Feeling micromanaged...

[n1wgmp]

Hello, I was wondering what everyones opinions are on feeling micromanaged by nurse managers, nurse educators, infection preventionist, etc.

I'll start with saying I tend to be a little of a perfectionist in the ICU that I work in (what ICU nurse isn't..lol) so I try to ensure I do all the little extra things perfectly that management likes such as: filling out white boards appropriately even though my patient is intubated and sedated, labeling IV lines with date stickers, ensuring all caps are on central line ports, dates on all lines/tubes, no loops in foleys, making sure theres an actual order in the chart for a central line a foley, charting perfectly on absolutely everything because it gets audited, and never bypassing a scan of the patient, even if its lab work because that gets audited as well, etc.

So anyone who works in the ICU knows that sometimes things get a little crazy and your patient tries to die on you every now and then or all shift ha! So it's very often that you just don't have time to make sure absolutely everything is perfect for when managers come around because your patient is having 15 beat runs of v tach and their BP is 70/30 and your assisting the docs at bedside putting in a quinton for emergent dialysis etc.

So sometimes I feel like I am being (or more every nurse on the unit) is being micromanaged by management, nurse educators etc. Like the other day, my nurse educator was auditing what we set our alarm limits at to ensure we're "setting them appropriately" (according to who??) and she comes up to me and tells me my parameters for my heart rate are inappropriate because my patients baseline HR is 86 my alarm limits are 50 for low and 125 for high. I tell her my patients HR gets up into the 120's and when he falls asleep in the 60s and this is where I like my alarm limits set for a patient like this. Another one she said is that the limit for systolic BP alarm at 90 low and 180 high was inappropriate because it is what was preset in the monitor and I did not adjust it. So we proceed to argue for about 5 minutes with me ending up giving in telling her okay Ill fix them to her liking.

I was extremely frustrated and upset. I feel as if I get offended that she feels the need to come around and check what I set my alarm limits at, I mean after all don't I have a nursing degree? Don't I know a little bit about nursing? Don't you think that I know what limits are best for my patient?

Most of the nurses that have been on my unit for 10 years plus tell me when management comes around to check all that stuff just say "uh huh I'll fix it" and walk away and don't think twice about it.

Just want to get some opinions on what everyones experiences are with this and how you deal with feeling like your being micromanaged.

Thanks.

[MOSTLYHAPPYRN]

It's literally their job to audit stuff, and to find stuff that they can "improve upon"... Don't take it so personally. They are just doing what their bosses tell them to do, which is just all part of being compliant with JC , to get Medicare reimbursement, or whatever else. It is not personal against you. Yeah sometimes it's BS. Sometimes it's helpful. And it can be annoying ! But it's not personal .

[Horseshoe, BSN, RN]

I'll start with saying I tend to be a little of a perfectionist in the ICU that I work in (what ICU nurse isn't..lol) so I try to ensure I do all the little extra things perfectly that management likes such as: filling out white boards appropriately even though my patient is intubated and sedated, labeling IV lines with date stickers, ensuring all caps are on central line ports, dates on all lines/tubes, no loops in foleys, making sure theres an actual order in the chart for a central line a foley, charting perfectly on absolutely everything because it gets audited, and never bypassing a scan of the patient, even if its lab work because that gets audited as well, etc.

Bold is mine.

Those don't sound like "extras" to me indicative of perfectionism. They sound like ordinary things that should be done without question.

And as to the white boards: your patient who is intubated and sedated may not need that information, but their family members might find that information to be very helpful. So, again, how is filling it out doing something "extra"?

[Anna Flaxis, BSN, RN]

I'm afraid I'm going to side with your unit educator on this one. Heart rate variability can be a strong predictor of mortality. Setting more narrow alarm limits can result in earlier recognition of deterioration, and thus earlier intervention, before the patient deteriorates into a code blue situation.

[imintrouble, BSN, RN]

You have my sympathy. There is, I believe, a direct correlation between morale on a unit, and the amount of autonomy exercised. I'm happiest when my employer demonstrates their faith in me, by letting me be the good nurse they know me to be. I'm not advocating letting the staff run amok, just allow for personal variations as long as it's within the rules, and is absolutely safe for the patient. One of the things I loved about nursing was you could have 10 nurses do the same procedure, and none of them would do it exactly the same. And they'd still all be right. I think you're describing the new way of nursing. Scripting and color coded scrubs. Variations are not acceptable.

[Been there,done that, ASN, RN]

Hello, I was wondering what everyones opinions are on feeling micromanaged by nurse managers, nurse educators, infection preventionist, etc.

I'll start with saying I tend to be a little of a perfectionist in the ICU that I work in (what ICU nurse isn't..lol) so I try to ensure I do all the little extra things perfectly that management likes such as: filling out white boards appropriately even though my patient is intubated and sedated, labeling IV lines with date stickers, ensuring all caps are on central line ports, dates on all lines/tubes, no loops in foleys, making sure theres an actual order in the chart for a central line a foley, charting perfectly on absolutely everything because it gets audited, and never bypassing a scan of the patient, even if its lab work because that gets audited as well, etc.

So anyone who works in the ICU knows that sometimes things get a little crazy and your patient tries to die on you every now and then or all shift ha! So it's very often that you just don't have time to make sure absolutely everything is perfect for when managers come around because your patient is having 15 beat runs of v tach and their BP is 70/30 and your assisting the docs at bedside putting in a quinton for emergent dialysis etc.

So sometimes I feel like I am being (or more every nurse on the unit) is being micromanaged by management, nurse educators etc. Like the other day, my nurse educator was auditing what we set our alarm limits at to ensure we're "setting them appropriately" (according to who??) and she comes up to me and tells me my parameters for my heart rate are inappropriate because my patients baseline HR is 86 my alarm limits are 50 for low and 125 for high. I tell her my patients HR gets up into the 120's and when he falls asleep in the 60s and this is where I like my alarm limits set for a patient like this. Another one she said is that the limit for systolic BP alarm at 90 low and 180 high was inappropriate because it is what was preset in the monitor and I did not adjust it. So we proceed to argue for about 5 minutes with me ending up giving in telling her okay Ill fix them to her liking.

I was extremely frustrated and upset. I feel as if I get offended that she feels the need to come around and check what I set my alarm limits at, I mean after all don't I have a nursing degree? Don't I know a little bit about nursing? Don't you think that I know what limits are best for my patient?

Most of the nurses that have been on my unit for 10 years plus tell me when management comes around to check all that stuff just say "uh huh I'll fix it" and walk away and don't think twice about it.

Just want to get some opinions on what everyones experiences are with this and how you deal with feeling like your being micromanaged.

Thanks.

The nurse educator only has THEIR guidelines to enforce. They are not smart enough to think outside the (parameter) box. I certainly realize the need to adjust parameters. This is why you DOCUMENT your rationale when you adjust parameters.

It is policy and keeps the micromanagers away:yes: