Getting staff to "own" the unit

nursemaa · Mar 11, 2006

Not coming to meetings/being on committees only means your nurses aren't 'owning' their unit if that is YOUR definition of 'owning'. But, if you reach out to those same nurses, not on YOUR playing field, but on THEIRS, you might find much more 'ownership' than you expected to find.
Ownership in things like not abusing sick leave and working extra shifts so my co-workers aren't short staffed (or so YOU don't have to come in on the night shift and work). Ownership like being a resource person for more junior staff. Ownership like taking pride in my work and trying to convey that to pts and family.
"Ownership" is a subjective measurement. I took umbrage before, not because I dislike management, but because of the attitude that 'ownership' is only defined by how well your nurses play the administrative game.
And most nurses working the bedside after 10 or more years - those nurses made, at some point, a conscious decision to invest their ownership AWAY from administration, or they would have been vying for YOUR jobs. You can't disrespect them for that.
And you can't hold that against them, or if you do, you do so at your own peril. Because there is probably a direct relationship between how much you feel your nurses aren't there for you and how much they feel you aren't there for them.

All of the above statements make sense. I think you have greatly misunderstood me.

I definitely do listen to my staff. Many great ideas and solutions to problems have arisen out of those hallway and coffee break conversations. I don't discount the tremendous value of getting out there and talking to and mostly listening to my staff- they are great idea generators. I spend enormous amounts of my day talking with them and getting feedback about various things.

I also completely understand those who just want to do their thing and go home- I've been there, especially when my kids were little. And I have lately come to the realization that most staff just don't care for meetings- OK, I can live with that.

It's just that I guess I see so many opportunities to get involved in projects and committees that are really trying to do worthwhile things, it's hard for me to understand not wanting to be involved- but that's me. I'm the same way at church, my kid's clubs etc.

I just got the feeling that you think all managers are is a bunch of pencil and paper-pushers, and that you felt that the reason we want staff to sit on committees is to get them to do our work. I wanted you to know that we're not all like that, some of us really support and believe in our staff and are not trying to push our work off on them- we just want their input. You're right, committees aren't the only way to get that. I know I care very much about my staff and their working conditions and do whatever I can to help and support them. I also believe that you don't have to be in management to be a leader, and to generate great ideas.

One more thing...I don't disrespect them or feel that they aren't there for me. It's not about me, it's about nurses at all levels working together to improve and sustain quality care and to have a voice in our organizations.

OK, just one more thing- I appreciate your positive comments about management in the post you quoted. It's nice when staff recognize the good managers and don't lump us all together. Now I'll shut up. : )

laurakoko · Mar 11, 2006

I say, for the staff that is complaining...make the complaint, and suggest a solution. Develop a PI team, with the complainer the president, and try to implement the suggestion (especially if it is workable/manageable). The complainers will then be a part of a team, trying to make a change, take "ownership" of their unit. If they don't want to do it, stop complaining. WHY NOT TRY TO CHANGE? Some nurses have some great ideas for making their jobs better, and for most nurses, it means effectively giving better, efficiant care to their patients. Isn't that what we WANT???????

Sable's mom · Mar 11, 2006

I agree- if you come to me with a problem, come with a possible solution. :idea: That is the policy nursing admin has for the managers, so we have adopted it with our staff. It has cut down on the '*itch and moan' sessions:uhoh21:

Point of interest - I have also told my staff - if you have a situation that you know is not changable, but "just want to vent:angryfire" , I am happy to listen, but please tell me that upfront, so I don't spend time or energy trying to fix the unfixable or trying to find a way to tell you that it is unfixable.:chair:

ZASHAGALKA, RN · Mar 13, 2006

I say, for the staff that is complaining...make the complaint, and suggest a solution. Develop a PI team, with the complainer the president, and try to implement the suggestion (especially if it is workable/manageable). The complainers will then be a part of a team, trying to make a change, take "ownership" of their unit. If they don't want to do it, stop complaining. WHY NOT TRY TO CHANGE? Some nurses have some great ideas for making their jobs better, and for most nurses, it means effectively giving better, efficiant care to their patients. Isn't that what we WANT???????

In other words, don't complain to you.

Probably every manager that reads this has said at one point or other that you have an 'open door' policy. But this attitude is the antithesis of such a policy. You don't really have an open door policy if you place limits on your staff coming to discuss things with you.

I can see why you are frustrated with your staff - and just as importantly, why they are frustrated with you.

And that's not a slam. But take a second look at what you said: if you don't have 100 hours to devote to a problem, then don't bring it to me.

My previous point stands. What you have suggested is the way YOU would work out a solution, as a manager. And you've superimposed YOUR job on THEIRS. Your staff aren't managers. If you want them to respond, you need to reach to them on their terms, instead of demanding that they reach out on YOUR terms. After all, if they wanted to be managers, many of your staff could have been so, by now.

This is a classic failure to look at problems from the perspective of your staff. And the result: you are needlessly frustrated because your bedside nurses resist being the manager they never wanted to be, and they are frustrated because they can't take any problems to their manager.

~faith,

Timothy.

Turk182 · Mar 18, 2006

Thank goodness for this forum!!!! I can't tell you how much the comments regarding "all nurse managers are not the same" theme has made me feel a bit more positive.

"Zashagalka" : I don't understand the hostility in your postings. I understand completely the frustration in feeling like managers just want to tell you what to do, don't care what it costs you personally or emotionally, even the perception that they are just "pencil pushers". But that is what it is, your perception, and though valid (as those are your feelings) not always accurate. You blasted me earlier saying that I was angry because the staff wouldn't "do my job", and something to the effect that I wanted to be a manager, so deal with it. Again, that was your perception. What you don't know is why I wanted to be a manager. I left a very secure position in the Emergency room that I LOVED, thrived on. and was very good at- to go to a unit that was left without a manager, was barely hanging on, but had the potential to explode with greatness... because I cared. I knew the strength and talent that was being wasted due to lack of leadership and the willingness to deal with the "problem people". When you have staff who bring the whole unit down, with their attitude, bad behavior, whatever, it doesn't matter if they are the greatest nurse in the world- the unit suffers and ultimately the patient suffers.

If you don't want to be on a committe, CQI, fine don't. Just have the integrity to follow the policy and procedures that are in place, or implemented. If you want change to happen you have to be willing to help. Most managers do 3/4 more behind the scene, on their own time and at an out of pocket expense. You won't hear them fighting for you against the higher powers that be, because you shouldn't. Just like you shouldn't know what happens when someone is counseled, you shouldn't hear what's going on between upper management and me. But that doesn't mean we're not doing everything within our power to make your environment and your time/pay etc. better.

Please do not think that nurse managers are people who have little or no clinical experience, don't care, and who want to hide in their office. The staff nurse answers only to their manager. The manager answers to more people and agencies than you realize. We just need a place and a moment to vent like everybody else, and we deserve the same respect for accepting the challange ( for whatever the reason ) in managing a department...that you do working in difficult conditions. It shouldn't be a "you" or "I", we are all nurses first and foremost, we should be working together, for the patient and then for our profession.

nursemaa · Mar 18, 2006

Thank goodness for this forum!!!! I can't tell you how much the comments regarding "all nurse managers are not the same" theme has made me feel a bit more positive.
"Zashagalka" : I don't understand the hostility in your postings. I understand completely the frustration in feeling like managers just want to tell you what to do, don't care what it costs you personally or emotionally, even the perception that they are just "pencil pushers". But that is what it is, your perception, and though valid (as those are your feelings) not always accurate. You blasted me earlier saying that I was angry because the staff wouldn't "do my job", and something to the effect that I wanted to be a manager, so deal with it. Again, that was your perception. What you don't know is why I wanted to be a manager. I left a very secure position in the Emergency room that I LOVED, thrived on. and was very good at- to go to a unit that was left without a manager, was barely hanging on, but had the potential to explode with greatness... because I cared. I knew the strength and talent that was being wasted due to lack of leadership and the willingness to deal with the "problem people". When you have staff who bring the whole unit down, with their attitude, bad behavior, whatever, it doesn't matter if they are the greatest nurse in the world- the unit suffers and ultimately the patient suffers.
If you don't want to be on a committe, CQI, fine don't. Just have the integrity to follow the policy and procedures that are in place, or implemented. If you want change to happen you have to be willing to help. Most managers do 3/4 more behind the scene, on their own time and at an out of pocket expense. You won't hear them fighting for you against the higher powers that be, because you shouldn't. Just like you shouldn't know what happens when someone is counseled, you shouldn't hear what's going on between upper management and me. But that doesn't mean we're not doing everything within our power to make your environment and your time/pay etc. better.
Please do not think that nurse managers are people who have little or no clinical experience, don't care, and who want to hide in their office. The staff nurse answers only to their manager. The manager answers to more people and agencies than you realize. We just need a place and a moment to vent like everybody else, and we deserve the same respect for accepting the challange ( for whatever the reason ) in managing a department...that you do working in difficult conditions. It shouldn't be a "you" or "I", we are all nurses first and foremost, we should be working together, for the patient and then for our profession.

On behalf of all of us managers on this board....THANK YOU !

We really do just as much work as the staff do, it's just different work. We're all part of the team, we just have different roles.

Sable's mom · Mar 20, 2006

thank goodness for this forum!!!! i can't tell you how much the comments regarding "all nurse managers are not the same" theme has made me feel a bit more positive.
"zashagalka" : i don't understand the hostility in your postings. you won't hear them fighting for you against the higher powers that be, because you shouldn't. just like you shouldn't know what happens when someone is counseled, you shouldn't hear what's going on between upper management and me. but that doesn't mean we're not doing everything within our power to make your environment and your time/pay etc. better.
please do not think that nurse managers are people who have little or no clinical experience, don't care, and who want to hide in their office. the staff nurse answers only to their manager. the manager answers to more people and agencies than you realize. we just need a place and a moment to vent like everybody else, and we deserve the same respect for accepting the challange ( for whatever the reason ) in managing a department...that you do working in difficult conditions. it shouldn't be a "you" or "i", we are all nurses first and foremost, we should be working together, for the patient and then for our profession.

:flowersfo as nursemaa said thank you!! :balloons: we need to be working together not tearing each other down, regardless of our roles.

ZASHAGALKA, RN · Mar 20, 2006

:flowersfo As Nursemaa said THANK YOU!! :balloons: We need to be working together not tearing each other down regardless of our roles.[/size']

I completely agree.

I'm not anti-manager. I understand that management is a vital role. I also understand that the committees and the paperpushing is part of that job. I have a great deal of respect for you managers for going to bat for staff.

But I don't think it's good management to look at your staff through a manager's role and then be upset when they aren't the managers THEY never wanted to be. I don't like the concept that as a manager, your door isn't open, or is only conditionally open.

You say THANK YOU for pointing out that we need to work together, and not tear each other apart. I agree completely. And that is the basis of my response. Because the thread's responses were complaining that nurses don't 'own' their units and the examples were because we aren't doing things that I would define as administrative. My POINT was that if you only measure your staff by how well they behave in administrative ways, then you will always be disappointed, and that disappointment will be mutual.

Because part of working together is excelling in your areas of expertise. And many of your nurses have no desire to be administrators. That neither makes them bad nurses for avoiding that like the plague, nor you bad nurses for embracing it. It's different cogs in the team.

So ultimately, my point was that you should open up your definition of 'owning a unit' to include more that just an administrative perspective.

And your door should always be open, whether I have a solution or not. Sometimes, good management is all about just listening to a good vent once in awhile.

~faith,

Timothy.

DallasRN · Mar 20, 2006

From a now staff RN with several years of management experience (and I was the worlds worst manager!)...I've said the same about the m/s unit I work on. Nobody will take ownership. So a couple of things...

Do the people on your unit have to float frequently? We did/do, and that creates issues. Hard to feel ownership when you have to leave all the time and/or have others with no feeling of ownership come in. If floating is an issue, perhaps you could work out something where the unit is covered by the regular staff? Flexibility in staffing? On-call people? Do you have agency staff? If so, do your best to get rid of them (and yes, I worked agency). Fact is, few agency nurses really care about the unit. The can't. Here today, gone tomorrow.

What about the docs? Are they treating the staff with respect? Do the nurses make rounds with the docs? Is there communication btw docs/nurses? Important. Team players. And that goes for all ancillary staff, as well.

Nursing "consults." Encourage it. Not every nurse knows every single thing. Docs consult. Why not nurses? Instead, we're made to feel inferior if we don't know something. Encourage "consults" among peers. What about weekly or monthly "nursing grand rounds?" Not a pick-apart session, but trouble shooting. If you can get admin support, try to have it in a conference room with a "catered" lunch from dietary, much like the docs do. Chips and sandwiches will do, but make it nice instead of something thrown together in the staff usually nasty staff lounge with littered bulletin boards.

Inservice education. Any particular needs on your unit? Chest tubes? Wound care? Any staff with particular expertise? Or even with NO expertise as it can be a fantastic learning experience. Have them arrange/coordinate inservice education. Company reps are generally eager to provide inservice education. Most staff inservice things are as boring as white walls. Assess the learning needs of your staff and slowly start allowing them to fill the gaps. Arrange speakers...one of the best we had was a bariatric surgeon that talked to us about obesity...not from the surgical standpoint, but from the emotional standpoint. Sensitivity. Soon after, we had the larger wheelchairs, walkers, etc. Really made a difference. We had all trudged in thinking...great, another lecture on how to care for the surgery patient. Surprised to say the least and learned much.

Are your CNA's doing their job? Big issue on my unit. Nurses busting their fannies but patients complaining they didn't get ice water, lowering our pt. satisfaction scores. Make certain nursing skills are utilized for nursing and CNA skills utilized for CNA work. I think we can all agree that nursing tasks have increased dramatically in recent years and most nurses simply don't have the time to do what is necessary, much less what unskilled staff can do, i.e., get the patient some blasted ice water!!

What about a "rotating" task force? Assign some of your "leaders" to the task force for a set time - maybe 2 months. They meet, discuss, uncover, rectify issues. After a couple of months, one rotates out, another rotates in. Keeps fresh blood and ideas coming in. If at all possible, get the medical director or other physicians involved.

Staff meetings. Yeah, right. Necessary evils. However, make the staff meetings worthwhile. Someone said something about setting a date/time, sticking to it. That's the case where I work and it so happens to be on my day off. Nothing irritates me more than dragging my fanny back to the hospital on my day OFF to hear a bunch of silly garbage that could have been put in a memo or e-mail. Occasionally the face-to-face is necessary, but every two weeks? I think not.

Now what about you? Are you a visible presence on the unit? Frequently? I don't want you to do my job and I don't want to do yours. I don't want to see my manager staffing on a routine basis. However, when things are bubbling out of control at certain times (lots of surgeries coming back/admits coming in)...help me! Get out there. Start managing. Coordinating. Answer the freaking phone! Get the overview of the situation and do something about it. Sometimes staff get so overwhelmed they can't see other possibilities. Has your staff had a lunch break? Order them out to eat if only for 15 minutes and either cover yourself or get coverage. Two of the best places I ever worked: 1) trauma unit. On the occasional days we were overwhelmed, admin would send down a cart with loaves of bread, cold cuts, soft drinks, ice, etc. What was the monetary cost? $30 bucks maybe? Made us feel special and important. 2) Busy ER. Charge nurse would "write you up" if you did NOT take your meal break. She knew we NEEDED physically and mentally to get out and away. Loved that woman!

Staffing. Do you constantly cancel your staff if census falls? Bad news, IMHO. First, every now and then, it's nice to have a "reasonably" busy day rather than the usual 90 MPH day. Second, let the extra person come in and work on unit issues - maybe reorganizing the paper files, chart reviews...lots of things that need to be done. Do REAL patient teaching. Maybe even attend some of those constant meetings with you. Admin has this strange thought process...cancel me when it's to THEIR advantage, but call me and beg me to work on the spur of the moment for increased census or call-in, etc. No go for me. If you don't honor my budgetary concerns, I'm not going to honor your staffing concerns. Goes both ways. Can't begin to tell you how many times we've been told...well, if you don't come in, I'll have to get agency. Too bad. Quit cancelling my shifts and maybe I'll feel compelled to come in - take ownership. :)

One thing you said that is a sore point with me...please don't try to entice me with donuts and other silly stuff. I'm not an eating machine. Most nurses want to be treated with professional courtesy and respect and that isn't always the case. We're often treated like kids in kindergarten and we then respond that way. Recognize me professionally. I don't want some silly gold star next to my name for a job well done. Give me a special pin to wear or a plaque to hang on the unit wall. At the entrance to my hospital, there is a wall covered in framed photos of medical staff. A sore point with me. Why not framed photos of the nurses? At least on their unit wall? I'm important, too, you know? Those silly nurses day gifts that some think are so important. Come on. I can buy the insulated coffee mug or carry bag at Wal-mart for $2 bucks. Show some orginality. Perhaps a big floral arrangement for the unit with a little card announcing nurse's week. Get the medical staff involved. One place...each nurse got to choose a favorite doctor to spend the day with or the CEO, CNO, Department Directors, etc. A paid day. And a huge success with a nice lunch thrown in. A great learning experience as well as the opportunity to share our profession.

OK...so I've taken off on many tangents. Bottom line, for many of us...treat us as respected professionals. It may be a slow process, but you know...nurses haven't been treated really well throughout history and we're rather gun-shy. It becomes hard to believe someone really wants us to take "ownership" when they speak the words but action isn't always followed. I am not a girl-friday. I am a Registered Nurse. (But I was a horrible manager! :) )

ZASHAGALKA, RN · Mar 21, 2006

OK...so I've taken off on many tangents. Bottom line, for many of us...treat us as respected professionals. It may be a slow process, but you know...nurses haven't been treated really well throughout history and we're rather gun-shy. It becomes hard to believe someone really wants us to take "ownership" when they speak the words but action isn't always followed. I am not a girl-friday. I am a Registered Nurse. (But I was a horrible manager! :) )

And this was my point. There are several ways to 'own' the unit. I was saying that measuring that only by how much I dot the i's and cross the t's of administrative stuff is a poor measurement.

This post had lots of great ideas. And others can't be that difficult to think up. But when you get into a rut where 'ownership' can only mean certain things, and then back that up with "don't grace my door unless you display ownership in ONLY that way", then everybody loses.

It's all how the staff is treated. I know nursing is the hospital's biggest expense but that means it is their greatest asset also. Too many administrations make the connection that means that nurses are their greatest liability. Don't those prima donnas know how much they cost? They should be GREATFUL.

But, job satisfaction is so not about the bottom line. Administrations desparately want nurses to see that when it comes with how we deal with them, but strangely, not vice versa. So this question cuts both ways: how does the unit 'own' the staff? Because here, correlation is definitely causation. Or lack of correlation thereof. . .

I really relate to the 'we don't need you, hope you can pay your bills' attitude when census is low, but I don't display 'ownership' when I don't come in day after day after day when census is high. My last employer used my paid time off time as their personal 'low census' account. I never used it for vacation, yet still never had more than 100 hrs and rarely called in sick. So yes, I eventually stopped 'owning' that unit, in more ways than one.

~faith,

Timothy.

lberghood · Mar 30, 2006

I recently read an article about BMGs(bellyachers, moaners,and groaners) and how these few people can really harm morale and they basically donot want to be part of the solution. They like to dump problems and have management solve them although they are generally problems that are impossible for us to solve or out of our control. The author had many suggestions but one of them that sticks out in my mind is that no one can present a problem without at least trying to come up with a solution. I thought that this was a good idea. And sometimes with these type of people i just ignore them (not the best solution probably but i can use my energy to work with those who are invested and want to help find solutions)