Hey DONs, Nurse Managers, Educators!!

[ainz]

It is difficult to find and keep nurses, especially good nurses. All of the administrators want agency usage eliminated. Nurses, as a whole, are usually unhappy with their current working conditions and salary. Usually nursing management is caught in the middle of this and that can be a miserable place to be. What do we do about all of this?

It is my opinion that addressing the current issues that are leading to a nursing shortage and directly contributing to the dissatisfaction of nurses starts with the nursing leadership. Unit and department managers have a primary responsibility to engage in leadership activities that will promote job satisfaction. Directors of Nursing or Chief Nursing Officers should support and expect their unit managers to work to improve morale of the staff nurses. If we are going to advance our profession and retain and recruit people into the profession we must start improvements ourselves. There is far too much fighting among ourselves and petty competition and bickering over patient assignments and a general lack of teamwork and so on. This is not to mention staffing issues and workload issues. American nurses are shouldering a heavy burden compared to nurses in other places so maybe we should start recognizing the skill, knowledge, and dedication our nurses possess and stop criticizing so much.

If your staff nurses are not successful and satisfied then you will not be successful or satisfied. Satisfied employees = satisfied customers = satisfied managers. Unit managers need to actively find ways to support, recognize, reward, and generally make the staff nurses' life easier. If the manager's success depends on the success of their staff then some of the major functions of their job become quite clear--support your staff!! There are many ways to do this and much literature has been written on the subject. Just a few of my ideas:

-stay out of your office, be visible, be available

-pitch in and help when you see staff struggling with something

-go all out to honor requests for time off

-come in early and take report with your staff

-work the desk and ensure good communication and flow of info

-stand up for and defend your staff when appropriate

-actively and aggressively look for things that are done right

-seek out, recognize, and actively celebrate high quality care

-leave your "power trip" at home, view yourself as a servant of your staff, not a "master"

-allow your staff to have the professional autonomy they need

-encourage educated risk-taking in trying new things

-create an open, relaxed, positive, professional atmosphere

-communicate, communicate, communicate

-do not criticize openly and be slow to reprimand

-do not engage in gossip

-do not criticize the administration of the hospital

-do not create an "us versus them" culture and feeling on the unit

-look for ways to make your hospital the best

-look for ways to build business in your hospital

-view your unit as your own small business

-be passionate about your work, your unit, your staff

I would encourage Directors of Nursing to have the same attitudes and to aggressively learn how to link nursing interventions to positive patient outcomes to positive financial performance for the organization. One view we must overcome is that administration often sees nursing as "a nurse is a nurse is a nurse." They also sometimes don't understand why a nurse is better and required versus an unlicensed person or an RN versus an LPN. Our staff nurses depend on you to communicate the value of nursing to administration. DONs must be able to identify and explain the interventions that are unique to nursing and that no one else can do so the value of nursing is promoted. We must be able to link these unique nursing interventions to positive patient outcomes to positive financial performance so that nursing can begin to be seen as a revenue generator and not a mere consumer of resources and a very high salary expense that must be contained and decreased in some way. You should know that making a profit and/or maintaining an operating margin is a top priority for the administration of all hospitals. Develop new and creative ways to show how nursing adds to the financial performance of a hospital and not merely chips away at their bottom line.

Educators--please consider incorporating some basic healthcare finance into the curriculum. Also some leadership training and training on professionalism. We have to present ourselves and communicate that we are professionals and I believe the socialization process for new nurses begins in nursing school.

[purplemania, BSN, RN]

All very good points: and most can go both ways. Just because someone is a staff nurse does not mean they are a valuable employee. Some are lazy, have borderline personality disorders, etc. Likewise, we cannot assume that all problems are due to poor management. Nursing is definitely a team effort and we are all valuable players. Some people just want to sit on the bench.

[ainz]

Very true. Not all nurses are high quality performers. I think it is frequent that nursing leadership is hesitant to deal with poor performing nurses or nurses with negative attitudes because they are afraid that nurse cannot be replaced. Many times nurses would rather work short than with a non-performing, negative nurse.

In order for nursing to be valued as it should be I think there is much that can be done starting in the nursing department itself. As we have read numerous times on this BB and other places, nurses can be rather cruel to each other and the in-fighting really hurts the profession.

I think it important that nurses portray a very cohesive, positive, energetic, professional image. If we don't do it no one else will and that is for sure. There are many small things that we can do that will chip away at the issues that cause us dissatisfaction with nursing. It all starts within our own profession and among ourselves.

[purplemania, BSN, RN]

I have developed more respect for nursing profession since returning to school. All those theories and nursing history I learned before were just loops to jump thru in order to get my license. This time I realize the value each of us contributes. Education (or awareness) is probably basic to any change in attitude and that is what some of us need. In case you have not heard it from anyone else today: We are special!

[barb4575]

I found these posts very interesting as I have served in the roles of CNA, staff nurse, charge nurse, DON and faculty. My own personal opinion is that most of the leadership that I have met in facilities just don't get it...perhaps it is because I was in the US Army Nurse Corps and I know that my staff's needs must be taken care of before my needs if I want to have a successful delivery of care. I have worked the summer as an agency nurse and I find that the managers are for the most part, not available, not concerned and do not value education. I believe that education is what fires a staff up along with showing them that you, as a manager, care about them. Regardless of the leadership tactic used, the bottom line is the customer and if the manager focuses on the patient as a customer and not the staff, he/she is in for a rough ride.

I also believe in the BSN as entry level into practice, but realistically we cannot do it with the shortage. Perhaps some restructuring of roles is in line. Above all else, we are the largest of departments and we do not stand together...quite sad indeed.

[ainz]

Sad indeed is correct in my opinion. I agree that most unit nurse managers just don't get it. Based solely on my observation, it appears that many nurse managers are promoted based on their seniority and/or clinical skills, usually some combination of both. And then there are the "favorites" of nursing administration. What a grave mistake to do this.

I believe the CNOs, DONs, whatever title you want to call them, have an obligation to the profession, their organization, and the patients to carefully choose nurse managers based on their leadership and management ability, not their clinical ability.

Satisfied employees = satisfied customers = successful hospital

Nurse managers are THE KEY to having satisfied employees.

[NurseBoricua]

It is the manager's responsibility to take appropraite course of action for those nurses that truly are placing patients' life at risk due to pure laziness, yet on my floor I feel as if my nurse manager does not hold other workers on the unit to similar standards, which creates an environment of fear and lack of support from those who report to nurses.

[19Claire59]

Ainz:

I really like what you said about how Nurse Managers should behave in order to create satisfaction amongst nursing staff. If you don't mind, I copied that list you made and I'm posting it in my office. I think it will be a great reminder for me in my relationships with my students as well as my co-workers. As a matter of fact, I worked under one nurse manager who did almost everything on your list. She values education and still makes her staff keep up with all that's new (that pertains to their unit). She's a terrific role model.

[hhrhrn41, RN]

Sad indeed is correct in my opinion. I agree that most unit nurse managers just don't get it. Based solely on my observation, it appears that many nurse managers are promoted based on their seniority and/or clinical skills, usually some combination of both. And then there are the "favorites" of nursing administration. What a grave mistake to do this.

I believe the CNOs, DONs, whatever title you want to call them, have an obligation to the profession, their organization, and the patients to carefully choose nurse managers based on their leadership and management ability, not their clinical ability.

Satisfied employees = satisfied customers = successful hospital

Nurse managers are THE KEY to having satisfied employees.

Ainz, you've taken the words right out of my mouth, although I could not have said things as well as you just have, espec. your initial post. I think I may print it out and it may "accidently" find it's way onto our bulletin board at work. My unit manager needs a wake-up call!

[Geeg]

I think that nurse managers and DON's get it. They are not stupid, they have just bought into the management propaganda. Sometimes, these jobs are stepping stones and or resume padders, so people don't stay in them for very long. The only quality that management rewards is the ability to contain costs and keep the staff at bay.

[weetziebat]

I think that nurse managers and DON's get it. They are not stupid, they have just bought into the management propaganda. Sometimes, these jobs are stepping stones and or resume padders, so people don't stay in them for very long. The only quality that management rewards is the ability to contain costs and keep the staff at bay.

I have to agree. Isn't it sad?

A nurse I know just had her fifth year anniversary at a large city hospital, and her 'reward' was 5 balloons. Not that one needs a reward, but far better to get nothing than what they thought of as a reward.

And, IMO, we have no one to blame but ourselves, and our nursing management. We won't stick together, we won't fight it - we just moan and groan, or turn away and quit - so we get as much as we'll take.

Hate to sound sexist, but possibly the best thing that can happen to nursing is for more men to enter the profession. Women are just too willing to put up with the crap.

[gloray]

This is a great list and among many of the issues that has gone wrong with our profession is the inability to be able to communicate. The issues facing new nurses are unfortunately the same issues we faced as new nurses. I worked as a nurse manager and I made myself as available as possible to my staff. I am now a nursing school administrator and I believe in teaching professionalism and to make sure students have excellent communication skills. We have to remember a good communicator needs to able to send and receive a message effectively. We need to listen to the staff and our young nurses it is unfortunant that this profession has the need to eat its young.