[VivaLasViejas]

I hear what you're saying, Kevin, and I know from experience that it's true. One of the first things a new nurse manager learns is how to kiss corporate's behind, then turn around and make the workers sniff her/his breath and say it smells like peppermint. I can't count the number of times I had to "lay down the law" with my staff because of some corporate dictum, whether I personally believed it was good policy or not. Sometimes I had to lay people off because "our census is down", despite the fact that numbers didn't tell even half the story (of the 40 beds on my unit, only 28-32 were occupied, but the workload was sometimes worse than when ALL my beds were filled with less-challenging patients). Other times I had to implement new rules or policies that I KNEW the staff would hate, and I spent half my time apologizing to them for the rules being so harsh. I swear, the upper-management people stayed up nights thinking up new ways to torment the staff and make a hard job even harder!

In the end, I couldn't do it anymore......couldn't enforce things I didn't believe in, couldn't toe the company line and be "tough" (I was a terrible manager, I was more interested in being fair). So now I'm back to being a peon again, and damned glad of it. Some people are cut out to be managers, and maybe I could have been a good one with another organization, but I never was able to reconcile the "nurse" part of me that cared about my co-workers with the "manager" side that was supposed to be all business. I felt like I was not able to be true to myself in that position, and nobody was more relieved than I was when I got kicked to the curb five months after starting the job!

[pieWACKet]

Lack of Voice is without doubt the largest demoninator. This includes within it the subtexts of wage, image, hospital culture and its components. Nurses at the bedside are not valued for their voice, and this cascades into a lack of voice inherent to their image and profesion. Even nursing leadership and education ignore the importance of bedisde expertise. WHY do we require a Masters/PHD to instruct at the BSN level, while medicine, and law, require only a person competent via practise? Law Schools and MD programs in fact gain prestige through the practise of their professionals giving ocurses. WHY is the same not evident in nursing? Because the bedside nurse is not esteemed and not given voice, in the hospital culture, and the educational component that "defines" it.

[flameangel]

Staffing is not our biggest problem, believe it or not. It's lack of resources and room. Most of our patients complaints are related to waiting times in the ER. They wait in the lobby until we have an ER bed to put them into. Then lab/X-ray/etc. usually takes 2-3 hours minimum. If they are to be admitted, expect a couple of more hours getting a bed. I sent one to the floor today who had been in the ER 18+ hours! Try to explain this to the pt and family... there just is no real good answer after you've used up all your "It won't be much longer now"s and "I'm sure they'll have a room for you soon"s. This is not an everyday occurence but it's becoming more and more frequent - I can see burnout starting to weasel it's way into our staff. Any suggestions?

[cotjockey]

For me it's a combination of things and one wouldn't really exist without the other. Staffing is a major issue, not really short staffing so much as corworkers who simply do not pull their weight. It frustrates me that a nurse with only four patients manipulates much of the time of the CNA who is supposed to be helping everyone when other nurses have eight patients. It happens a lot here because we are often assigned by halls rather than acuity. We also have a couple of nurses who are very good at sitting and reading magazines while the rest of us run. They get away with it because management doesn't do anything about it. A lazy nurse is better than no nurse at all in their eyes. I also see problems with lack of recognition. I know the hospital cannot run without everyone who works there, but it often seems that the nurses get shafted. Which would hurt more, if no one from the business office showed up for two days or if no nurses showed up for two days? I think the importance of nurses is often forgotten.

[canada]

Poor management which leads to not enough staff. Its a vortex that pulls every nurse down because you cannot give the care your patient needs. Within this vortex you'll find low moral, negative attitudes, high abesenteeism, high stress and burnout.
I'am working hard at changing my attitude in hopes of seeing things differently. Anyway with all this my vote goes to POOR MANAGEMENT along with LOW STAFFING.

[Agnus]

Poor management. I have worked short and carried on with good management behind me knowing I was not expected, by management, to be 5 people. I was expected to just do the best I could. I have had management (in these cases) pick up slack for me. Even non nursing management pitched in to help where they could.
Good management makes all the difference. Because stuff really does roll down hill. Management sets the tone for everything.
On the other hand no matter how well staffed, etc. If you have management that only cares about the bottom line and considers you a warm body to be kicked then it suks. Also management that is disorganized, doesn't know what the left hand is doing, doens't do its job, life is miserable.

If you meet me half way that is all I need to be great, even in adversity.

[POPRN]

Since I could only choose one. I choose staffing. But I think that short staffing and poor management go hand in hand. I work in the OR and not on the floor and they have us doing cases alone that just a few short months ago it was a 2 circle case. Because of the shortage of nurses, sometimes we have a tech as a second circle. They are great techs but as a 2nd circle. it just makes more work for the RN. They don't like to answer the phone or pagers. They can't do the many pages of paper work. Sometimes they are even in the room to run for supplies.
We have lost so many good RN's due to the poor management we have. Favoritism is rampant, communication is poor to say the least. There are too many managers for our dept. I could go on and on. I love what I do. I like the Dr. and staff. they aren't my best buddies. But I can work with anyone. I have been a nurse for 12 years and have never been written up. I have wanted to look for another job, maybe even get out of the OR. The only reason I am still here is simple...the hospital is 2 miles from my house. Poor reason I know.

[barefootlady]

Poor management is the biggest cause of low morale, lack of staff, increased rates of absence, and depressed work environment. I just quit my job today because I could not take another day on a unit so badly ran and so risky for my future. I hope to find another one soon, but if not, then Walmart here I come. Yes, I am truly tired of the politics, overwork, lack of respect from Doctors and other health care workers. Maybe I will feel a little differently after a break, but right now, I just want some time off to rest up and decide if nursing is still what I want to do for a few more years.

[cheerfuldoer]

I feel ya barefootlady. Rest up. I may join you at Walmart one day.

By the way...practice the slogan and you may land the job:

Hello! Welcome to Walmart!

[barefootlady]

Cheerfuldoer:

Thanks for the understanding kind words. Hubby almost had a cow! Did not really want to stay but it paid the bills. Am not looking forward to job hunting again in this slow economy.