Help I have a huge choice to make!!!!

Having a business background would put you light years ahead of most novice nurse managers.

I took a job as a nurse manager at the request of both staff and administration, and lasted only about a year. To sum it up, I had the following problems and saw no realistic way of improving them so I chose to go back to staff: 1.) I had very little knowledge of management principles and basic management skills. My employer did provide some formal training on staffing and budgeting which I found tremendously helpful. But I needed a mentor or preceptor to guide me on daily issues such as hospital politics, handling conflict and disciplinary issues. I was not able to find such guidance. My immediate supervisor was not accessible and not helpful. The person I replaced was gracious about accepting phone calls for help, but she had moved on to a new hospital, and I didn't think I could continue to bother her indefinitely. 2.) I had 24 hour accountability for the unit (a small specialized unit), which became overwhelming. I lived 30 miles from work and had problems with being able to drive in at night in bad weather which was when most staffing issues occurred. (Because our unit was so different from any other in the hospital, there was no other manager or administrator who could make decisions or help out as staff.) I had to insist that I would not be disturbed on my vacations, and simply stopped taking my cell phone with me. My staff did not call me unnecessarily, but fellow managers and administrators frequently did. 3.) I finally decided to resign when I was not allowed to re-train, re-assign or dismiss 2 staff nurses whose practice was dangerous. They worked together on the same shift, often as the only 2 RNs scheduled and had long been known to be borderline in their performance. One particularly stressful night, they collectively committed so many errors as to be downright dangerous. I went to administration and insisted that they be put on probation and required to re-orient to the unit, accept an assignment on a less critical unit or resign. Administration refused my reasonable request citing cost. I was no longer to be legally responsible for the care on a unit where I couldn't address safety issues, so I tendered my resignation from management. I stayed as a staff nurse, and was perfectly happy providing patient care, but not willing to accept responsibility for the actions of others.

Just a few thoughts on one person's (brief) management experience. I hope it will help you to avoid some of the same pitfalls.

What is the current job description? What are the additions/changes supported by administration and staff?

Is there 24 hour accountability for the unit? Will you be required to fill in on any given shift if staffing can't be found? I was required to do so, and even though I didn't have to go in often, it was incredibly demanding to be on call 24/7 (except when I was out of town).

There is no such thing as M-F days for a manager. Even if that's what the job description calls for. Your staff needs to see you in action, and you need to work side-by-side with them in order to evaluate their performance. That means working evening, night and weekend shifts on a semi-regular basis. When disputes arise over scheduling for holidays, you will need to show your goodwill by picking up some holiday time.

What are the expectations for office time versus patient care time? My job was supposed to be 80% management time and 20% patient care. But when the census was high and staffing low, I had no choice but to take patients for 8 hours, then stay another 4 hours to get my office work done. I went from working 8 hours per day to 12 (on a salary, of course) just to get things done.

Lastly, I would insist on an interview. I naively accepted the job based on recommendations without having the opportunity (or realizing that I needed to) interview my new bosses. I won't say that I would have turned the job down if I had known their expectations ahead of time, but I certainly would have given it more thought!

Jolie -

Your response was an eloquent review of exactly what is happening all across the country. It is not unusual for Nurse managers to have to cope with 75+ direct reports these days. Experienced nurses are bypassing management positions in favor of (more controllable & sane) staff jobs.

The paperwork burden increases with each new federal mandate -- core measures anyone? Now, with the POA reimbursement coming in to effect last week -- it will be even more pressure and stress. All without any clerical or admin support.

Me?? Never again. Been there, done that.

Personally, I would take the job offered by your current department. You are already familiar with the policies and procedures and with your background, you'd do very well. I know the case manager position sounds great working from home, but from colleagues I know who have chosen this path: it consumes you. You spend much time on the road, solving patient problems, and invest a lot of yourself in this type of position. Not that it wouldn't be a worthy goal, I just think the offer from your dept director is a better choice for you. I hope this helps and best of luck to you!