The Enemy... The Nurse Manager

Flatline, BSN, RN · Feb 9, 2017

Sour Lemon said:

That sounds like a job with a lot of responsibility and no power ...the worst kind.
I decided that staff meetings were a waste of my time before I even got off new grad orientation ...and I don't think I've been to one since then at ANY job. It's not that I don't have suggestions, it's that I know they will never be taken. It's a forum for managers to talk to US, not for us to talk to THEM.

I could go on about some of the other issues, but I'm already bored. I've already heard myself say it all too many times before.

I do wish you luck, but you may not find any.

That is too bad.

I know I have used employee suggestions to make changes.

In industry we call it the VOC or Voice of Customer and it is considered the most important data one can find and one of the most difficult to obtain.

Do you abstain from voting in elections as well?

llg, PhD, RN · Feb 9, 2017

AliNajaCat said:

Wonderful. When I was a clin spec and classed as middle management, I wore street clothes and a well-fitting lab coat with my scissors, clamp, steth, and suchlike in the pockets. They got pretty regular use, but I still put on scrubs and worked a shift in the ICU about once a month to keep my hand in. Once somebody said to me, "Oh, Ali, you look like a nurse today," and fortunately I had the presence of mind to say, with a smile, "I look like a nurse every day."
On a related note, in my present role I get asked when the last time was I worked as a nurse. Same answer. "I'm working a a nurse today, counselor." Opportunities for education are boundless.

I've run into that a lot. I even wrote a paper about it for grad school. For some nurses, if you are not doing the same job they are doing .... then they don't consider you to be working. We can't allow that. We have to speak up for ourselves and teach them that we also have legitimate jobs.

It's sort of a "reverse NETY."

Ruby Vee, BSN · Feb 9, 2017

Do you know what it's like to not have anyone like you? To know that everyone hates you? That's my life as a nurse manager. They now see me as the enemy. I have to deny vacations, write people up, give not so good performance evaluations, tell people how to do their job better, short the unit. They think I am sitting in my office everyday doing nothing when I am drowning in work. Blah!!!! I spend almost all my time in meetings. Sometimes I literally have 30 minutes outside of meetings. So then I work at home or on my days off. When I am in my office, sometimes I close my door. I literally cannot get a thing done when my door is open because people always come in to talk. I cannot send people away because I don't want to unapproachable.
What they don't know is how hard I fight for them. They forget about all the new equipment I fight for. They forget all about the changes I have made so they have it easier. I talk about these in our staff meetings but very few people come. I send out weekly emails but people don't read them.
I was so happy to take this job. It has proved to be the hardest job ever. I have senior leaders handing never ending tasks down to me and staff level employees complaining so much. It's exhausting. Was I like that as a staff nurse?
Balancing the schedule for 70 people is nuts. No one gets 100% of what they want. That makes people very angry but someone has to work!
People complain and gossip but refuse to get involved. They won't come to staff meetings, they won't join committees, they won't offer solutions.
I love my job and I love the team. However; it is so exhausting. I am on call 24-7. People tend to forget that too. I respond to calls and messages all day long.
I just want people to meet me in the middle.
I try to get to know the staff members, send thank notes monthly, ask people what they think.
I can't seem to get ahead. I think a big part of the problem is that I came from this unit. People wonder why I got the job. I'm sure some people even hate it. No matter how hard I try, I can't get them to understand that I work for them. I want them to grow and succeed. I want us to be a great unit that everyone wants to work on.
Any tips??? Any advice???

You're not the enemy -- you're the one protecting your staff from frivolous edicts from on high, from abusive patients and family members, from ill-conceived policies that will negatively impact their paychecks, their schedules or their working day. Staff nurses don't know what you do because they don't see you doing it. But they do know when you have their backs.

The best managers I've ever had (and I've had some good and some bad) realize that despite Press-Ganey, you cannot please everyone. There are some folks that just cannot be pleased, no matter what. Make sure your staff sees you standing up for them to those folks that just cannot be pleased. Trying to please THEM is wasted effort -- standing up for your staff is an investment in your staff. Your staff ought to be able to count on you to run interference with ranting and raving medical staff as well. Your staff may not always be in the right, but they need to know you'll keep an open mind until you've investigated the complaint, that you won't automatically take the side of the physician or upper management or the visitor who claims to be best buds with the CEO.

Start scheduling the staff meetings into their schedules. If they don't show up, it's an occurrence unless they've cleared it with you in advance for solid reasons such as they'll be on a previously scheduled vacation, they're taking final exams at that moment or they're scheduled for surgery. Make committees a prestigious thing. I was in my first year of nursing when my head nurse asked me to represent our unit at Nursing Grand Rounds . . . I was so flattered! I was primed to volunteer for committees after that.

My current manager ascended through the ranks, and there was some pushback at first from the nurses who were more senior to her when she got the job. Most of them have moved on now, the newbies never knew her before she was a manager and those of us in between have grown to respect the way she stands up for us. Hopefully you'll be as respected as she is!

NotYourMamasRN · Feb 9, 2017

It is refreshing to read this, as you care and want to try. I just want to tell you, that in and of itself, is absolutely awesome!

BlueDawnRN, BSN · Feb 10, 2017

I just wanted to let you know that I really respect my manager even though it seems the majority of my co-workers do not, and that I'm sure there are employees on your floor that respect you as well. I stay out of the gossip and basically keep my mouth shut, smile and nod. Your job is incredibly hard. I would never want to do it. It's a never ending 24 hour job and you have to somehow advocate for your employees while also bowing to the administration. You have to deal with everything from staffing to policies to difficult families and still keep a smile on your face. I just wanted to say thank you and assure you that not everyone hates you.

Workitinurfava, BSN, RN · Feb 10, 2017

Stay strong and try not to worry.

KatieMI, BSN, MSN, RN · Feb 10, 2017

I just want to say that, despite of everything I got from management so far (and there were some terrible things indeed), I deeply appreciate the OP's post.

OP, you are not a $100 banknote to be enjoyed by everyone. Stand by your staff, make them feel safe, value your nurses for the best they can offer, let the new grades thrive - your staff will see it, and one day you will know it.

(((HUGS)))

gemmi999 · Feb 10, 2017

So, as someone who has been forced to go to the last three staff meetings due to timing, I can understand why RNs don't want to go to meetings. WHY hold staff meetings at 0700 at change of shift when night RNs just want to go home and sleep? Before report is even given! It does nothing to make staff *like* staff meetings.

That being said, I know our nurse manager gets a *lot* of flack but because she is the first person to put on a pair of scrubs and work when we're short staffed, I know she is more respected and that people listen to her and are more willing to work with her. Just last weekend she came in on a Sunday and took not only Charge but a full team! I've never seen a RN manager do that before.

Maybe pitch in on the unit, be seen at change of shift and just be available for people to talk to...that might help a bit.

allnurses Guide · Feb 10, 2017

I've had a small taste of what it is like to be in management... and

believe me, I'll NEVER do it again. I have all the respect in the world

for you. You sound like a wonderful manager.

Kooky Korky, BSN, RN · Feb 10, 2017

This is exactly why I chose nursing education as a specialty rather than management when I went for my MSN. Managers are squeezed from both sides.
I did have one manager who I loved and who really motivated me. She was on the floor all the time. She wore scrubs to work and would keep an ear to the ground about what was going on with her staff and the patients. She helped do things like place a Flexiseal on an incontinent patient, turning and cleaning patients...the stuff nobody likes to do but still needs doing. She would go in and work with the night shift sometimes...not all night, but staying until 12 or 1. She would pick one of us and ask if she could follow us for part of our shift. It was like having a second pair of hands, let her get the lay of the land and a feel for our personalities, strengths, weaknesses and bedside manner. It helped her identify deficits in practice to pass on to the unit educator and it gave us time with her to both know her as a nurse and a person as well as a feel for where the unit needed support. Even if she was unable to make changes, we could see that she was a nurse first and foremost, that what we did mattered. She never denied people PTO. Ever. Were we short sometimes? Yes, but we all knew when it was our turn, we got the time off we needed. She was super good at building teamwork among the staff nurses.
I wish you luck. Management is both a skill and a talent. If you want to be respected by your nurses you have to show them you understand what they do and are in the trenches too. Most people are capable of understanding the pressures you are getting from on high. They need to know you understand the pressures they themselves are under and that you care. My advice would be to get out of your office and get on the floor as much as possible, even if it is just to come out and help turn a patient or answer a call light for someone once or twice a day. They will notice. Believe me.

A manager who lets the floor be short-staffed and never denies PTO - wow, that is nice on the one hand but dangerous on the other. It's great to try to help your staff, but if any problem arose because of how she staffed, she would probably stop doing that.

Some managers are great at building teams and I applaud that. Others realize that, no matter how much they do for some staff, it will never be enough.

OP, just do your job and stop worrying about people liking you. You are literally caught in the middle and you just can't win. Do try to be good to your staff, but don't let yourself or the unit be harmed in so doing.

There are only so many hours in the day, so if you need to close your door, close it. You should try to spend time with each staff member - nurses, aides, secretary, etc. They do need to see and feel your presence and you theirs. Yes, answer a light or two, stock a dressing cart, pass some food trays, whatever. But mainly your job is no longer hands-on. You are to do staffing, budget, carry out directives from your superiors, and solve problems. And your staff need to know this.

Require meeting attendance by every single staff member at least 3 or 4 times per year. Make attendance part of the annual evaluation. It is not fair for some staff to refuse to participate in the life of the unit by never attending a meeting. Give plenty of notice so that babysitters and rides and days off can be arranged well in advance.

Make the meetings meaningful. Don't require people to get all convoluted for the sake of holding a meeting because you are supposed to do so. Give everyone a chance to speak or ask a question. Don't just talk to them, have them talk to you and to each other. Make participation worth their while.

Hold meetings on each shift, that is, rotate the times you hold the meetings. Don't expect evening and night staff to be the ones who have to re-arrange their schedules every time. It's horrible to disrupt your sleep schedule and that is what going to a meeting at 0900 or 1 p.m. requires of the Night staff. So equalize the pain. Or try to have people on Eve or Night shifts able to join in by Skype or some similar means if you must have meetings all on Day shift. At least they won't have to drive in to work after disrupting their sleep.

Better yet, hold more than one meeting on the same topic in the same month or however often you hold them. You could try holding a meeting at shift change between Nights and Day shifts and then another between Day and Evening shifts, and another between Evening and Nights. Hold them on different days of the week, too, including weekends.

I wish you well.

Kooky Korky, BSN, RN · Feb 10, 2017

Staff nurses will never fully understand the Manager Role unless they have been managers in the past. That's just a fact of life -- and is true of just about any position that is not the staff nurse role they know. Being happy in any role that is not the traditional staff nurse usually involves having to come to terms with the fact that many nurses will misunderstand your role and think you don't "really work for a living as a nurse like they do" because you are not doing the same job as they do. So, accept that and move on.
However, you can do some things to foster their support of you even though they never fully understand your job.
1. Let them see your work. Tell them what you are doing on a regular basis so that they can see you being their advocate. Instead of saying that you are doing paperwork, say that you are "preparing a report to try to get XYZ improved for them." Instead of saying you are doing the payroll, say that you are making sure their work hours are correct so that they can be correctly and on time this pay period. etc.
2. Don't ever let them say something like, "Oh, I see you working today" when you help them on the unit clinically -- which implies that you are NOT working when you are doing office stuff. Respond with something like, "Oh I work every day -- I just don't do the same job tasks that you do." Of course, say things like that with a smile.
3. Give them updates on your work and progress with projects that are meaningful to them. I have been in mostly educational positions -- but I have had some jobs that were a combination of education and management at the unit level. I found that posting a monthly report of my activities (written in politically wise ways, of course) was very helpful. When people knew what I was working on and how it could help them ... they were much more supportive.
4. I am also a big fan of being as honest as possible. Sometimes, you have to say something like ...."Listen, I have my doubts about the value of this change, too. But we need to give it an honest try. We'll collect data and if it doesn't work, then we'll have the evidence we need to change it to something that will work better." Or ... "Listen, I know this isn't the most convenient thing for us to do ... but it will really help our colleagues in the XYZ department. Let's given it a try to help them and maybe we can figure out a way to make it work for us by adjusting it a bit. But we won't be in a position to help either XYZ or us until we start giving it a try."
Those are just a few thoughts off the top of my head.

Why do we have to smile when someone is insulting and ignorant?

Kooky Korky, BSN, RN · Feb 10, 2017

So, as someone who has been forced to go to the last three staff meetings due to timing, I can understand why RNs don't want to go to meetings. WHY hold staff meetings at 0700 at change of shift when night RNs just want to go home and sleep? Before report is even given! It does nothing to make staff *like* staff meetings.
That being said, I know our nurse manager gets a *lot* of flack but because she is the first person to put on a pair of scrubs and work when we're short staffed, I know she is more respected and that people listen to her and are more willing to work with her. Just last weekend she came in on a Sunday and took not only Charge but a full team! I've never seen a RN manager do that before.
Maybe pitch in on the unit, be seen at change of shift and just be available for people to talk to...that might help a bit.

Night nurses might need to get home to get their kids off to school. Or their spouses need the car to get to work and the Night nurse is going to do child care all day while needing to sleep. Just sayin'.