We are down and dirty in a way of thinking and care that is unique to the ED theater and does not lend itself to interoperability between nurses.

Therefore, most ED staffing issues are solved internally, through frantic pages, emails, and phone calls to the staff who are enjoying their day off. Sometimes the sweet siren call of overtime gets answered, but more often than not, it doesn’t. So EDs work short-staffed, and we learn to be flexible and carry on. I’ve learned to take a minute to breathe, approach the situation of being short staffed as an opportunity to become a better leader and settle into the “this is what we’ve got and we’ll make it work” mindset.

Don't forget to check out parts 2 and 3 of this blog series, where we cover the critical obstacles ED Charge Nurses face, including "Barriers to Facilitating Flow for ED Patients" and "Ineffective or Innacurate Communication."