Clinically Inexperienced Manager

mdsRN2005, ASN, BSN, RN · Mar 22, 2023

I think clinical experience should absolutely be required but as to whether it relates to that specialty may depend on the specialty in question and the manager's clinical experience. For example, I have many years ER experience and could probably manage an ICU or urgent care more easily than L&D. However I do think it's possible to make this work if you have someone with exceptional leadership skills; but I do agree they should first learn the clinical side of the specialty (if I took a L&D manager position, I'd spend time "orienting" with the staff nurses). I also think in this case you should defer to those with clinical experience for clinical questions.

However, to be devil's advocate, managers are hired to do management tasks - staffing, budget, compliance, manage poorly performing staff, mediate conflicts between staff, handle patient complaints, etc. Contrary to what many staff nurses seem to think, which is that managers are supposed to be running around starting IVs, giving meds, etc whenever it gets busy. I fully agree that a good manager should be willing to help when needed, however this is not actually their primary job. And since it pulls them away from their job, they'd be better served staffing the unit in such a way that this is not regularly required. Just a reminder that there is a difference between nurse manager and float nurse. ?

ChaosCoordinatorRN · Mar 22, 2023

mdsRN2005 said:

I think clinical experience should absolutely be required but as to whether it relates to that specialty may depend on the specialty in question and the manager's clinical experience. For example, I have many years ER experience and could probably manage an ICU or urgent care more easily than L&D. However I do think it's possible to make this work if you have someone with exceptional leadership skills; but I do agree they should first learn the clinical side of the specialty (if I took a L&D manager position, I'd spend time "orienting" with the staff nurses). I also think in this case you should defer to those with clinical experience for clinical questions.

However, to be devil's advocate, managers are hired to do management tasks - staffing, budget, compliance, manage poorly performing staff, mediate conflicts between staff, handle patient complaints, etc. Contrary to what many staff nurses seem to think, which is that managers are supposed to be running around starting IVs, giving meds, etc whenever it gets busy. I fully agree that a good manager should be willing to help when needed, however this is not actually their primary job. And since it pulls them away from their job, they'd be better served staffing the unit in such a way that this is not regularly required. Just a reminder that there is a difference between nurse manager and float nurse. ?

I agree with most of what you said. The specialty in question is obstetrics and the manager has no experience with high-risk antepartum patients or actively laboring patients. More than half of our staff is new to OB. 25% of our staff are travelers. The hospital is for-profit, so we are often understaffed. On the understaffed, high-census days, the manager has historically been expected to fill the role of charge so that the charge can take patients. When you don't have experience with obstetric patients, how would you know how to manage an obstetric emergency? Because, believe me, the charge nurse, too, gets pulled into depositions. In my book, it is a patient safety issue.

klone, MSN, RN · Mar 22, 2023

The problem is not that the manager doesn't have an L&D background. The problem is that they are expected to take a floor assignment at times. That should NOT be the expectation of a nurse manager, unless they are hired as a "working manager" in which case it makes sense that it would be someone with an OB background.

But I suggest you're approaching the issue from the wrong angle. The fact that the manager has no OB background is NOT the problem here.

ChaosCoordinatorRN · Mar 22, 2023

klone said:

The problem is not that the manager doesn't have an L&D background. The problem is that they are expected to take a floor assignment at times. That should NOT be the expectation of a nurse manager, unless they are hired as a "working manager" in which case it makes sense that it would be someone with an OB background.

But I suggest you're approaching the issue from the wrong angle. The fact that the manager has no OB background is NOT the problem here.

Ah, but I agree with you! The manager should never have to worry about working the floor! Yet, a corporate-level CFO recently said that managers needed to work the floor because the company didn't have to pay them more!

klone, MSN, RN · Mar 22, 2023

So if that really is the expectation, why would they hire someone who is not trained to do so? That would be like hiring an ICU nurse to work in L&D and just throw her into the job without orientation.

Are they at least giving your manager time to orient to basic OB? Fetal monitoring training? Also, are you unionized? Because putting a non-union person into a unionized role, for purposes of not having to hire/pay for additional union nurses, goes against pretty much every CBA I've ever seen.

DallasRN · Mar 23, 2023

My perspective is different from many. Years back, I worked in a trauma center ER in another state and the manager was, hands down, the best manager I ever worked under. As I recall, she was an "old diploma school" grad and was the first to admit she'd never worked a day as a staff nurse in any ER. That said, we always had great staffing and any equipment/supplies we needed. She was adamant we were to take our dinner breaks. Wouldn't hesitate to go to bat for us with the admin or docs when needed. During busy times, she'd hit the floor running...maybe not fulfilling the role of many of the staff nurses, but picking up slack wherever needed...getting blankets, water, intervening with family. members. In a crunch, she could drop an NG tube with the best of them or pop a tetorifice in someone's arm in a flash while she gave the discharge instructions. If a staff member was weak in any particular area, she teamed them with mentors. (I was NOT a pedi person but she arranged for me to work with a great pedi specialist for a few shifts to develop some comfort level).

So, in my opinion, she managed the busy and specialized unit like no other manager I've ever worked under. She didn't know much of what most of the staff knew in terms of ER/trauma nursing, but she knew how to organize and manage a team.

DallasRN · Mar 23, 2023

mdsRN2005 said:

However, to be devil's advocate, managers are hired to do management tasks - staffing, budget, compliance, manage poorly performing staff, mediate conflicts between staff, handle patient complaints, etc. Contrary to what many staff nurses seem to think, which is that managers are supposed to be running around starting IVs, giving meds, etc whenever it gets busy. I fully agree that a good manager should be willing to help when needed, however this is not actually their primary job. And since it pulls them away from their job, they'd be better served staffing the unit in such a way that this is not regularly required. Just a reminder that there is a difference between nurse manager and float nurse. ?

I've been out of the hospital loop for a good many years now, but I recall years back there was talk about hiring people with Masters in Business and Associate degrees to manage busy units in major hospitals. Actually, it made sense to me for the reasons you mentioned...budget, compliance, etc. I don't think a degree makes a manager. I have a BSN but can tell you with no hesitation...I was the world's worst manager. Took me about 3-4 years to realize how bad I was and I really feel bad for those I "managed". But I had other great qualities. LOL

klone, MSN, RN · Mar 23, 2023

I would also offer that hiring a manager who doesn't have the background to be able to take a patient assignment is a good way of preventing an otherwise great manager from burning out. My last job where I was in OB leadership, I quit after a year because I was working 60-hour weeks, most weekends, etc. Because when they were short-staffed, I was always the option of last resort. Because I COULD. And being a good manager, I would not let my team drown if I could help them. But as a manager, where I do not have the training or background to take a patient assignment, I can help out in other ways, as previously mentioned, while still maintaining that boundary.

Hoosier_RN, MSN · Mar 24, 2023

DallasRN said:

I've been out of the hospital loop for a good many years now, but I recall years back there was talk about hiring people with Masters in Business and Associate degrees to manage busy units in major hospitals. Actually, it made sense to me for the reasons you mentioned...budget, compliance, etc. I don't think a degree makes a manager. I have a BSN but can tell you with no hesitation...I was the world's worst manager. Took me about 3-4 years to realize how bad I was and I really feel bad for those I "managed". But I had other great qualities. LOL

A bad, or good, manager can happen regardless of degree. But no healthcare experience is how we've gotten this penny pinching, bottom line, makes no sense, policies and procedures

DallasRN · Mar 24, 2023

Hoosier_RN said:

A bad, or good, manager can happen regardless of degree. But no healthcare experience is how we've gotten this penny pinching, bottom line, makes no sense, policies and procedures

I don't understand the second line of your comment. How do you equate "no healthcare experience" to the things mentioned? As far as I know, the profession hasn't arrived at a point where they are hiring people with no healthcare experience. Thanks for your explanation.

DallasRN · Mar 24, 2023

klone said:

I would also offer that hiring a manager who doesn't have the background to be able to take a patient assignment is a good way of preventing an otherwise great manager from burning out. My last job where I was in OB leadership, I quit after a year because I was working 60-hour weeks, most weekends, etc. Because when they were short-staffed, I was always the option of last resort. Because I COULD. And being a good manager, I would not let my team drown if I could help them. But as a manager, where I do not have the training or background to take a patient assignment, I can help out in other ways, as previously mentioned, while still maintaining that boundary.

Good points and may have contributed to my downfall in management. I had some very specific skills (beyond ICU/ER) and as a result, spent a huge amount of my time in staffing duties. For some reason, nursing staff always want to "test" a manager. Interestingly, I haven't seen that in the business world.

klone, MSN, RN · Mar 24, 2023

DallasRN said:

I don't understand the second line of your comment. How do you equate "no healthcare experience" to the things mentioned? As far as I know, the profession hasn't arrived at a point where they are hiring people with no healthcare experience. Thanks for your explanation.

I think Hoosier is saying that people with no healthcare or nursing background who are in hospital leadership positions (or at least, frontline leadership) look at it from a business/finance perspective only, and not a patient care and safety perspective. The best of both worlds is if they actually taught business courses in nursing leadership master's degree programs.

I can tell you that half the clinic leaders in my organization do not have a healthcare background - they have MBAs or MHAs.