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Lev <3, BSN, RN 46,245 Views

Joined Jun 3, '11 - from 'Another planet'. Lev <3 is a ED Registered Nurse. She has '4' year(s) of experience and specializes in 'Emergency - CEN, upstairs, troll bashing'. Posts: 2,799 (53% Liked) Likes: 5,200

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  • May 25

    It's been along time since I've felt like I worked for a good manager... but I'm VERY familiar with bad ones.

    A good manager doesn't stand in the middle of a unit filled with patients, family members, consultants and others and scream at a nurse for some unproven error.

    A good manager understands the job well enough to know what's realistic to expect a person to do and what's an absolute impossibility.

    A good manager is visible and approachable to his/her staff, in a way that doesn't make them want to hide when they see him/her coming.

    A good manager knows that every additional paper I have to handle, every new assessment I have to score, every new protocol I have to follow, every new research project started on the unit, will add to my workload and take time away from something else.

    A good manager will ensure that each employee is doing their job, their WHOLE job, every day. I don't have time to file all the chart copies of lab reports, track down an aide to help me with linen changes and turns, go to three different supply carts for the items needed to start tube feeds and any number of other tasks that are part of someone else's job description on top of my own.

    A good manager consults with his/her staff when changes are being made to ensure their points of view are considered. This applies to purchasing new equipment - don't ask us to evaluate several options and then go ahead and buy the one nobody liked because they're not user-friendly for one reason or another... or they aren't going to do what we need them to do. This applies to process changes - the people who are actually DOING the job will know better than anyone else what's going to work and what's just going to make their jobs more difficult.

    A good manager knows enough about his/her employees to know what their strengths are and acknowledges them for their skills and abilities through assignments appropriate to their rung on the clinical ladder and through fair distribution of responsibilities.

    A good manager knows that recognizing individuals for their good work, even privately, can more than balance out criticism for their their slips. It's unbelievably patronizing to send out a mass email telling staff what great team players they are, how hard they work, who much their efforts are appreciated after a horrendous shift that they've just survived without any help from those in higher pay grades. It doesn't really validate their value in anyone's eyes. In the same way, sending out a mass email castigating the entire group for errors made by one or two really isn't a great strategy.

    A good manager makes the effort to be visible to those who don't work banker's hours. When the people who work nights have never even met their manager, that's a problem.

    And finally, a good manager doesn't desert his/her staff in the middle of sweeping changes occurring on their unit that affect EVERY aspect of their working lives. That's going to kill morale deader than dead.

  • May 24

    We had to do this a few years back. One of the patients blew a gasket after being hospitalized for a few days and hearing the same thing over and over and over....his response? "Why the h*** do you people act like d*** robots? I'm an individual; talk to me based on me! Get the h*** outta my room"!

    Of course the manager that would stand outside the door eavesdropping with the script and clipboard to make sure we were "following the protocol", went scrambling back up the hall when she heard the patient's reaction. So much for treating the 'individual' patient.

  • May 24

    I work in a free standing ED for the local hospital so "we" are away from the typical BS. I've had the pleasure of knowing my manager before either of us got into nursing. She ran EMS as I did and do on occasion still.

    My opinion, if managers operated the way mine does, there would be a huge difference in morale everywhere. This lady does more and goes above her salary and job specs. As laid back as they come, fair, personable, comes out of the office and works when needed and she does the work of 10 people! She has to do her share of butt kissing I'm sure but we hardly see it and knowing her it is as little as possible.

    Just got a new nurse to the ED that came from the floor in our hospital. The things they had to say and do was so off the wall it was comical.

  • May 24

    Quote from Ruby Vee
    I've had good managers and bad ones, too. The good ones will listen to the story, the problem, both sides of the argument before reacting.

    The good managers will support their employees and then, if required, discipline them behind the scenes. I had a colleague make a really dumb mistake, and she made it in the middle of physician rounds. Voices were heard loudly exclaiming about the morons that work in this ICU, and how did someone so stupid make it through nursing school. The manager went in, defused the situation, told the physicians they needed to apologize for their rudeness toward her nurse (and waited until they did) and then whisked the nurse into her office for a little talk. Only after my colleague was done crying over being humiliated so publically did the manager discuss the actual mistake with her. And although not everyone knows it, there was discipline involved as well. The bad ones -- and this was me -- will pile on publically and then never seek out the rest of the story. "Did you, Ruby, tell Dr. Iusedtobeapathologistandamnowtryingoutcardiacsurge ry that he was a moron?" "No, ma'am. I only told him that if he wanted to do a heart transplant on every patient who had a cardiac tamponade, he'd better have a cousin in the enforcer business to go around and line up donors for us. He told me that only an idiot would say that to a man who had just finished telling a patient's wife her husband was going to die without a transplant, so I told him that only a moron would talk to the wife about a heart transplant without at least checking with his Fellow about opening the chest because the experienced ICU told him his patient had a tamponade and he needed to get on it NOW rather than after his pizza break." (OK -- I was somewhat more tactful -- but the manager didn't understand my POINT. The patient had a tamponade -- needed to be fixed now. He didn't need a transplant, although he would have needed a pine box had the charge nurse not dragged the Fellow out of the OR -- the resident was so sure he was right and I was wrong he wouldn't even PAGE him -- and we opened the chest.) She told me I needed to apologize to Iusedtobeapathologistandamnowtryingoutcardiacsurge ry; the Cardiac Surgery Fellow brought HIM to apologize to ME.

    A bad manager tells you that if you need Wednesday off because the biopsy came back positive and the HMO's only oncologist is only available on Wednesday in the clinic three hours away, you'll need to find your own replacement. A good manager asks you how you're doing, and if Wednesday is the absolute soonest you can get an appointment and if she can call her friend who is the oncologist's scheduler's mother to see about getting you in sooner. And by the way, I've taken you off the schedule for Wednesday and if you need any other days off, please let me know.

    A poor manager hears about you being on your cell phone all day while your orientee (who is nearing the end of her orientation) and tells you that you're obviously not fit to precept. A good manager asks you if anything is going on at home, because you're not usually on the phone at work. When you tell her that Mom has Alzheimer's and your sister programmed your cell phone number into Mom's direct dial and Mom has been calling you all day looking for your father, who died two years ago, a good manager takes you off the schedule so that you can fly home and sort out Mom's living situation, faxes the FMLA papers to you in hour home town that is so small there's no cell phone coverage and sends you an Edible Arrangement because that's all you have the time and energy to eat.

    A bad manager accosts you at 7:35, waves your rhythm strip which is already analyzed and signed in your face and says "This is inadequate charting." A good manager wanders by at 7:35, sees that you've already posted your rhythm strip and says "Good -- now we'll have documentation that he actually WAS in atrial fib so that cardiology resident will have to believe that nurses can distinguish A fib from that other rhythm."

    A good manager either knows the job and can do it well, or understands the outlines of the job and trusts her staff to do the job well and believes them when they tell her that they need more X, Y and Z and perhaps someone could talk to Dr. Dick and explain to him that "Yes, nurses can analyze a rhythm and if he ever again refuses to come when called because of a serious dysrhythmia, she'll be having a talk about it with the Highest Head Honcho of Doctoring." A bad manager will talk to her nurses about not pestering Dr. Dick at nigh because he needs his sleep.
    This is eloquent and accurate!!! My only addition to the "bad manager" list is this: managers should not hire, nor protect from firing, incompetent friends and relatives.

  • May 23

    I experienced leadership and management training in a very unforgiving environment a long time ago and dealt with the harshest peer review imaginable, would they come back for you when your a** was hanging in the wind. I learned the single most important quality of a leader is to protect your team, then make sure everyone has what they need to succeed (training, tools, defined roles, and a plan succession) Recruit and hire for cohesiveness, be responsible for a unit culture that thrives on high performance and teamwork.
    A good manager takes responsibility for short comings as well as rewards success.
    Then this manger gets ground to dust by corporate management, and all those people that hang around the part of the hospital with carpet on the floors. And the older staff will sometimes say "remember so and so, he was a good manager what ever happened to him"

  • May 23

    Quote from Ruby Vee
    I've had good managers and bad ones, too. The good ones will listen to the story, the problem, both sides of the argument before reacting.

    The good managers will support their employees and then, if required, discipline them behind the scenes. I had a colleague make a really dumb mistake, and she made it in the middle of physician rounds. Voices were heard loudly exclaiming about the morons that work in this ICU, and how did someone so stupid make it through nursing school. The manager went in, defused the situation, told the physicians they needed to apologize for their rudeness toward her nurse (and waited until they did) and then whisked the nurse into her office for a little talk. Only after my colleague was done crying over being humiliated so publically did the manager discuss the actual mistake with her. And although not everyone knows it, there was discipline involved as well. The bad ones -- and this was me -- will pile on publically and then never seek out the rest of the story. "Did you, Ruby, tell Dr. Iusedtobeapathologistandamnowtryingoutcardiacsurge ry that he was a moron?" "No, ma'am. I only told him that if he wanted to do a heart transplant on every patient who had a cardiac tamponade, he'd better have a cousin in the enforcer business to go around and line up donors for us. He told me that only an idiot would say that to a man who had just finished telling a patient's wife her husband was going to die without a transplant, so I told him that only a moron would talk to the wife about a heart transplant without at least checking with his Fellow about opening the chest because the experienced ICU told him his patient had a tamponade and he needed to get on it NOW rather than after his pizza break." (OK -- I was somewhat more tactful -- but the manager didn't understand my POINT. The patient had a tamponade -- needed to be fixed now. He didn't need a transplant, although he would have needed a pine box had the charge nurse not dragged the Fellow out of the OR -- the resident was so sure he was right and I was wrong he wouldn't even PAGE him -- and we opened the chest.) She told me I needed to apologize to Iusedtobeapathologistandamnowtryingoutcardiacsurge ry; the Cardiac Surgery Fellow brought HIM to apologize to ME.

    A bad manager tells you that if you need Wednesday off because the biopsy came back positive and the HMO's only oncologist is only available on Wednesday in the clinic three hours away, you'll need to find your own replacement. A good manager asks you how you're doing, and if Wednesday is the absolute soonest you can get an appointment and if she can call her friend who is the oncologist's scheduler's mother to see about getting you in sooner. And by the way, I've taken you off the schedule for Wednesday and if you need any other days off, please let me know.

    A poor manager hears about you being on your cell phone all day while your orientee (who is nearing the end of her orientation) and tells you that you're obviously not fit to precept. A good manager asks you if anything is going on at home, because you're not usually on the phone at work. When you tell her that Mom has Alzheimer's and your sister programmed your cell phone number into Mom's direct dial and Mom has been calling you all day looking for your father, who died two years ago, a good manager takes you off the schedule so that you can fly home and sort out Mom's living situation, faxes the FMLA papers to you in hour home town that is so small there's no cell phone coverage and sends you an Edible Arrangement because that's all you have the time and energy to eat.

    A bad manager accosts you at 7:35, waves your rhythm strip which is already analyzed and signed in your face and says "This is inadequate charting." A good manager wanders by at 7:35, sees that you've already posted your rhythm strip and says "Good -- now we'll have documentation that he actually WAS in atrial fib so that cardiology resident will have to believe that nurses can distinguish A fib from that other rhythm."

    A good manager either knows the job and can do it well, or understands the outlines of the job and trusts her staff to do the job well and believes them when they tell her that they need more X, Y and Z and perhaps someone could talk to Dr. Dick and explain to him that "Yes, nurses can analyze a rhythm and if he ever again refuses to come when called because of a serious dysrhythmia, she'll be having a talk about it with the Highest Head Honcho of Doctoring." A bad manager will talk to her nurses about not pestering Dr. Dick at nigh because he needs his sleep.
    Ruby Vee,

    You are truly a great story teller, or a writer of interesting exemplars, as some would note.

  • May 23

    I suspect the majority of what a manager does is invisible to me. Kind of like outsiders see us on the computer and complain that nurses do nothing. I like it when good managers hire quality people who don't need heavy-handed management. Quality coworkers makes work so much better.

  • May 23

    One that pitches in when you are drowning instead of chasing after you to tell you what you already know you have to do...I will get to it, but I have to put out the fire first. Priorities. If you have the time to chase me down and tell me, you should have the time to maybe do it and have someone call me to let me know it's already done (I will be forever greatful and tell you so when I can finally breathe and take myself off life support, figuratively speaking) Teamwork. Teamwork. Teamwork.

    One that answers her phone when I'm left in charge of 110 residents. I'm only calling you because it's an emergency. I've arrived for my shift and NOBODY is HERE (except the residents and their soon to arrive family visitors....HELP ME!!!). Do not leave me to a book of phone numbers that we already know will go to voicemail and no one is willing to come in.

  • May 23

    i have a management team that I cannot say enough good things about. All of them are easy to talk to and totally understand that i am in a new environment (Many years in the OR, now on the floor) and it's a tough switch. Even when i've had problems with organization and charting and such, it's not been punitive. They really want to help me succeed. For that, i am eternally grateful.
    In recent jobs I have had managers that run the gamut from those who probably haven't been within 20 feet of a patient in a coon's age and their overtures of offers to help are totally fake to the ones who would gladly throw their colleagues under a bus (then back that bus over them again) if it meant better recognition and advancement for her. So I have had some pretty crappy managers and it makes me appreciate what I have now that much more.

  • May 23

    I think the best manager is the kind that remembers what it's like to be a floor nurse, who isn't afraid to get his or her hands dirty and show some solidarty for their staff. I had a manager at a former job who worked 3p-11p. She was the "night manager" since it was such a huge floor and would help with meds, get patients on and off the bedpan, answer call lights. All the time. It was amazing. My first shift ever at my current PRN job ended with my manager coming in, in her scrubs, on a Sunday, to help from 7p-11p until the supplemental 11-7 nurse came in. The sight of those women did more for morale than any silly nurse appreciation week gift I could imagine.

  • May 23

    I had one manager who I admire so much till this day. She was very supportive and a great listener. She knew I wanted to pursue a higher education and would kindly donate brand new NCLEX books and A&P learning material for me to have. She would even send me hand-written "Thank You" notes that were personable because she took the time to get to know my strengths. I never had a manager that supportive with great people skills. Best of all, I admire her integrity. She was challenged in many ways, but I witnessed how she handled things with respect and ethics. I always told myself if I ever become manager I want to be like her

  • May 23

    Quote from NightNerd
    Offers to help on the floor when needed. .
    Yes, this! Actually has the ability to help out on the floor!

    I'm sure there are exceptions but my favorite nurse managers have been the ones who have been there done that. Seasoned nurses who were willing to get their hands dirty when we were being clobbered and were a help rather than getting in the way attempting to verbally interject their lack of experience all the while clutching their clipboard like its the holy grail. In my experience the best NMs have worked as a nurse, imagine that?, know when a policy coming down the pike is BS and will have the decency to say "look I know this sounds absurd but its the directive so we need to at least attempt it" and then will advocate for the team and stand up to admin when the latest impractical idea from above doesn't work.

  • May 23

    I've had good managers and bad ones, too. The good ones will listen to the story, the problem, both sides of the argument before reacting.

    The good managers will support their employees and then, if required, discipline them behind the scenes. I had a colleague make a really dumb mistake, and she made it in the middle of physician rounds. Voices were heard loudly exclaiming about the morons that work in this ICU, and how did someone so stupid make it through nursing school. The manager went in, defused the situation, told the physicians they needed to apologize for their rudeness toward her nurse (and waited until they did) and then whisked the nurse into her office for a little talk. Only after my colleague was done crying over being humiliated so publically did the manager discuss the actual mistake with her. And although not everyone knows it, there was discipline involved as well. The bad ones -- and this was me -- will pile on publically and then never seek out the rest of the story. "Did you, Ruby, tell Dr. Iusedtobeapathologistandamnowtryingoutcardiacsurge ry that he was a moron?" "No, ma'am. I only told him that if he wanted to do a heart transplant on every patient who had a cardiac tamponade, he'd better have a cousin in the enforcer business to go around and line up donors for us. He told me that only an idiot would say that to a man who had just finished telling a patient's wife her husband was going to die without a transplant, so I told him that only a moron would talk to the wife about a heart transplant without at least checking with his Fellow about opening the chest because the experienced ICU told him his patient had a tamponade and he needed to get on it NOW rather than after his pizza break." (OK -- I was somewhat more tactful -- but the manager didn't understand my POINT. The patient had a tamponade -- needed to be fixed now. He didn't need a transplant, although he would have needed a pine box had the charge nurse not dragged the Fellow out of the OR -- the resident was so sure he was right and I was wrong he wouldn't even PAGE him -- and we opened the chest.) She told me I needed to apologize to Iusedtobeapathologistandamnowtryingoutcardiacsurge ry; the Cardiac Surgery Fellow brought HIM to apologize to ME.

    A bad manager tells you that if you need Wednesday off because the biopsy came back positive and the HMO's only oncologist is only available on Wednesday in the clinic three hours away, you'll need to find your own replacement. A good manager asks you how you're doing, and if Wednesday is the absolute soonest you can get an appointment and if she can call her friend who is the oncologist's scheduler's mother to see about getting you in sooner. And by the way, I've taken you off the schedule for Wednesday and if you need any other days off, please let me know.

    A poor manager hears about you being on your cell phone all day while your orientee (who is nearing the end of her orientation) and tells you that you're obviously not fit to precept. A good manager asks you if anything is going on at home, because you're not usually on the phone at work. When you tell her that Mom has Alzheimer's and your sister programmed your cell phone number into Mom's direct dial and Mom has been calling you all day looking for your father, who died two years ago, a good manager takes you off the schedule so that you can fly home and sort out Mom's living situation, faxes the FMLA papers to you in hour home town that is so small there's no cell phone coverage and sends you an Edible Arrangement because that's all you have the time and energy to eat.

    A bad manager accosts you at 7:35, waves your rhythm strip which is already analyzed and signed in your face and says "This is inadequate charting." A good manager wanders by at 7:35, sees that you've already posted your rhythm strip and says "Good -- now we'll have documentation that he actually WAS in atrial fib so that cardiology resident will have to believe that nurses can distinguish A fib from that other rhythm."

    A good manager either knows the job and can do it well, or understands the outlines of the job and trusts her staff to do the job well and believes them when they tell her that they need more X, Y and Z and perhaps someone could talk to Dr. Dick and explain to him that "Yes, nurses can analyze a rhythm and if he ever again refuses to come when called because of a serious dysrhythmia, she'll be having a talk about it with the Highest Head Honcho of Doctoring." A bad manager will talk to her nurses about not pestering Dr. Dick at nigh because he needs his sleep.

  • May 23

    JCAHO has a lot of really old school people in the organization with really old school mindsets and that is where the this archaic "explicit orders for everything" BS comes from. They HATE the idea of nursing judgement. It is antithetical to JCAHO philosophy. They want cookbook care only, and even push that approach at the physicians.

    They are so off in la la land that something like "Norepinephrine - titrate between X and Y to keep MAP>65" will not satisfy them. They literally want to see, "start at Z rate and titrate by steps of A every B minutes" added to the order... at a minimum. They really only get happy with "and notify physician after each titration step."

  • May 23

    Kudos for doing what was right to keep the patient alive! My hospital more recently has worked to address this same issue; we also got cited for practicing outside of scope for drip titration. What was implemented into the eMAR order sets was the condition that any deviation from the ordered titration parameters requires a physician/ service note. Luckily for us, there is an almost full staff of providers at night, minus attending/ surgeon. We will inform the team and they will write a quick note justifying why titration was deviated from the order set for that event. We will see how we do on the next survey.

    Also, I thought out of curtesy for the nurses JCAHO usually does not get involved during a code like situation? As in they will step aside to allow the nurses to work? Did they audit you right after? Or during?


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