Managers can I change your opinion of them? - page 7

by madwife2002 17,032 Views | 65 Comments Senior Moderator

it is a very lonely world out there for managers. i became a manager of a dialysis facility in august 2010. i was promoted from within, not the best way to start out in your new role! why-because everybody has certain... Read More


  1. 0
    Quote from kbrn2002
    Our management nurses don't work any holidays. We are a 90+ bed facility, on 1rst shift, Monday through Friday we have 4 staff nurses. We also have a DON, ADON, 2 Nurse Managers and 2 MDS and Admission nurses. So, 4 staff nurses and 6 management nurses. The DON is the only one officially on-call for after hours emergencies. Not a very efficient ratio for staff care in my opinion.
    Unfortunately the paperwork requirements make it so that many organizations are top heavy this way. In home health sometimes we would have 4 nurse managers and only 2 or 3 RNs out seeing patients. This is a tremendous cost to the facility.

    I will say that you are only mentioning 1st shift so I am sure there are nurses on the other shifts too. The two nurse managers don't do any patient care? I am guessing they are in charge or supervisors, but how do they not do any patient care? What is their role? If they are so essential they should be alternating holidays. I would think that the DON and the ADON would share the on-call responsibilities too.

    My experience in LTC is limited- casual PRN work for a small nursing home. But even at 1/3 the size we had a DON and a ADON. The ADON did most of the paperwork, rounded with the doc if she was there, and pitched in as needed. The DON occasionally worked as a staff nurse if no one could be found to cover. I guess we had a pretty good team.
  2. 0
    Quote from barbyann
    An example would be when I worked in sub-acute (I lasted four days). I had a 15 pt med pass and no clerk. I remember hearing laughing in a conference room around the corner. I took note of who exited that room 3 hours later. The DON, ADON, case manager, infection control RN, Clinical educator, scheduler, MDS. I remember thinking how bizzarre that it was me and one other nurse on the floor for 30 pt, same scenario on the floor above. It just seemed a little top heavy to me at the time. I had no break....they had lunch delivered.
    Exactly! I know just what you went through. It's frustrating beyond belief to work your "donkey" off trying your best to provide adequate if not great patient care while the management brigade is having a 3+ hour meeting in the next room.
  3. 0
    Your post reminded me--- I HATE HAVING A CLOSED DOOR!!!!!!


    However, I am constantly being scolded that for joint commission, CMS, and the fire marshall it is a violation. Some environment of care nonsense. I am sorry but, really? It sends the message that "I am too busy for you" or "I want to be left alone" or "I am doing something private" ugh! If I am needing privacy I will shut the door. I do not understand the basis for the rule and I feel like it alienates people, so every chance I get..... I OPEN the door! FYI doorstoppers are contraband......If it is a fire safety thing why can't I shut the door when the alarm sounds? This is procedure for patient rooms...
  4. 2
    Unfortunately, I don't think nurse managers have much control. It's upper managemant who doesn't really have a clue. Most nurse managers have experience as floor nurses. I do think some of them have been managers for so long they have forgotten what it's like in the real world of nursing. You couldn't pay me enough to be a nurse manager. Someone is always upset with you. If it's not a nurse on the unit, it's upper management for asking for too many things to make your unit better. I have complained abut managers here too, everyone can always be better, myself included. I know that most nurse managers work hard and do things that I don't know anything about. It would be nice though if we could all just work better together. We have the same goals, pt. safety, pt. care ect. Sometimes it really isn't personal although I'm sure it seems that way. As floor nurses we want better working conditions and better care for our pts. Most of us will continue to work on that and I think most nurse managers will too. Good luck to you.
    RNAM1965 and justalpnwmg like this.
  5. 4
    I am a nurse manager who has to close the door.
    I am very hands-on with patients, staff, and work on the floor as needed. I have to keep the dang door shut because I cannot file state reports, audit the MARS, look into investigations with the mounds of paperwork attached, file incident reports, etc, with the constant stream of people going in and out.
    Do I stop when I have a patient or family or a stressed employee at my door? Yes. Do I have my work cell phone constantly ringing? Yes. Do I often end up working 60-70 hours a week? Yes. Am I the first there in the morning and the last one there at night? Yes. Do I work weekends and neglect my family due to deadlines because I had to instead deal with employee relation issues? Yes. So I keep my door shut!!
    Also, I take to task employees who work a solid 8 with mandatory breaks who have issues with my smoke breaks. Hmmm- salary means I don't get lunches (unless I wolf something down I brought in over some reports at my desk), I don't get to work a straight 8 and I am on call 24/7 so I earn my smokes in peace.
    RNAM1965, justalpnwmg, madwife2002, and 1 other like this.
  6. 1
    Quote from cxg174
    Unfortunately the paperwork requirements make it so that many organizations are top heavy this way. In home health sometimes we would have 4 nurse managers and only 2 or 3 RNs out seeing patients. This is a tremendous cost to the facility.

    I will say that you are only mentioning 1st shift so I am sure there are nurses on the other shifts too. The two nurse managers don't do any patient care? I am guessing they are in charge or supervisors, but how do they not do any patient care? What is their role? If they are so essential they should be alternating holidays. I would think that the DON and the ADON would share the on-call responsibilities too.

    My experience in LTC is limited- casual PRN work for a small nursing home. But even at 1/3 the size we had a DON and a ADON. The ADON did most of the paperwork, rounded with the doc if she was there, and pitched in as needed. The DON occasionally worked as a staff nurse if no one could be found to cover. I guess we had a pretty good team.
    To answer your questions the two nurse managers don't do any patient care at all, they are strictly paperwork nurses. There are no managers after their day ends, promptly at 4:00 pm I might add. They do not alternate holidays, they simply don't work any [neither do therapy and office staff] so on holidays the staff nurses are on their own. There is also no "supervisor" on other shifts, the senior nurse in the building does their regular job plus any supervisory duties that may arise. As for the on-call responsibilities, the DON is the only "official" on call, but good luck reaching the DON or the ADON after hours. I have never had either one answer a phone call. The only upside is the staff nurses are extremely talented and capable of handling almost anything.
    barbyann likes this.


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