Welcome to our third installment of our Coffee Talk series, Taking Charge, Empowering Emergency Department Charged Nurses for Success. I'm excited to get this event started. For anyone that has attended our prior Coffee Series webinars, you won't need this introduction of our host, Zankana Desai. But for those just joining us, I want to introduce you, and I'm honored to do so, to our Coffee Talk series host, Zankana Desai. She brings us 23 years of experience in the emergency department. Having worked as a charge nurse, clinical coordinator, and ED manager, her extensive expertise in emergency care has equipped her with a deep understanding of the complexities of the ED environment. Currently, she serves as a nursing content specialist here at Emergency Nurses Association and is contributing to advancing nursing practice and education. So we'll get started. Hello, Zankana. Hi, Nan. Thank you for the introduction. Hello, everyone. I'm so glad you can join us today for the Leadership Coffee Talk series. I am your host, Zankana Desai. What we are presenting today is a brief synopsis of the ED charge nurse core competencies. And if this topic is of your interest, assuming as it is, because you are joining us today and looking for further development as an ED charge nurse, please let us know by typing in the chat box what that training looks like for you, if you're interested, and what that training should look like. Without further ado, today with me, I have two amazing experienced charge nurses, Meredith Holder and Marie Hoppe. They are here to present to you a very interactive webinar. So have your phones ready. Take charge in the emergency department. Hi, Marie. Hi, Meredith. Hello. Good morning, everybody. Morning. Let's go ahead and introduce yourselves. All right. Hey, everyone. Good morning. Thank you so much for joining us today. My name is Meredith Holder. I have been an emergency department nurse born and bred for the last 12 years. Spent the first half of my career in Texas and have been out here in Northern California for the last six years. I've been an ENA member since 2013 and have served in various roles across that time. I'm currently working bedside at Stanford University in Palo Alto. And I'm so excited to give you guys a little bit of insight of what it's like to be a charge nurse. And I'm Marie. I'm from Wisconsin. I've been in the emergency department since 2014, started as a tech, and now I am a lead nurse here in Wisconsin. So I'm excited to get this started. All right. Diving right in here. These are the objectives that we hope to touch on today. In 45 minutes, we hope to at least brush on a few of these things. But truth be told, charge nursing cannot be learned in a day, much less 45 minutes. So we're going to outline the essential roles and responsibilities of an ED charge nurse, build a strong leadership foundation, develop strategies to improve ED efficiency, manage patient flow effectively and allocate resources wisely. We are also going to try and address staffing challenges, prioritize tasks and negotiate effectively to support optimal team performance. We're going to utilize techniques for clear communication and fostering of collaboration to create a cohesive and high performing team. And lastly, we're going to apply insights from real world scenarios to meet common challenges and implement best practices in the charge nurse role. And as Zankana mentioned initially, the purpose of this is to be very interactive. So please use the chat and we're going to give some case studies later on. So please participate. We welcome all questions and participation. All right. Next slide, please. So this is our first poll. I wanted to kind of gauge the group and see how many of you guys are charge nurses, how long you've been doing this role for or if you're thinking about it or if you've been doing this for a while and you kind of joined us to see if you could learn something new. So I'll give this a second. You should have a pop up on your screen right now. All right. So it looks like we've got a pretty good chunk of you guys that have been a charge nurse for a while. But we also have a few people that have either been a charge nurse for less than six months or they've never been charged, but they're interested in maybe taking on this role. So if you have been doing this for a few years, thank you for joining. I hope that these topics resonate with you in your current role and maybe you take home something new today. But some of the most basic functions of a charge nurse include management of people. That was including, but not limited to, nursing, physicians, techs, nursing assistants, patients and their families, patient flow, which includes our door to disposition times, moving patients up to inpatient units or ICUs, difficult discharges from the emergency department, allocation of resources, who to call when something goes wrong, where specific equipment or supplies are, keeping track of broken equipment, ensuring there is follow up for situations that you're handling. Is there enough bandwidth or skill set to handle specific patient assignments in certain areas? And then your day to day operations, which really encompasses kind of all of the things I mentioned above. You're on an ANA webinar, so chances are you're no stranger to the feeling of what most ED nurses have a tendency to describe as a dumpster fire. In fact, fire tends to be a bit of a thematic element here among us ED nurses. We have trial by fire. We have rapid fire, baptism by fire, putting fires out. This image actually was so kindly provided to us by Nan today. This was taken outside the Vegas conference this year that ENA had. This is a dumpster truck that is on fire. So this is hopefully not how all of your shifts go. But, you know, with the right amount of patience that you have with yourself, practice, organizational skills and preparation, you can be effective at this role. So thanks again for joining us. And I am curious to know later how we all got into these roles, too. So we'll cover that in a little bit. But right now, this is kind of a charge nurse responsibilities. This whole list of stuff are things that we're responsible for. And if you want to drop in the chat, if you see something on or don't see something on here, we're curious to know if there's other things that you have handled that, you know, job roles come up and in a 12 hour shift that you may not have anticipated. So a few of these things, conflict mediator, counselor, patient and nurse educator, physician educator, mind reader, miracle maker. There's a bunch of things that you're responsible for. See in the chat, somebody just put I.T. maintenance, HVAC, electrician. Yeah, all of these things come up in a 12 hour shift and you try to manage it and move forward. So let's see anything. All right. Yep. Sorry. Reading the chat and talking at the same time. So that's kind of just a basic run through of different responsibilities here. So. OK, next slide, please. All right. So I have another poll for you guys, because I'm curious if you are assigned the charge nurse role in your department based like you volunteered for it. It's an entirely separate job role. Or if you were voluntold to be in this role. Wow. OK, so almost an even split between it's an entirely separate job role, voluntold to be in the role, which is my favorite nursing word that I've ever learned. So and then about 21 percent of you guys were assigned the role on a volunteer basis. So it is great when you work for a department that allows you to volunteer. That means that you are seeking that next level of leadership. And in some cases, I know for me, it's part of our clinical ladder at my current institution. So and the last institution that I worked, it was a separate job role. And Marie and I will touch on how it's a separate job, because for her it is that is her full time gig. So I will go over that later. But let's talk a little bit about building a foundation. These are the top five ranked most important competencies of a charge nurse, according to the ENA clinical research team. So this is patient flow management, communication, situational awareness, clinical decision making and clinical supportive staff. According to this article, those who are ready for the charge nurse role demonstrated strong teamwork skills in the ability to think systemically about the emergency department. So I look at charge nursing kind of like just how I would look at my initial patient assignment, but just on a grander scale. And if you're working in a department where you're not charged 100 percent of the time, your deeper understanding of department operations from that charge perspective can help with patient flow when you're in those regular assignments. And as I mentioned before, unlike nursing, there's no set of textbooks to tell you really how to be effective at this job. A lot of it is trial and error, learning from your past mistakes and learning from from others around you, too. So we'll dive into each of these topics and throughout this webinar. So. All right. Next slide, please. So as I mentioned before, I work one or two shifts per week as a charge nurse rotating through my department. My facility actually uses three different charge nurses during our peak hours. We have one charge that oversees department operations from top to bottom. We have one that is concerned primarily with patient flow. And then we have one who works front of house in the lobby or in the waiting room. I also live and work in California and we have state mandated patient ratios. So that is something that comes into accountability when you're putting together your staffing for the shift. I have also been a charge nurse since 2022. Thanks, Merida. I've been a charge nurse since 2018 and a lead RN since 2020. They are separate roles in our department. Charge nurses are staff nurses that rotate in. Leads are a position where you have to apply for it. It's considered leadership. We do try to strive for 24-7 lead coverage. If there's not 24-7 lead coverage, we'll have a staff nurse jump in as charge while we're at meetings or we just have a day off. We do not have state mandated patient ratios here in Wisconsin. Our facility uses two to three RN leads during our most busy times, which is seven to seven. One focuses on ambulances, arrivals of patients. And the other one focuses more on like the flow of the department in and out of patients, like delays and CTs and stuff. So that's usually what the other person does at our facility. Next slide. Now we're going to talk about patient flow management, which is a big part of charge nurse in the ED. Effective patient flow management requires complex real-time decision making, and it requires placing patients in correct treatment areas. That is prioritizing, anticipating patient care needs based on the ESI level. Whether that's by EMS or walk-ins through triage, the charge nurse needs to assess and anticipate the needs of a patient based solely on the EMS page to determine if a patient is sick or not sick, as well as waiting room patients. ESI algorithm helps to regulate patient flow by sorting and grouping patients for effective and timely care, as well as moving stable patients out of ED rooms to prioritize those sicker patients. That's why it's very crucial to have direct communication with your triage nurses. They know what's coming through the door. They're the eye and the ear out there in triage. Well, you might be in the back. So having that communication with them, whether that's on a like a chat or calling them, is very effective. So you know what's going on. Also, awareness of hospital capacity of your hospital. Although ED charge nurses lack control over inpatient hospital beds, we maintain awareness of inpatient bed availability and patient boarding. Having this knowledge with the help of like house supervisors or other clinical professionals will help impact patient flow. Boarding equals fewer rooms in the ED for ED patients, which can equal higher triage times and the potential for sicker patients in the waiting room, which all can lead to a higher rate of leaving against medical advice, elopement and left without being seen. So having that direct communication with those other departments, seeing what's going on in your hospital. Like, for example, today we were I think we're boarding like 30 patients. So we're in communication a lot with patient placement. Just calling them every so often for updates is very important. So you can see how the flow is going to go in the department for the day. Next slide. Charge nurses can be described as having a 360 view of the waiting room, ambulance arrivals and department acuity and outstanding patient needs. That is why we're described as thinking a shift ahead. Patient flow management relies on real time knowledge of current patients and current resources. Charge nurses are always anticipating department needs such as staffing, the bed availability, flow barriers with other departments such as CT, X-ray and transport, and then the lack of beds. ED charge nurses are always planning for potential closures of certain areas in the department, such as an example would be pod A is closing at 2100 tonight, which is in three hours. But I still have six active patients in those rooms. What do I do? So you start looking ahead, looking for other rooms to move patients to, which could mean having patients wait longer in the waiting room because you need to move those patients out to those other rooms. Also causing flow delays, moving patients in and out, getting scans done and stuff. Patient flow management should promote timely patient care. Charge RNs are always anticipating care orders, accomplishing patient tasks, assessing and reassessing patients, recognizing those delays and communication with the providers. It's very critical to have communication with the providers. If you know your patient's been an average ER stay is between four to five hours, you're hitting that five hour mark. Go talk with the provider. Hey, it looks like CTs are done. Everything is coming back. What are we waiting for? Are we waiting for a consult? Are we waiting for just a disposition? Sometimes they're busy just as we are with multiple patients. Sometimes they just need that quick, like, hey, it looks like everything's back. Do you think we can dispo this patient? Also allocating float and break RNs for better flow. As an ED charge, we're always looking. We always know what's going on at all times in the department. That might be meaning knowing that critical care area is being hit with a lot of patients and the need to send extra staff for help. Allocating those extra nurses without assignments can help decompress those critical situations for better flow in the department. By that, they can accomplish tasks. They can hang meds. They can take patients to CT. They can take someone up to the ICU. They can take someone down to MRI. That's all going to help with the flow in the department. And it's nice that they don't have patient assignments where they can just jump in, help the team, and then jump back out where they need to be. Charge nurses are also recognized when transport times become higher and send help to get those patients to inpatient beds. In our department, we have techs. And when we see that the delay for transport could be up to 30 minutes to an hour, if a tech is not busy at the moment, we send our techs to help get those patients upstairs. So just knowing where your staff is and where to allocate where the need is most needed. Patient safety is the ultimate goal of patient flow management. We have our first case scenario. Case scenario one is on the flow management. So you're working as a charge nurse working in a level one trauma center. You get a radio call for a patient in cardiac arrest and make plans accordingly to land the patient in a specific zone of your department. Immediately following that call, you get a second call for a code three lights and sirens acute respiratory distress. Before you can make the decision where you can place the patient, you get a trauma patient immediately following that call. Anticipating three very sick patients arriving all within five minutes of each other. What action do you take first? So if anybody wants to put it in the chat, what are, and there's no wrong answers. We're just looking at what people might do. I think a lot of people right now reading the chat are talking about their staffing availability at this point and ensuring that there's enough people to take care of these sick patients for sure. And all of these patients are acute. And I would add insult to injury here and say, and you have one bed left. So if that's like a typical day in your department, you know, there's a few options that you can take. Anyone that doesn't require cardiac monitoring could sit out in a hallway, calling the house supervisor, trying to move some people around that way. So that's a few options that you can take. And I would add insult to injury here and say, and you have one bed left. So if that's like a typical day in your department, you know, there's a few options that you can take. Anyone that doesn't require cardiac monitoring could sit out in a hallway, calling the house supervisor, trying to move some people around that way. So calling in your additional resources. If you have a pharmacist that can help out with, you know, the code three. Or like, so you'll have, you know, possible intubations for both of those patients. So respiratory and respiratory backup, because it sounds like both those patients may be a pending intubation. And obviously deciding where those patients are going to land. And delegating to each of those teams who's going to be caring for those patients. So as Marie mentioned, you know, always knowing which patients can move out of what rooms is kind of like your bread and butter in patient flow management. Constantly be discussing with your care teams what patients are going to be anticipating discharge. and if you can kind of allocate resources around. So if the trauma team can help out getting that patient started, just make sure that you're following your facility protocols. If you need the trauma attending for that specific case, and those of you that work in level one trauma centers, in order to keep your accreditation, you need to make sure that people have arrived to your traumas in a timely manner. So and then making sure you have enough staffing to cover this. So that is a good segue to our next slide here. Our staffing concerns within clinical decision making. So this part of becoming a charge nurse will be somewhat based on your previous experience as a bedside nurse. ED nurses are generally known for their resourcefulness, their ability to make something out of nothing. I would be willing to bet there is not one nurse on this webinar that has not been affected by some sort of staffing crisis, at least one shift in your career. And I think you're getting lucky if it's just one shift in your career. So I'm just going to use a personal example really quick. I had a weekend shift where I was short by about eight nurses due to call outs. In some cases on the weekends, you may have less patients. But I I really think the acuity is what really hurts you in these situations. So during peak times at my facility, we staff up to forty two nurses. Someone asked earlier how many beds I have. I think physical rooms. We have sixty five in my department, but we have a lot of flex spaces that we've opened up in the past few years. So running eight short on that weekend was going to be a challenge. And so we're going to discuss some strategies and another case scenario in a few slides. But think about some staffing strategies that your department has used over the years and some things that you can do as a charge nurse. An additional component here for me was also staffing ancillary positions, making sure that we have enough techs and unit clerks to maintain day to day operations. And I spend a lot of time in the mornings, usually about an hour, making sure that staffing is completely covered for my shift, because you don't want to dig a hole for yourself later on. If you know you're going to need people, put that call out early, give people an opportunity to make a decision about coming in extra. A lot of times I'll play let's make a deal. If I'm desperate to get people in, then, you know, tell me where you want to be for the day. Do you want to be in a specific assignment? Will that get you to come in if I can promise you a triage space or something like that? So all right. So next slide. This is our kind of some additional components of clinical decision making model, just your ability to prioritize. Clinical competence is huge when you're considering staffing as well. Are those nurses trained in triage? Are they able to anticipate deterioration? And I know I'm in an apartment where we have new grads, and so just making sure that they're adequately prepared for some of these higher acuity patients that we're getting and critical thinking skills necessary to charge nursing. A lot of times you'll have these challenges that you're dealing with day to day. And I feel like I never handle the situation the same way twice. So using your own critical thinking to handle these problems and your problem solving skills and with that. And then again, considering your new versus seasoned nurses and your staffing assignments, you don't want to try to put all of your new people together because then that pod is just going to be kind of running behind for the entire shift. So so let's touch base with a staffing concern case scenario to my next slide here. You are in charge. And when you look at the assignment for the day, you see that you're I made it easy. You're only four nurses short around your midday. Historically, this is your department's busiest time. You've made several calls for help, but no one can come in to work extra hours today. What do you do? Look into the chat box here, if you guys have any sort of. Insight on this. Knowing strength and weaknesses of staff member helps and assignments, that's imperative. Yes. Float pools and resource nurses. Yeah. Flexing staff. Agency, if you have that availability, yeah. So first and foremost, knowing your chain of command, use your chain of command, let management know that you're working short nurses and you've put the call out for help if management can't provide any immediate assistance during that block of time, start to look at what what other areas you can pull nurses from. Does your department use a float? You may need them to take an assignment for a few hours. Do you have a zone that's not open until a later time? You can pull some of those people from that zone to cover. And I work in a union hospital. We are very serious about our breaks and making sure that our nurses get those breaks. So that is part of my role as a charge nurse. Do you need to potentially close some beds down to accommodate that low staffing or can you do some bed moves to help even out staffing? So, again, patient ratios in the state of California. ICU is one to two, one to one if they're especially sick, and then our typical E.D. staffing is one to four. Could a break nurse or a float nurse help out with more than just breaks in your zone? Can you coordinate with house soup to get your patients moved out faster? So just being creative in your staff plans for the day can help you out a lot. So all right. Next slide, please. Communication and teamwork are also imperative in this role. So this is just kind of nice encompassing everything that comes with communication and teamwork, ensuring that you're clear and effective with your communication. If you're the department leader, you are setting the tone for the shift. If you come in chaotic, your shift is going to be chaotic. If you come in calm and organized, the shift is probably still going to be chaotic, but you're going to channel that controlled energy to your peers and it's going to help you in the long run. Something I know I've worked on personally is ensuring that the loop is closed, for lack of a better term. If I need something specific done or if someone needs something specific of me done, then I repeat back to that person. OK, so this is the plan. This is what we're going to do. And that way we're all on the same page before something goes awry or something is misunderstood. Conflict resolution. We're going to touch on that in a little bit. You work in a department full of adults and you really want them to behave like adults. But again, that doesn't always pan out. So crucial conversations are huge in this role day in and day out. And not just with your co-workers, who may also be your friends, but also with patients and families. Diplomacy, emotional intelligence, listening skills. A lot of these things, you know, your co-workers will come to you for solves for problems. And honestly, just listening to them for a second, having them take a step back from the situation and talking with them about what the problem is that they're facing that can bring them a lot of solace in the shift. Maintaining your calm, like I said, don't come in chaotic because that will channel the energy to your whole department and time management. It's it applies at the bedside and it applies with charge nursing, too. I personally use a charge nurse brain. And when you were first a nurse, you like wrote down all the things about your patient, had your your brain when you were working. I have a charge nurse brain and it reminds me all the things that I need to make sure happening throughout my shift and autonomy. You get a lot of decision making power when you're in the role and, you know, use that use that wisely. Next slide, please. And so, again, these crucial conversations can happen across the shift in many different ways. So whether you're speaking nurse to nurse, nurse to patient or patient family, I think the best way to go about this and again, I'm no expert. There are six, eight, ten week courses, an entire book about crucial conversations. So just drawing on personal experience here. What typically works for me is having one on one conversations with individuals when they're having problems and knowing that there's two sides to each story. So if you're having a nurse on nurse conflict, listening to both sides, having a second to just talk to those people. Same thing with nurse to patient issues and a lot of times patient family issues, too. I think that no one ever comes into the emergency department on their best day. So stress runs high. Your stress is running high as a charge nurse. But just kind of working through that and, you know, hopefully everyone gets on the same page eventually and knowing that if people don't get on the same page, that we should not be tolerating any sort of violence in the emergency department. So if you have a violent patient, violent family, making sure that those people are out of the picture. So I'm going to touch into a case scenario here about a nurse that has come to inform you that they no longer wish to care for a patient in their assignment due to behavior from a rude family member. What do you do? And you guys can use the chat box and say. What do you think you would do in this situation? Awesome. Finding the root of the problem. And find a nurse that may be a better fit for that patient. Validate. I like that. Investigate why there is a problem. So you do have several options here. You have to understand that there are always two sides to every story. A lot of times there is misunderstanding between family and staff. In my experience, this stems from miscommunication or misinterpreted communication. So as the charge nurse in the situation, I make sure that someone can cover the phones for a minute and then I go have a conversation with the nurse one on one and then with the patient or the family member that's causing the issue. It's important to set boundaries as well, letting families know that their behavior is unacceptable. But you also have to offer alternatives. One of the biggest things for us is that we have family members that come out to the nurse's station. They feel like that's way more helpful than just hitting the call light, which in most cases we would prefer that they hit the call before they march out to the nurse's station. And so making sure that the family are aware that this is a boundary that we're setting. Please use the call light. If no one is responding, then you can potentially come out to the nurse station. But chances are we're in with another patient and it's a critical situation. So people come to the emergency department, as you know, and expect things to just happen like that. And we know that that's not true. It's a marathon to the finish. You can always reassign this patient if, you know, I don't want to put nurses in situations where they feel uncomfortable caring for someone, especially if there's not going to be any solution to that problem. Marie, do you have some insights on? Yeah, like you said, I mean, we don't tolerate that behavior in the emergency department or any health care setting. So getting security involved, knowing your resources, you know, sometimes just removing that rude family member, that patient sometimes gets better and is nice to you, and sometimes it's just that visitor and they just have to leave and really all of us just switch assignments. There's no harm in switching assignments. You know, it's better for the nurse. You don't want that nurse to keep going in that room or, you know, mental health is a really big thing here in the emergency department. And self-care, you just don't want her or him going home and thinking about it. So just switch those assignments for them. OK, next slide, please. OK, time for a quick pulse check. Everybody still with me? As you can tell from this webinar, this is not a job for the faint of heart. But then again, neither is nursing. Everyone has these moments where they're brand new and inexperienced at something. Charge nursing offers a new set of challenges that will affect your professional growth and development. I have a tendency to leave many charge shifts mentally drained more so than physically. As this profession has made great strides towards focusing on resiliency and mental health, a few things that I like to do during some tough shifts include making sure that I take some breaks when I need them, I step away from the desk. I have lovingly referred to them as my smoke breaks, even though I'm not a smoker, but just going out to the ambulance bay for even two or three minutes, getting some fresh air, feeling the sun on your face if you're a day shifter or feeling the moon on your face if you're a night shifter can really make a difference. Then you can come back and reset and be ready to take on some of those challenges. So after my shifts are done, I make sure I get a good night's sleep when I'm off the next day and I plan to do something for myself. I have picked up running recently and also so shout out to my running buddy who's on here today and shout out to my carpool because we like to do a debrief after every shift to on the way home. So, Marie, I know you'd have some things that you do, too. Yeah, up here in Wisconsin, when it's cold like today, when it's 12 degrees, sometimes I'll have somebody watch the desk for me and just take a lap around the department or take a lap around the back hall just so you can just take a breather, walk down the cafeteria, even if you're not going to get anything to eat or walk to Starbucks. We have good supervisors here and good supervisor support. So lean on them. Talk to them a lot. All right, well, I'm just kind of flipping through the chat here and see if you guys have questions. One of the ones that came up, my charge nurse brain, just to do like a quick description, I write all of the things that I'm supposed to check off for the shift. So I'm ensuring that there's N95s available, ensuring that there's the crash cart checks have been done. We're responsible for going to a bed huddle at the first thing in the morning and then making sure that we have enough gurneys and pumps for the shift. And then I kind of keep track of we have rotating teams that take critical patients. So I keep track of that, keep track of where my ICU patients are located, where my psych patients and one to ones are. We're also a stroke STEMI center. So keeping track of MRNs that have come across a stroke or STEMI when I have call outs, writing those down and then accepting transfers, as well as keeping track of our peak points in time and how many patients we're seeing across the shift. So and that's that's kind of what I add to my brain. That is exactly what we do here. Every night we go around, check all the defibs in the department, all the critical care supplies, we check the trauma room. We have a new design trauma room. It's fully stocked. We check that, check all the Lucases, make sure the batteries are all working. Some of that we do on night shift and throughout the day. If something's used like the Peds cart is used, leads and charge nurses will make sure it's restocked and tied back up and tidied up for the next patient. Well, thank you guys so much. We have four more minutes before we end this webinar, and I have some questions that are coming in. So let's go ahead and answer some of those questions. One of the questions I have is how are you handling borders when there are just enough nurses? In my department, we have border nurses that come down inpatient and they come down and board our patients in the emergency department. So right now, if we have 30 patients boarding, we might have eight border nurses and then four CNAs that come down to help take care of those patients so we can, as soon as they get admitted, we send them off to the, we call it borderland, and those nurses take those patients, so then our ER nurses can take and see patients. It kind of gets hard when there's not enough rooms. We have about 64 care spaces. Sometimes we do utilize those halls for patients, rather that's like fast track patients for ER that are quick vertical patients, or sometimes if they're easy enough patients that are boarding, they can go in the hall. Thank you, Marie. I have another question that came up. Are you using provider and triage or a split flow? For me at my hospital, we have a, we have triage and we have an intake. That's all out in triage, and a provider does sit there from, I believe it's nine in the morning till six at night. After that, we do nurse orders, nursing orders in triage. How about you, Meredith? My facility also uses provider and triage during the peak times. We have started kind of a split flow program. We've sanctioned off part of our waiting room to be vertical patients, so we can at least start patients out there. We've had plenty of patients that fail out of the vertical zone, and then we can move them back to rooms if they are inappropriate for that side. Thank you. I have a couple more questions. Are you guys OK to answer those? Absolutely. OK, one of the other questions I have is what is your favorite and your least favorite part about being a charge nurse? I'll start with that one. I would say my favorite part about being a charge nurse is like leading my department and having people come to me to seek out my advice, even though there are times where I feel like it's not really great advice, but it's just, you know, validating their feelings and just kind of guiding my co-workers who a lot of whom are my friends through a shift and how to handle certain situations. Let's see, my least favorite part about being a charge nurse, I think, is not being able to manage flow. In some cases, there are some days where you're just wall to wall with patients and you can't move anyone and it just seems like the world is on fire and you were given like one pail of water to put it out with. So and I just have to remind myself that, you know what, 7 p.m. will be here before too long. And I will I will go home and we'll deal with this again another day. Thank you. Well, that is all the time we have for today. I want to thank everybody for joining us on this charge nurse webinar. If there's something that you are looking to further development to further develop your charge nurse skills, please let us know and thank you so much again for joining us. Thank you, Marie. And thank you, Meredith, for being our panelist today. Thanks again for having me. Thank you so much.

charge nurse competencies

emergency department

patient flow management

communication skills

conflict resolution

staffing challenges

teamwork

resilience