Calling All Nurse Managers/Clinical Directors

Greetings All,
I am a nurse manager of a rural ER along with the Outpatient clinic. I started as a floor nurse and was able to develop this position as well as my department. The ER is thriving and we have actually contributed to overhead for the last 2 years!! I am very proud of my department and have the best nurses in the world working with me. I have been in management for 3 years. I have learned alot, but boy I sure have alot to learn!!!! I have a great role model with my CNO, she has been an excellent mentor.

How delightful to find a forum for Nurse Managers & Directors. I started out in 1993 as an ADON in a LTC facility 19 months out of graduating as an Associates Degree RN. The DON I worked for was most interested in 'eating her young' & in my not succeeding. I managed to survive a year of "training" with her and moved to my first position as a DON of a brand new 95 bed rural LTC facility.

It was very exciting to open a new facility in which we started out with 5 patients and 10 years later we had admitted almost 600 patients over the years. Believe me, it was the most intense highs and lows I've ever experienced and such a learning experience!

The most important lesson I can pass on, especially to those of you just starting out is this - NEVER lose your sense of humor It will carry you through the most frustrating of times. My most frustrating time was during a state survey on day 3 when things get very testy and intense and I had an administrator that made me responsible for every department in the building from the front door to the back - I hadn't had a break all day and could NOT get a moment away from the administrator so I took a Bathroom break - would you believe she stuck a note under the door while I was in the bathroom to ask me about something?? I was so upset & mad I stomped out of the bathroom to my office and immediately typed out my resignation. Luckily I took a moment to cool down and did not give it to her, but boy was it tempting. There were many more rewarding times - I just love the elderly and enjoyed every minute of it in the long run -

Now I have a new challenge as Director of a Home Health Agency. We do PDN and specialize in vent patients and also do skilled nursing in the home. At present I am trying to get our office certified to do Medicare & Medicaid as well. If anyone has any tips for this area, I would be more than grateful.
Till Later...... Nurselulu

I am a Hospital Supervisor in a 500 bed Teaching Hospital. My career spans 27 years and I have had many different clinical and management roles over the years. I like where I am now. Dealing with staffing issues and every other "problem" that comes up while I am on duty can be a real challenge. I'd like to hear about some of the Recruitment and Retention successes other managers have had, I am currently chairing the R&R committee.

Awesome, love the ability to share thoughts and ideas with other managers, thanks for the opportuntity.
I am new to nurse management, I have been an RN for 11 years from floor nurse to speciality area, charge nurse and now nurse manager. This is a big challenge for me. I started in the department when it was only me and another agency nurse, built it up to 6 nurses, transfered to another job and in three weeks the department was in trouble, no one would step up and take charge. After 5 months, I came back to be the nurse manager and have had a huge challenge of trying to get everything back in order and had a big physcian turn over in the process. We are a new hospital and still need alot of protocols and policies to be implemented. I am looking for any ideas to help make this easier and run more efficiently. Lots of patients, very little space to work with.

It is so nice to hear from nurses with so many varied backgrounds and years of experience - and those just starting out. I applaud all of you Since I am so new into the Home Health arena, I would love to hear from other nurses with HH experience and nurse managers used to dealing with Medicare and Medicaid. We are a small agency (13 patients at present) but I know once we become Medicare/Medicaid certified we are going to get real busy real fast. Any suggestions? Thank you, Nurselulu

Hi, I have been a unit manager for almost a year now in LTC. It's been quiet a roller coaster which most of my days I felt I was at the bottom trying to get to the top(as far as my work goes). I have had good training and the support system at the facitility is one that I have never had. It's a very hard position but there are people there willing to help in any way they can. More than that they know what can be done and cannot be done.

Not only learning the job is hard and trying to manage the unit. My most problem area is delegation. I know that everyone is busy and I tend to try to do more than delegate and of course that gets me long hours and overtime. I don't want long hours and overtime. I just want to be able to take care of my residents the best possible way. I want them to call our facility as close to home as you can be. I do recieve constructive critism which is hard to take at times but the way it's done makes me want to listen more. I am just a person that wants things done right and not have to be told but working in my position that's now possible because there will always be something that I forgot or an improvement that needs to be made. I want to be the best I can be and I know I have lots more to learn.

I enjoy my position and at this time I can't think of another place I'd rather be.

I do care alot for my residents, their families my coworkers and my bosses. It really feels like we are a family.

I'm a nurse manager, in a small rural hospital, of a 20 bed medical surgical unit. I use the term medical surgical loosely because we care for patients that would otherwise be on a cardiac step down unit or in ICU unit in other hospitals. We regularly have cardiac drips, an even intubated patients on the floor ( not often though ) because 1) we are the only floor in the hospital and have no ICU and 2) we are waiting for a bed to become available at another hospital. I currently oversee approximately 22 FTE's, and I do not use agency nurses.

I've been in this position for 10 months now, and was one of the night time supervisors before this, as well as the night shift ER nurse. ( In our ER we have one nurse, one tech and one doc on nights, with a nurse on call each night.) When I took this position, I knew I had many challanges facing me, which was one of the reasons I applied for the position.

The floor had 3 different managers in about 5 years. My perception as a supervisor was the staff pretty much ran the floor. I don't know if the managers just wanted to be "liked", if they were too tired to stand up to the staff after a while, or what.

My first challange was for the staff to see me as somebody other than an "ER nurse taking over." ( there has been an on going turf war between the departments.) There was a lot of resentment as well as suspicion. The talk was I had been placed in the position to do the ER's bidding so to speak. My second challange was to help the staff see the bigger picture. They felt their floor always got the short end of the stick regardless of the situation. We have a nursing home attached to our hospital, and therefore people are pulled to other departments ( if they are competent ) and to the nursing home if staff have called in. Our department has the flectuating census, so often it is my staff who are pulled, and they resent that. They also resent being placed on call or called off when the census is very low. I'd say that my biggest challange would be having the staff admit that they see the bigger picture and that my job is ultimately patient safety, safety of staff and how effectively the unit runs.

The staff sees me staying late on crazy days, putting in overtime to get them through, and working in the trenches with them when needed. That has probably given me the most "street credit" in their eyes. I've gotten rid of nurses who were flat out unsafe ( who had been there for a long while and never delt with) and delt with a multitude of bad behaviors that had been ignored for years. I would have to say that my biggest accomplishment would be when I had an LPN, who's been there for over 30 years and did what she wanted basically, go to the nursing home when it was her time to be pulled. It was a scene, and she actually asked me what would happen if she refused to go... after I told her, she went... and nobody in the hospital believed she would.

I don't expect anyone to be my friend, I'm fair, and I have clearly defined expections. I get very aggrevated at times because it feels like I'm dealing with children and not professionals, but I try to keep it in check. I'm glad to have found this forum and look forward to reading other manager's challanges and solutions.

Thanks!
"If you are not part of the solution, then you are part of the problem."

Hello. I am the nursing care manager for a multi physician pediatric office. I am only 6 weeks into the position though I have worked in this office for 19 years. I amzes me the how differntly my co-workers are since I accepted this position!!! Suddenly nobody seems to be able to be independent thinkers. And the worst one is the former nursing care manager who voluntarily resigned from the position. I really expected her to be more of a mentor not to undercut me at every opportunity.
I feel I am bringing some structure and guidance though I am not feeling I am able to portray the advocate of the nurses as I was hoping. Thanks for the opportunity to vent.

Hello,

I am the Coordinator of the Outpatient Surgery, Endoscopy, and Pre-Op Clinic. I have been in this role for over 2 years. Prior to this I worked in the Mental Health Field as a QDDP, Residential Director, and Nurse Coordinator....(I know interesting jump.) I have worked at Mission in Asheville in the Peds units and have worked all over the Western part of NC.

Hi I just recently accepted a position of a supervisor of a 180 bed acute psychiatric hospital on weekends Inever wanted to go into management but i am surprised to find out how much i like it.. I am very new and my responsibilities are far less than a "manager" Mostly i handle staffing, patient and staff complaints, performance evaluations, and collobaorating with other departments such as dietary and admissions
My experience has opened up a whole new world for me and i am very interested in pursuing this farther and i feel that my experience has also helped me to be a better staff nurse and see more of the "big picture" I also am struggling with the adjustment and dealing with some difficult personalities and the transition in some of my relationships with coworkers. I finally am at a point in my life where i really can say that i do not care if everyone likes me but i want to do a good job, be fair and be respected. Any suggestions from anyone with similar experiences would be appreciated