Nurse Managers Abandoning [sinking] Ship

  1. I work at a fairly small, 125 or so beds, hospital. Last year we got a new DON after the old one who actually stood up for us got canned. In the last month, the director of surgery & OB nurse mgr left with notice. I found out yesterday that the nurse mgr of one of our med/surg units gave notice. I, having a pretty big mouth, asked the DON what the heck was going on?!? She just smiled and said "I'm not going to feel guilty about their leaving." So who should?

    From what I've read, the problems my hospital is experiencing mirror many of those across the nation. Anybody else out there can't keep a mgr for more than 2 years tops? Anybody else out there crazy enough to touch the job of middle nurse mgmt? I've been tapped for my feelings on taking the job of med-surg mgr.
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    About TracyRN

    Joined: Jan '01; Posts: 67; Likes: 6


  3. by   swmn
    Several possible issues here, maybe some will apply to your situation.
    One is working for salary instead of hourly, and one I would urge you to consider carefully before accepting a management slot. If you can not come up with staff, guess who gets to work that shift for free, while still being held responsible for all that paperwork and the performance of whatever staff you do have? That would be you. Nurse Manager is one of a very few professions that get less pay and more responsibility than floor nurses. No more OT. No more shift diff. Lots more headaches.

    Another thing to consider is the managment culture of the facility. A new DON can have a huge impact on management culture, the way things get done, by deciding who gets what, and which other somebody is paying for it. Frequently DONs are changed because management culture or structure does need to change. Sometimes new DONs...well nevermind.

    A third item is the boatload of new requirements coming down the pike in the last few months. Two years ago everyone had to know where the fire alarm pull was, come up with something reasonable if a JCAHO inspector asked about "R-A-C-E" and demonstrate reasonable competence applying universal precautions universally. Now we proabably all are looking at new documentation with a space for that "new" fifth vital sign, plus we got the ergonomics inservice to get through annually. On top of that, the defense lawyers clearly had some big top secret national convention somewhere, 'cause CYA charting is tripling everywhere I have been or heard about lately.

    The real shame of all the new paperwork and computer screens is I have yet to see a new blank on a form or "required field" in a computer screen that is doing anything but wasting the precious little time I have. I would be a lot happier in my job if I could charge triple time for all the times I write "N/A" or "see nurse's note", even just one day a week.
    This comes back to frustrated management because the nurse managers can't just add a box to the assessment form for "pain assessment." They got to go to meetings, lots of them, with lots of different departments to get that one little box put on the form. The bigger the instituition or corporation is, the more committees and risk managers there are to put their two cents in.

    True story, I was on an Endo unit at a big teaching hospital, the nurse manager went to meetings for a soild month and a half to get the "pain assessment" block onto the unit flowsheet. Finally, nursing steeering, risk management and executive management all three signed off on the new form and she sent it over to the hospital printer so we could start using it. Five days later, still no form, she calls the printer to see what's up with the form and she gets the run around for three more days. Finally the printer calls back, and says the risk manager of the printing department says the text describing the numeric, thermometer and faces scale in the new pain assessment block is "too small" and poses a liability to the facility because some nurses might not be able to read it, and therefore might misuse it, exposing the hospital to potentially expensive litigation and therefore they are not going to print it, but are instead forwarding it to legal, not risk management this time, but legal, for a second opinion. In the meantime, no we could not have any more copies of the old form even if we were out, because the old flowsheet form did not have a pain assessment block on it, and even the printer's secretary knows assessment forms have to have a space to chart pain assessment. It was a total circus. Not even the medical director of the unit could get actual preprinted forms from printing. We finally called the Chief Medical Officer of the University Health System and left him a voice mail to the effect that we were going to start Xeroxing our last copy of the old form until we got the new form in, and wouldn't those look great to a jury. If this sounds like something fun for you to do all day every day, by all means consider management.
  4. by   mustangsheba
    Tracy: Everything swmn says is true - and so much more. Personally, I would seek out the managers that are no longer and take them out for a beer! Listen very carefully to what the DON said - "I'm not going to feel guilty about their leaving". What that screams to me is that she is responsible for their no longer being there for whatever reason. I have worked with wonderful DONs and some not so wonderful. The title doesn't guarantee intelligence or ability. However, their mode of practice affects everyone over whom they have dominion. They also seem to gather like personalities around them. Find out who this person really is before you put yourself in an untenable position. Keep in touch and good luck.
  5. by   OC_An Khe
    Previous two posters have given excellent advice. I spent a number of years in nursing management before I realzed what a thankless jobit is. Would never go back. I am a nurse because I enjoy patient care, going into administration takes you away from being a nurse. You also have to learn and accept the managerial culture which doesn't place
    patients first. How much job security do you have as a staff nurse? Compare that to the nurse managers at your institution.

    [This message has been edited by ocankhe (edited March 04, 2001).]
  6. by   canoehead
    If you are being asked to apply I think you should be entitled to ask during the interview what's up with all the other managers leaving. They need to give you a straight answer, or risk having to go through the process all over again in a couple of months.

    In our facility the managers get a salary and then on top of it they get the top hourly pay if they need to come in to fill in for a staff nurse position. So they are compensated for their hours but by times end up working 70 hour weeks.