ANM considering return to bedside nursing

[bewitched]

Just looking for some insight from anyone who's been here or similar.

I am an Associate's-prepared RN with four years of experience in IMCU, ICU, hospice nursing, and PCU. I've worked my way up from CNA to new grad to floor nurse, then to preceptor, relief charge, and for the past year I've been an Assistant Nurse Manager. I am the youngest of the ANMs on my floor, and I feel that I am both intelligent and mature for my age. I take my profession seriously. I have gone back to school for my RN to MSN with a focus on Nurse Leadership and will be getting a BSN degree along the way.

I am growing increasingly stressed at my current ANM position as leadership changes in my hospital as well as changes on my unit's patient population have become more and more challenging. The morale on my unit is dragging due to most days everyone having 5:1 because we are now doing a specific pilot program requiring a 3:1 pt ratio for one nurse. The staffing overall in the hospital has become an issue in the last few months, and we are often intentionally shorting ourselves because we are floating our nurses or techs to other units. Our patient experience people have stepped up in a big way and have gotten very strict about their scripting and other initiatives, which I am a proponent of in a general sense but don't believe in coming down hard on nurses if they don't do it perfectly, because I feel like you've got to trust your nursing staff and let them deliver quality care in a genuine way. That's more important to me than being a hard-ass about using key words, signing rounding logs on the hour every hour, etc.

I don't feel that my own manager realizes ANMs need support too. It's as if she feels that our support and engagement is a given, and that it's the bedside staff we need to compliment (and write-up if necessary) and boost the morale of. I feel that my ANM role has all the expectations of a manager's role-the scheduling, employee rounding, leader rounding, employee annual evals, observations, etc--but with all the day to day struggles of a charge nurse--throughput, staffing, patient complaints, code blues, clinical audits for central lines, etc. I also get texts and emails from my boss on my days off regarding this question or that event or this/that patient who went home, etc, and every time my phone jingles on my day off I feel stressed because I know it's going to be her.

I am getting frustrated because I am working my 3-4 12 hour shifts per week, then I have to come in on my days off for classes and our weekly meeting, plus I do the schedule on our unit so that is a time-consuming task on my days off as well. I enjoy the nurses I work with for the most part, but I am just not totally thrilled with my own job on a daily basis. Unlike bedside nursing, I can't not take a difficult patient back the next day; all the difficult patients are all mine to handle, which is OK sometimes, but I swear we get ALL of them that pass through our hospital doors. I also haven't called out sick in the entire past year because we have no relief charge on the unit to take my place, and I don't want to let the unit down.

I am strongly tempted to look into returning to bedside nursing, partially because I miss having my own group of patients, I miss the hands-on activities of nursing. I miss my days off being my own, and I'd certainly have more time to complete my RN-MSN which it is sometimes hard to do with the demands of my current schedule. I'm also strongly considering leaving my company and going for the "other guys" hospital across town, who I've never worked for but the pay is said to be competitive if not a bit higher, and the work environment may be better. They also offer different specialties, including trauma, and I am getting a weary of my current hospital's culture.

I am thinking about going back to bedside nursing for a couple of years while I finish my RN-MSN degree, then moving back up into management when my lifestyle can support a M-F/9-5 sort of schedule, and when my MSN degree qualifies me. Do you think there would be issues with having been in middle management only to return to bedside nursing? What would you do if you were me?

[cleback]

Are you sure you want to continue with your nursing management degree? I mean, the job you hsve now seems to be the best experience for what you're going to school for, and sounds pretty typical for hospital management. If you work 3-12s at the bedside you would still need to come in on your days off for meetings, trainings, etc.

[KatieMI, BSN, MSN, RN]

As your school advances, things will only get more difficult, especially after you hit grad level classes. If you can get something which will at least let you leave work at work, go for it. Hopefully, it will be in another place without those crazy scripting and the likes.

P.S. I second the idea... are you sure that the management is really what you are looking for? If you are not happy now, think again before you started grad classes

[bewitched]

I am fully aware that bedside nursing does require staff meetings, inservices, etc. However, I am currently meeting on a weekly basis with myself and the other ANMs and our manager, for several hours at a time, which kind of ruins a whole day off, and it is basically getting reminded/lectured of things we all already know, for the most part. Instead of being helpful or encouraging, it feels discouraging to me and only increases my feeling that what we do is never enough for our manager or upper management.

I am considering other routes with my Masters' but I am still interested in leadership and management, but likely not with the hospital company I currently work for. I have another 6 months or more before I'll be into the leadership coursework with my masters so I have time to make that decision. I also feel like being both a charge nurse day to day yet still having the expectation of management-style work is a lot--I didn't feel this stressed as a charge nurse, and I don't think I'd feel this stressed as a Nurse Manager. It's being in the middle, I feel, that makes me not as effective at either part of the job as I would be if I was JUST charge nurse or JUST management.

And I do think as the 2nd commenter said (shadowposted, sorry!) that for right now, I'm looking for something where I can leave work at work, focus on my school, have balance between work and home life for a while, then eventually when I have more clinical experience and have the degrees I need as well as the knowledge of leadership and management then I can move back up the chain.