Clinical Manager offer

Kyle46N · Jan 21, 2023

I would make sure that having to manage people, and all the annoying things that go with that, is something that you can handle from a stress perspective. Meaning it's one thing to handle the situation appropriately in the moment, but is that something that you're gonna take home with you? Are those frustrating interactions that inherently come with managing people going to be something that you carry with you after work and on days off? Many leaders and managers make the decision to take management positions based off their confidence on handling the situation's as they arise. But it's more than that. You can't have it bothering you and on your mind for days on end, because that stress will hurt you when it's all said and done.

Duncan6 · Jan 21, 2023

@Kyle46N- Great points! I'm pretty good at leaving things at work- but I know it's a whole different ball game when you're the one in charge.

I've had two vastly different management experiences in my career. One was as an interim CM 20 years ago. I would have taken it permanently, but I was having my first baby and wanted to go part-time. Great clinic, a great staff- was really "easy" as far as a management job goes. The second time was 3 years ago- hired as a clinical coordinator for an endocrinology group. I hated it. I had worked there before as an educator and so I jumped at the chance because I loved the providers there. But there ended up being no training and new providers that joined the group were nightmares to deal with, the antiquated IT systems never worked and I ended up having to do a lot of the staff nurse jobs like PAs for insurance (that is soul-sucking work- bless the people that have to deal with insurance companies all the time!)

So the stress you are mentioning is definitely a concern for me. I think this current CM position would fall somewhere in the middle.

Kyle46N · Jan 21, 2023

Everything I mentioned above is exactly what I've learned about myself the past 6 years of management in the Air Force. I definitely dwell on the tough decisions before and after the fact. Sounds like you might have a pretty good situation at your current place of work though. Only one way to find out!

Duncan6 · Jan 26, 2023

Well, I don't think I'm going to accept the offer. My CM talked to me last Friday, yesterday she was in the office and told me and the other nurse that our hours were getting cut to 30 a week. Not enough patients and they don't think they need more than 1 nurse there each day. Then the CM said to both of us, "If one of you took the CM job, no one would lose hours." So they really don't want me in particular- they just want the position filled. And they wouldn't hire another staff nurse. I would be required to work as the only nurse 2 days a week, still have to work every other Saturday and cover vacations for the other nurse- while learning all the CM stuff- and we are getting ready to put a new water system in the clinic and the state should be showing up anytime. And we only have a part-time secretary, so would also have to be answering phones, etc on days she's not there. Yeah, not going to do that. So now we are both wondering if we are even going to stay there or not.

parolang · Jan 30, 2023

Wow, I don't blame you. It always seemed to me that they have an SOL approach to FA's, and they will cut you on budget and staff, and then kind of silo with any internal problems you might be having.

Duncan6 · Mar 19, 2023

Interesting turn of events. Our DO was at the clinic this week to give a hiring update to the staff- only one person has applied, no really great options. I was able to ask some general questions and he did clarify that even though the census is low, we would always have 2 nurses and a CM since we are 6 days a week. I talked to my CM again and reviewed some of my concerns. Then I was able to talk to the DO about those concerns and they both had the same answers which I felt were acceptable. He is also allowing me to work 4 10s if I want instead of 5 8s. He said that I was their first choice and he had been hoping I would accept. (He could just be saying that but he seemed genuine.) In light of that, I decided to pursue the position. I have applied and am waiting for an offer to before making a final decision. If I take it our current CM will be there through April, so I'll have a chance to train with her. She has also done a lot of work to update everything for the next person coming in so that it's as easy as possible to transition. Should have a final decision this week!

Trauma Columnist · Mar 24, 2023

Whats the overall outlook in your area for dialysis chairs? I'm in Illinois in a very large nephrology practice. We go to 17 outpt dialysis units (FMC and Davita). However, staffing is so low that the smaller units RNs float to other units to "help out." The managers often manage more than one unit and in several units there is no manager at all. Only one unit has a full time secretary (and that unit has 130 pts).

Are units around your area closing? Are they profitable? What happens if your census continues to fall? Will you be forced to "float?" What is the company's plan if there is an illness of staff, not just RNs but techs as well?

Duncan6 · Apr 1, 2023

@TraumaRus We are in a rural area and are the only clinic in 20-25 miles. We have providers from 3 different organizations due to our central location, so we stay pretty steady- it's unusual for us to have such a low census. I will say we have added 3 new patients in the last 2 weeks, so it looks like we're on the upswing. All of our clinics within driving distance have full-time managers at this point, so there is no floating from that standpoint. We are pretty well staffed compared to other clinics, so we are offered shifts elsewhere to make up time if we want to, but most of them are an hour away, so we don't do that all the time. And unfortunately, we've found that when we go to help we are given the crappiest assignments and are not given much assistance as far as the layout of the clinic, where supplies are, etc. We have a part-time secretary and now they are considering letting her work from home due to health issues- but not sure how she would actually do the secretary stuff from home...

We did have one clinic close a couple of months ago. It opened right before covid I believe and never built a census above 15 patients. Everyone else has been around for a while and we have been assured that no one else in the area is closing.

It's always a challenge to cover illnesses, but doable- usually the CM covers when one of the RNs is out. And the techs cover for each other. We used to have float pcts but haven't used them in well over a year. We are really fortunate that we have a lot of long-term employees who call off very rarely.

Duncan6 · Apr 8, 2023

Venting a bit this morning. I have now been waiting 3 weeks for an offer. One of the clinics our region received and IJ and so I figured that was part of the issue, I assumed our DO was just wrapped up with that. Frustrating but understandable. In the meantime, though, I am watching valuable time slip away that I could be using to train with the outgoing CM.

She's working today so I mentioned that I still haven't heard anything. The DO was supposed to be here Thursday to talk to me but never showed. She then shared that the problem is that I didn't pass my initial assessment after applying. Which is humiliating. And then the DO won't even just tell me so I know what's going on. The CM says both the DO and her have tried to around it but the company has said no. "My chances of leaving the position within the first 18 months is higher because of my score." Nevermind that my superiors recommended me for the job and I have 16 years of dialysis experience, 5 of those with the company at this clinic. Kind of bummed out. I was starting to look forward to doing something new.

I guess there is an option on the table that I could apply for a different CM position and take the test again, and then they would transfer me to my clinic. But would really be embarrassed to not pass twice, plus really annoyed my DO couldn't just be straight up with me.

Duncan6 · Apr 12, 2023

The DO texted me on Sunday-Easter morning! To say Happy Easter and I'll call you Monday. How about leave me alone on Easter and just call me Monday? I waited all day Monday- he never called. So when I got home I emailed him. I told him I had been updated on the situation, and that I would pass on the CM position even if there are other options for me to reapply and I reviewed my reasons. I then got an auto-reply that he is out of the office until next Monday the 17th. I'm starting to feel better about getting passed over.

Duncan6 · May 20, 2023

Another update- just because it helps me feel a little better- even if nobody reads it!

I still have not heard from the DO. No call, text, or reply to my email. He was in the clinic last week and made a big deal in front of the CM and staff saying he would call me that afternoon- never did.

They are now in the process of hiring a CM from out of state with several years of management experience, but no dialysis experience at all. So there's that.