New in Nurse Management, tips anyone?

stephva1008 · Jan 1, 2011

The budget and productivity stuff will come in time. Don't stress about it.

My advice: Don't make any major changes for at least 6 months. Get to know your staff and the facility and your new role.

The first year is hard. You will make a lot of mistakes. Your first disciplinary action/write up will be rough. Some of your former "friends" and coworkers will talk about you behind your back. Going from peer to leader is challenging for folks. Those who think they are your friends will think you will give them special treatment and when you don't, they will talk about you. You will learn to grow a thick skin if you haven't already.

There are days you will feel like quitting, esp since staff nurses can make more than managers. Hang in there, it does get better. Middle management is a lonely road; find another manager you can rely on for support.

I love my job even though it was challenging at first. It has become easier and more enjoyable the longer I do it. Congrats!

MomRN0913 · Jan 1, 2011

Thank you! I am preparing for major changes in my role. I luckily am at a different hospital where I just happen to know a small amount of the staff nurses. The best advice I got from my current and ex nurse manager was don't get too close to your employess. My second nurse manager took on the role when a newly hired one quit after 2 weeks. She was very close with alot of people and it has taken a toll on her in her management role, and she wants to go back to be staff nurse. I do tend to make alot of friends, but I have to remind myself I can't get too close.

I know the first time i have ot write someone up, will be very difficult for me. Thanks for preparing me for that, I hadn't thought of it.

I am actually making 25K more as a manager than staff nurse. SO I'd better do verrryyyy good.

It's a new position, so you are right, I am having a gung ho attitude, but really, what I need ot get to know for a while is my staff and how things function. I really think I need to do some major observation before trying to change things. I am the ONLY nurse manager in the facility. It is one floor! 26 beds, but a new one is opening and I will be running that one too, until things start to fill up.

I know my work is cut out for me as I have gotten some negative feed back from the families of patients that came from the facility into my ICU. It's a new hospital and concept that is still evolving and needs lots of tweaking. IN addition it is a very high percentage of new grads there.

Question: I was thinking about putting together a small questionaire for the nurses, anonymous probably asking them a few simple questions. Are they comfortable with ventilators? Are the comfortable with drips? Do they feel comfortable talking to the families and incorporating them in their care? These are critical care patients. I want to the best patient outcomes which I believe stem from the nurses feeling comfortable, not too overwhelmed and somewhat happy!

does that sound like a stupid idea?

stephva1008 · Jan 2, 2011

he survey is a great idea. I would use http://www.surveymonkey.com and get them to do it online. There's a small fee (maybe $25 or something) to use it but your hospital system might have purchased it already, so ask about that. Survey monkey is a very easy way to get a barometer of how things are doing.

In addition to the critical care questions, I would ask:

What is the unit doing right? What can we do better? Do they feel like they can report medication errors without penalty? Do they feel the unit is a safe environment to practice? Do they feel they have the equipment needed to do their job well. How do they feel about the staffing patterns, etc. Do they know what their quality indicators are for NDNQI?

National Database of Nursing Quality Indicators

One of the major focuses with the healthcare reform is HCAHPS, which is an assessment tool for the consumer (patient). Basically, Medicaid and Medicare will withhold monies from hospitals that don't meet patients satisfaction scores. There is a lot of money at stake here and if you're already getting comments from former patients, this will be an area to target.

HCAHPS - Hospital Survey

NDNQI and HCAHPS should be regular things discussed in your staff meetings. These are huge and will affect the way hospitals get paid and ultimately whether we'll all still have jobs. Your employees need to understand that every single person is important in keeping abreast of these scores. Patient satisfaction is the new buzzword and it's not going away.

this is a good book to help you understand HCAHPS:

Fire Starter Publishing

Your hospital system probably has a patient satisfaction rep that is looking at these numbers. Get with them regularly to try and bring up your scores once you find your feet and such.

You seem to have a good head on your shoulders and know what to expect. You're lucky you're getting a payraise too, most of the veteran staff or the staff that work nights make more than i do.

Post anytime your have questions or feel free to PM me. I've come here a few times to pick folks brains and get support.

Good luck!

Long Term Care Columnist / Guide · Jan 2, 2011

Please don't feel inferior because you hold "only" an ADN---there's no need to defend your education to anyone! Believe me, if your supervisors had thought you couldn't handle the job, they would never have even interviewed you. You deserve to be where you are.:)

BTW, I'm the DNS of a large assisted living facility responsible for some 45 staff and a budget of nearly a million dollars, and I have no more formal education than you. So don't sell yourself short, OK?

For the rest, I agree with the poster who advised not to get too close to your subordinates. I made this mistake twice, early on in my management years, and it bit me in the bohunkus both times. It's fine to enjoy their company while at work; personally, I like to keep the mood light and am always joking around with my staff, because I like to laugh and there's no reason work can't be fun. But I make a point of NOT socializing with them outside of work; maintaining a friendly, but professional distance is necessary because I'm being paid to take control when things start going sideways. I also prefer to avoid accusations of favoritism and the inevitable backstabbing by disgruntled employees who will use anything they can to fight disciplinary measures (without, of course, taking any real responsibility for their actions).

Another philosophy I stand by is the belief that NO ONE goes to work thinking "How can I screw up somebody's day today?". I think almost everyone does the best they can, with what they have to give each day: sometimes it's 110%, other times they're only capable of mustering 75%, but they give what they have. Therefore, I deliberately give employees the benefit of the doubt---at least the first time they mess up in a given manner---and assume it's an issue of education rather than discipline.

I'll pull them aside and talk with them completely in private, ask if they know what the policy is and how I can help them to understand and abide by it. Usually that's all that's ever needed to get someone back on track. I don't believe in humiliating a person by yelling at them in front of other staff, residents or families.......But when the teaching approach doesn't work, I use a progressive form of discipline beginning with a documented verbal warning, then a formal write-up, then suspension and finally termination if the offending behavior isn't corrected. A word of caution: you also have to document every step of the process so you have a 'paper trail' should the employee ever decide to fight the discipline or termination. I once saw a CNA who should never have been allowed to work in healthcare actually reinstated to her job after she'd been terminated for cause, all because management didn't have their ducks lined up and were unable to provide written documentation of previous complaints and discussions about this employee.

So to summarize my advice to you......Never feel inferior to a higher degree, keep things light but don't socialize with your staff, remember that you're a leader, and keep meticulous records. And GOOD LUCK!!!

MomRN0913 · Jan 2, 2011

Thank you guys! I always took personal pride in my degree. We are all RN's. And a degree doesn't make you a good or bad RN, it's the experience and what you make of it. I know some master's trained RN's i wouldn't trust with my life.....

I am one to always keep the work environment light. But I will not take these relationships outside of work like my nurse manager does from my previous job. It is not doing well for her. Would you believe when there is wrong documentation done she photcopies it and posts it on the bathroom wall? And we all know who it is, because we are so close and know everyones handwriting!!!

Those websites are so helpful. I chose management for this reason: I have been very observant in my years as a nurse in what makes a nurse happy and more productive and what is dificult for them. I truly believe a happy nurse leads to better patient outcomes, which is first and foremost and that also leads to happy patients and families which leads ot more profit! If only upper management asked bedside nurses these questions! They are ont he frontlines. They know!

I know this is not that simple, but it is a starting point. I hope I can be successful at what I do.