Charge Nurses’ (CN) work includes 54 different skills that shows both the daily work but also how to lead at a MI. The 54 competencies are divided into four different categories: clinical / technical, human relations skills, organizational and critical thinking. The risk of MI has increased during the last decades and threatens to overwhelm the healthcare system. Nurses have played a significant role in response to disaster ever since the beginning of the profession. Nurses knowledge and ability to act in MI are of critical importance. CN are the extension of the clinics management as they lead the daily work and are important as front-line leaders in the organization. As soon as MI is declared, the emergency department (ED) role changes as the CN implements the MI plan, coordinate the ED management team, allocate resources to optimize patient safety.

The aim of the study was to describe the charge nurse's perceived experiences in managing daily work and handling a major incident in the emergency department. A qualitative study design using semi-structured interview. Four focus groups (n=12) were included in the study. The interviews were analyzed based on Malterud's method for systematic text condensation. The analysis of the interviews revealed four main categories: executive supervisor over disorder, needing further training, uneasiness, and strategies. To become a skilled CN in MI they must be an experienced nurse in the foundation and worked for several years as a nurse. Most CNs feel like they do not have enough training to lead at an MI. CN worries about some elements such as the example to lead the scenario of chemical hazards. CN has disaster plans to work by, but they build strategies themselves to handle certain events. The conclusion of the study is that the CN work is very diverse and multifaceted and often not fully described in the job description. CN needs recurring education and training to be able to develop into a skilled leader. To increase CN's perceived competence to manage an MI, they need to demonstrate both for themselves but also others that they have the highest expertise in acute care but also have good leadership qualities.