Clinically Inexperienced Manager

[ChaosCoordinatorRN]

What are your thoughts on having a manager who is completely inexperienced in the type of nursing they manage? Let's say they have great administrative skills but have never worked your field of nursing as a bedside nurse and you work in a highly specialized area like obstetrics, for example. What are your thoughts on this?

[DallasRN]

klone said:

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.

Thank you for the clarification.  I agree that nursing managers with NO healthcare background would be detrimental on many fronts.   My point was that having a manager with SOME nursing/bedside experience and background but with an advanced business degree would benefit nurses.  I appreciate your "best of both worlds" scenario.  

As noted, I've been out of the patient care environment for a long time.  I find it interesting half of your clinic leaders have no healthcare background.  I think the biggest issue is total lack of respect for the profession from the highest level of management (any organization) down to the very lowest.  And that includes patients.  My eyes were opened wide when reading comments pertaining to the illegally received licenses....comments from many healthcare providers and MANY in the general public...they've been doing the job so just let them keep doing it.  Total dismay.  So...now I'm off to my very low-paying, no stress, no-responsibility, no thought required, non-nursing job that helps me pay my electricity bill in my "retirement" years!  ?  Great day wishes to all!

[traumaRUs, MSN, APRN]

Hoosier_RN said:

A Fresenius in my region tried that. That person got escorted out yesterday, after leaving a clinic short staffed, 1 nurse and 1 tech for 24 patients. He said he didn't realize that was detrimental or dangerous. In dialysis, I know it goes on, but it's concerning when things like this happen. It wasn't this clown's first time doing it, but it was his last. His DO "forgot" that he had no direct patient care experience, and couldn't help on the floor. I'm sure they're answering some tough questions currently 

We are experiencing such a shortage of dialysis staff that the big two, both Fresenius and Davita are looking to close units leaving patients in rural areas in dire straits.  

 

Its certainly desirable to have a clinically competent manager but in this marketplace, that isn't always possible

[Hannahbanana, BSN, MSN]

The two best nursing managers I ever worked with were smart enough to say, explicitly, that they could not do what we did at our level of expertise but they would do everything—everything— they could to make it possible for us to do what we did at the highest level. Neither had to do staff work, they both had great support from staff educators and higher-ups. If anybody had a good idea about how to do something better, each of them said, "Do it, and let me know how it works out.” Managers like that are worth their weight in gold. Well-educated ones who bring business acumen to their position, platinum. 

That said, the best managers can be (and often are) hamstrung by management constraints: taking a patient load, not getting the resources they want, not being able to implement new procedures or set unit-specific policies. That's not their fault, and you're not likely to know about it in real time. Churn in management is as bad as churn in staffing, too. Nobody takes a management job intending to leave it in a year, they take it to do good, so if management is turning over every year or so, that tells you something. 

[Hoosier_RN, MSN]

traumaRUs said:

Its certainly desirable to have a clinically competent manager but in this marketplace, that isn't always possible

I agree. But when you have an idiot putting patients in jeopardy because of lack of knowledge and only looking at $$$, something bad is going to happen. It's a matter of when, where, and who

[Hoosier_RN, MSN]

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.

Some dialysis clinics is one example, which in some, the manager is expected to help on the floor, no clinical experience can be detrimental to deadly to a patient. This was mentioned by someone else in this thread, as DaVita does it regularly. Fresenius tried it and it failed, as managers are expected to help on the floor, at least in my region. A patient almost died, and I can't say much more, as I'm sure that there's going to be a lawsuit.

The hospital that my mom retired from as the nursing director of surgical services replaced her with a gentleman with his MBA. His cost cutting ideas were mainly staff. Umm, not in surgery. He was replaced after 4 months by a nurse with her MSN, and they've not had problems since 

[Hoosier_RN, MSN]

klone said:

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. 

You nailed it! It can be dangerous with the wrong person

[JBMmom, MSN, NP]

I think if a unit is well staffed and the new manager is the sort of person that is able to truly take constructive feedback from others, it could work out fine. However, these days units are not well staffed and so a lack of understanding of the job on the part of the manager could be detrimental to patient care. Or if they come in and make decisions that can impact patient care without relying on the staff that know the job and the floor that could also turn out poorly. But if a manager who is responsible for administrative tasks has the resources necessary to provide support for their staff to do their jobs I think it could work out fine.

For the OP, I can't believe they would hire someone with no experience knowing that in an emergency they could be relied upon for patient care. That seems negligent on the part of the organization and I can't imagine what person would accept that position if it were presented to them in that way. 

[CommunityRNBSN, BSN, RN]

I think part of the problem is that it's hard to find people who are both clinically experienced AND experienced managers. At my last job, they internally promoted a nurse to nurse manager. She was a GREAT floor nurse, and knew the clinic inside and out. However, she was awful at management and supervision. Honestly, I would rather have had someone who didn't know anything clinically— but was good with management and leadership— than the inverse. 

[ChaosCoordinatorRN]

klone said:

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. 

Exactly...out of desperation for a manager, they hired someone without the experience.

I figured they would give her time to orient to the floor but they did not. They have not put her through fetal monitoring training. Nothing.

We are not unionized. In fact, our hospital put out a POLICY threatening us against even mentioning unionizing. They threaten to immediate terminate us if we even whisper about it. They threaten us against talking about what other people are paid, etc. Pretty sure that's illegal.

[ChaosCoordinatorRN]

JBMmom said:

I think if a unit is well staffed and the new manager is the sort of person that is able to truly take constructive feedback from others, it could work out fine. However, these days units are not well staffed and so a lack of understanding of the job on the part 

For the OP, I can't believe they would hire someone with no experience knowing that in an emergency they could be relied upon for patient care. That seems negligent on the part of the organization and I can't imagine what person would accept that position if it were presented to them in that way. 

Our unit is definitely not staffed well enough. Most of our staff are brand spanking new to L&D. We rely heavily on travelers. The experienced staff are leaving, fed up with seeing everyone but them get bonuses. 

I was in this manager's interview and asked her specific questions about her L&D experience. She has postpartum experience, which I can tell you from having worked PP, is NOT the same. I posed questions about specific OB emergencies and she could not answer them. She said she can start IVs. That's adorable.

[klone, MSN, RN]

ChaosCoordinatorRN said:

They threaten us against talking about what other people are paid, etc. Pretty sure that's illegal.

That is very much illegal. https://www.nlrb.gov/about-nlrb/rights-we-protect/your-rights/your-rights-to-discuss-wages

[Hoosier_RN, MSN]

ChaosCoordinatorRN said:

They threaten us against talking about what other people are paid, etc. Pretty sure that's illegal.

That is 100% illegal, even though employers still encourage those conversations not to happen