What do nurse managers and clinical directors actually do?

  1. On any given day, what are the responsibigies you have as nurse manager or clinical director? I think management sounds fascinating and the 30+ year career nurses in my unit say they see me in management or as a director down the road, so I thought I’d see what it’s all about!
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  2. 35 Comments

  3. by   klone
    Typical day:

    Sit in on report.
    Update the white board.
    Make a mental list of patients who will potentially be discharged.
    Glance at my emails from the past 12 hours to see if there's anything that I need to address now, or can it wait.
    Listen to my voicemails.
    Update the time cards to reflect any sick calls for the past day.
    Go to leadership safety huddle.
    Check in on staff to see how they're doing, do they need anything.
    Round on patients to make sure everything is okay, do they need anything.
    Update my spreadsheet for the past day's shifts to reflect patient census and staffing in order to get a daily PI tally.
    Address any incident reports that have been filed, do I need to address anything with a staff member? Do I need to involve executive leadership?
    A staff member has decided to accept a job in another state - need to submit a "request to post" her job. Log into the HR portal to see if there are any new applicants for the open positions we have.
    Someone from some company that offers a product specific to OB would like to send me samples - read about the product online, tell them sure, we'd love to see samples.
    Address the issue of why item XYZ is not getting restocked on the unit. Call central supply. Get it sorted out.
    Check in with the nurses and the unit secretary to find out if the patients we thought would get discharged actually have d/c orders. Find out the physician in question is not planning on rounding until lunch. Call provider, tell him he needs to round this AM because patient wants to leave and we need the bed.
    Check in with those nurses who do have discharge orders, find out where they are in the d/c process - do they need help with anything to get the patient out the door.
    Clinical manager meeting - discuss new initiatives and new processes that are going to be implemented.
    Look at our current census and staffing - suggest to charge nurse that she send a nurse home because we are now overstaffed for our census.
    Look into a 38-week induction of labor that's on the book for later in the week - read through patient chart to make sure she's medically qualified for an induction before 39 weeks (per our policy). Call the provider to get clarification on her medical diagnosis. Run it by the head of OB, decide it's not eligible. Call provider back and tell her that she needs to reschedule it until after the patient is 39 weeks. Listen to her rant and complain for 10 minutes.
    Look at staffing for next two shifts. Realize we're short a nurse for our current patient census. Send out a group text, asking if anyone is interested in picking up an extra shift.
    Charge nurse is getting slammed in triage, take one of her triage patients.
    A woman walks into the unit at 8 cm, screaming in pain. Help charge nurse get her into a labor room. Grab the IV start kit and throw in an IV, pull out emergency delivery meds from Pyxis and put them in the patient room. Ask the patient's nurse what else I can do to help her. Check over the infant warmer supplies to make sure everything is stocked and in working order. Ask the tech to set up a delivery table quickly and put it in the room.
    Break the unit secretary, who hasn't had lunch yet. Sit at the desk and answer phones/buzz people in. Hold a baby who's at the nurse's station crying and parents are outside smoking.
    Once everything settles down a bit, go back to my office and look over my emails. Email HR, asking where they're at with finding a traveler for us.
    Complete 2 annual performance evaluations.
    Have a closed door conversation with a nurse regarding a med error that took place, come up with a written plan together on how she is going to improve her practice, as this is her second error in just a few months.
    Sit in on afternoon shift report.
    Update the white board.
    Find out if any patients have a late discharge. Ask the nurse where she is in the process.
    Try to catch up on emails.
    Update time card edits.
    Check in with the evening charge nurse. Everything under control? Okay if I go home?
    Go home.
    Do it all again the next day, with individual variations.
  4. by   klone
    OMGosh, I'm exhausted reading through that. When I write it all out, it seems like I do way more than what it feels like I do. But that's a pretty accurate representation of a typical day.
  5. by   MBARNBSN
    OP: The only thing I would add is if you are an Assistant Nurse Manager (entry level middle management) you may have to also be the charge nurse because you do not have one, so you are on the floor in-between meetings with operations working with patients, as Klone has pointed out (not so much the further you go up the food chain, however).

    Thus, you also must also:
    Deal with the complaints from your shift's dismay with his/her assignment
    Make the assignments for the oncoming shift
    Get yelled at by oncoming shift regarding his/her assignment
    Deal with staffing issues for your shift and the oncoming shift (to include sick or late staff and modified/injured employee issues)
    Reconcile staffing and productivity with whomever to make sure your current and the oncoming shift are not over or under budget based upon your staffing mix
    Huddle the oncoming and off going shift huddle unless your colleague wants to do so
    Perform audits in real-time to address documentation and concerns prior to regulatory fall outs
    Address regulatory fall-outs.
    Round on staff
    Round on patients
    Perform patient/visitor service recoveries
    Perform environmental rounds
    Talk to Engineering about some issue
    Talk to Housekeeping about some issues
    Talk to the ED Charge
    Coordinate admissions, transfers, and discharges multiple times with the House Supervisor
    Train your staff on some new process or some new equipment (you get minimal training but are suppose to be an expert in all things....)
    Count the Pyxis
    Attend trainings during, before, or after your shift
    Attend meetings during, before, or after your shift
    Be in multiple places at once and be all things to all people.....
    Don't forget to smile
    Don't forget to breathe

    There is more..... Klone and I are leaving things out because we are all things to all people so it is hard to recall it all....

    Good luck!
    Last edit by MBARNBSN on Oct 9
  6. by   Flo.
    Holy cow! I wish my manager was like that. I never see her and I work day shift. She is always in meetings or off the floor. Never helps out, even when we are in a critical need.
  7. by   klone
    Quote from Flo.
    Holy cow! I wish my manager was like that. I never see her and I work day shift. She is always in meetings or off the floor. Never helps out, even when we are in a critical need.
    I've been told the manager of my unit who worked here before I took the job was like that. I am VERY hands on. I feel like my main job is to help the nurses receive what they need so that they can take care of the patients. Sometimes that's patient care. Other times that's advocating for them with senior leadership to get them equipment or whatever other tools they need.

    I would never ask the staff to do anything that I would not be willing to do myself. We recently were super busy in triage, and what they needed most was someone who had the time to administer a soap suds enema to a pregnant patient who was painfully constipated. So that's what I found myself doing one morning, with the help of the CNA.

    I feel like I'm fairly well-respected by the nurses whom I lead, and I attribute it to the fact that I am visible on the floor and willing to help out wherever. And frankly, I far prefer putting in an IV than going to a meeting. Which is probably why I will never advance beyond a unit manager position. I would much rather wear scrubs than a dress and high heels!
    Last edit by klone on Oct 9
  8. by   DS-181-1
    Quote from Flo.
    Holy cow! I wish my manager was like that. I never see her and I work day shift. She is always in meetings or off the floor. Never helps out, even when we are in a critical need.
    Managers like this are rare. Leading by example are the best to work for. They fall in the trenches when things get tough. I miss this type of boss.
    Unfortunatly the "career" mangers especially external hires managing outside their specialty are generally aloof and out of touch with their bedside nurses.
  9. by   jrt4
    Quote from DS-181-1
    Managers like this are rare. Leading by example are the best to work for. They fall in the trenches when things get tough. I miss this type of boss.
    Unfortunatly the "career" mangers especially external hires managing outside their specialty are generally aloof and out of touch with their bedside nurses.
    It really depends on the organization and span of control. I have worked at a few different hospitals in my career and they have all been different. I would love to be more involved in my units but I cover 4 different units with over 100 employees and would never have the time in my day to do all of the things that the above poster does for each of my areas. I feel more effective when I have a smaller span of control but unfortunately its not my reality.
  10. by   MBARNBSN
    Quote from jrt4
    It really depends on the organization and span of control. I have worked at a few different hospitals in my career and they have all been different. I would love to be more involved in my units but I cover 4 different units with over 100 employees and would never have the time in my day to do all of the things that the above poster does for each of my areas. I feel more effective when I have a smaller span of control but unfortunately its not my reality.
    No worries.... this is why I pointed out the "higher up the food chain..." one typically would not see a particular manager providing this kind of care/service/management to the units because it would not be possible and I do not think RNs by the bedside expect one of your stature to be on the floors. In fact, where I work you would be considered a senior leader because you have more than 1 department. Middle managers only run 1 department.

    I work for an organization that is a trend setter nationwide. The trend for middle managers within innovative and effective organizations is that management is visible and present to operate the floors in real-time. Otherwise, other elements such as cliques of staff can and will prevent change that is important to innovative and safe patient care or disrupt the budget in areas such as productivity and overtime.

    Do you have middle managers? If not, there is plenty of data to show your organization is better served to have managers (Assistant Department Managers or Department Managers) that report to you while handling the day-to-day operations as well as various issues related to employees to free you up to effectively oversee 4 departments.
    Last edit by MBARNBSN on Oct 12
  11. by   Jessy_RN
    You sounds like an amazing manager. FAR from what I have experienced. Our manager(s) never step out of their office unless it's for breakfast, lunch, snack and meetings. Touching a patient? Unheard of. I am willing to venture that they wouldn't remember how to start an IV nor would I think it's safe for my pt. This is nowhere near the representation of all managers and I have worked in soooo many places given we move a lot due to being active duty. Kuddos to you.
  12. by   Shrileynicolas
    I heard a lot of I" no teamwork no collaboration it's time to reach out to your staff you don't need burned-out nurse manager good luck to you and thank you.
  13. by   Truth_be-told
    What do nurse managers usually do? The truth be told, the house slaves (managers)
    sit in their nice, cozy, almost sterile, air conditioned cubicles and watch TV, play on the computer, stuff their faces with food, etc . Things they would write us up or terminate us for. The rest of us field slaves (floor workers) are out breaking our backs doing actual work on the floor, going home after each shift like we have been through the first day of boot camp or in a boxing match with Mike Tyson with our hands tied behind our backs, exhausted, sore feet, knees, legs, and backs. When its hot out, we are drenched with sweat, as either the AC is not repaired or the patients are always cold. Some come out and yap on their cell phones or eat at the nurses desk, while the rest of us field slaves, who never have time for a break, would get written up or terminated if we took an emergency call on our cell phones or grabbed a quick snack or drink of water. They get paid more and get treated better by the owner/master to threaten, intimidate, and bullwhip those of us who actually do the real work, all the while knowing they themselves could not even begin to do what they are asking us to do, always threatening and intimidating us to do more and more and more. Some of them used to be a field slave and since they got promoted to being a house slave where they push around paperwork and act like they have been shot with an elephant gun as a result, bellyaching about how supposedly stressful their jobs are (try walking in our shoes)dread having to go row with the rest of us field slaves. I will never forget one obese manager (most of them seem to be), when asked to help out on the floor because there was 1 nurse for 90 patients, the person stated "once I do, they will expect me to all the time" (referring to helping out on the floor) (my, wouldn't that be a tragedy). The truth be told, they are mostly very selfish, lazy excuses of human beings that could care less about the happiness or the well being of the patients unless it threatens their cozy, basically do nothing but be a slave driver type of job. Some are full of their titles and brag about their years of being this or doing that. It is hellishly gratifying to see the ones who are mandated to actually be a field slave and push the cart and work the floor. They are clueless, I have seen some in tears, they run over to other units and ask the usual field slaves what to do, how to do this, where is that, etc etc . The last place I was at, the unit manager quit "I didn't become an RN just to work the floor". Ditto the ADON who is incapable of listening and uses every occasion when we have to endure her know it all mouth brag about her decades of management experience, each and any topic that is brought up and she goes into a long and unbearable speech where she uses each and every occasion to show off or broadcast her bravado and ultimate knowledge about this procedure, ailment, diagnosis, etc yet can't pass meds or do a narc count. Why great and inquiring minds ever studied rocket science, quantum mechanics, etc when all this time we had miss full of herself to provide us with all the answers human kind's enduring questions and the mysteries of the universe. When the surveyors shadowed this legend in her won mind to do a simple treatment, they cited the place with numerous citations based upon her "expert" performance. Truth be told, it is what you learn after you know it all that counts. Then the DON, who is actually pretty nice and makes me worry that she will not last long (as the ones who are sane and show respect for us usually don't last long) , commented after working the floor a few times "I don't know how you do this everyday". You don't say. The truth be told, neither do we. Now there are some exceptions and I am sure some will protest and claim that they are not like that, but the truth be told most of the house slaves are there to get the fat check and take the path of least resistance and they have no mercy on us, no matter how hard we work, and most act like they had their legs and fingers cut off when they got that gravy office job to shamelessly whip and torture us with endless threats, write ups, suspensions, and even terminations (especially if you are an older, seasoned veteran and they are under orders from the top to harass and terminate us so they can hire in fresh grads for lower wages, a whole different story). They will shamelessly follow these orders. The truth be told, most of us field slaves (floor nurses) have no respect for them and even despise them. I have been at facilities where they throw parties when certain management people are marched or escorted out of the building. That usually means we get someone as bad or worse, even when you think that is not possible. Meet the new boss, same as the old boss.
    Last edit by Truth_be-told on Oct 14 : Reason: better version
  14. by   CapeCodMermaid
    What kind of word is responsibigies ?
    As the DNS I am responsible for all 150+ patients, 100 staff--everything they do and don't do. It's a very stressful life...been on call 24/7 for the past 10 years.
    If anyone calls out, I have to either fill the slot or take the cart...deal with families, deal with recalcitrant doctors who don't do what they're supposed to do, deal with the DPH, DEA, BON and many of regulatory bodies...and then there's the budget

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