Has anyone ever stepped down from a role?

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Specializes in Rehab/Nurse Manager.

As I’ve mentioned previously, I was recently promoted to a Nurse Manager role at my facility. After a text message tonight, I’m now questioning my ability to perform my new role. I was just informed that a patient was being sent in to the hospital for a possible bowel impaction. I’m upset that I didn’t catch this sooner, although really the nurses should be reporting any issues of constipation. I don’t know...it just seems that no matter how nit picky I am, I still miss things. And it seems that the other manager does her job perfectly, even though she comes to work later than I do and leaves earlier. Somehow, she doesn’t mess up, and I’m angry that I did. I’m doing everything in my power to be a good manager but this event proves otherwise. Would you step down from your role if you were in my position?

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We are not going to catch everything. And the other manager, as competent as she likely is, there is no way she does her job perfectly.

When I worked in ltc, we had to chart qshift if patients had bowel movements. And we did that pretty well. If the patient didn't have a bm in 3 days we had standing orders for mom. Despite that, I remember a particular resident having just as you described, even though he was having bowel movements practically everyday! He was impacted...quite terribly...Maybe look to improve standing orders or monitoring of bowel movements. How would you know?

I personally wouldn't resign my position over this. In acute care, healthy young people get impacted too.

And I'm guessing, that they notified you because you are the unit manager, that doesn't make you in the wrong. Maybe check when he last had a bm, and if not why nothing was done by the floor nurse?

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Specializes in Nurse Leader specializing in Labor & Delivery.

Do you think you should step down from your position because of what happened? A resounding NO. You sound incredibly conscientious and caring, and want to do a good job. That is a really valuable trait in a manager.

Is this your first manager role? If so, I would suggest you're suffering a bit from "imposter syndrome" - something that I suffered from a lot the first time I became a manager. I remember just constantly thinking "What the hell am I doing here? I can't manage people! I've totally got them all conned that I'm qualified for this job!"

I can tell you that over time, that feeling does lessen.

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On 1/25/2020 at 9:55 PM, SilverBells said:

I was recently promoted to a Nurse Manager role at my facility. After a text message tonight, I’m now questioning my ability to perform my new role. I was just informed that a patient was being sent in to the hospital for a possible bowel impaction. I’m upset that I didn’t catch this sooner, although really the nurses should be reporting any issues of constipation.

You got promoted to NM, not S/He Who Makes or Breaks Everything. ?

That is to say don't misunderstand your position. If you think you are a failure/not cut out for this role because a patient had an occasion of altered health status, you actually are kind of thinking of yourself and your role as a little too important in a way that is not good for your own self-esteem and is going to become kind of unbecoming in short order (even though you don't sound like a prideful person). None of us are "all that" (as they say), including managers--there's no reason they or anyone else should think otherwise.

Just do your best. Find out if bowel regimens are being followed and go from there.

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Specializes in Surgical, quality,management.

No!

I really think you are struggling with severe self confidence issues at the moment. You are measuring yourself against this perceived "perfect manager " in your peer. How long has she been in the role? What skills, further education and mentoring has she had? How do you know that she is not got issues with her staffs performance or her own?

Like others have said see if bowel regimes are being followed. However, also wait until the hospital does it's treatment- this could be totally unrelated to the care she was receiving with your TEAM. e.g. a bowel obstruction, perforation or intrasucception. I put TEAM in capital letters because that is what you manage, a team. Set the standard for care, manage people who do not meet it and once you have faith in their ability to provide the care ease up on the nit picking. Nothing will destroy team moral quicker.

Your job is to manage and lead the team providing the care. You can provide care to a patient, but who is going to do your job if you are doing that? Learn how to get the balance right between both, and still have a work life balance.

Take time for your own PD as a manager, its ROI will be amazing for your staff and patients. Don't spend all your time reacting to issues, do some forward planning e.g. internal PD days, developing staff to do other roles etc. Proactive work is much more enjoyable than reactive, but a word of caution- other proactive work such as changing process needs engagement with staff and only change 1 thing at a time and ensure that the change is embedded before moving onto the next thing.

Ease up on the self flagellation.

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Specializes in Psych (25 years), Medical (15 years).

I concur with the others. Keep on keeping on, SilverBells.

Have I ever stepped down from a role? As an administrator with two different agencies, I was laterally moved out of the door on one, and shown the door with an adieu of "Don't let the screen door hit you in the behind!"

Now, I stepped out of a role working in the OR back in '91. I was in orientation and could do nothing to please my mentor. The final straw came when I was first scrub for the first time, with my mentor acting as the second scrub, on a TAH with a doctor referred to as "The Nazi Surgeon".

In those days, each surgeon had a file card that listed the instruments and a basic outline of the procedure for a specific surgery. The night before the surgery, I studied that card til I knew it by heart.

The surgery was progressing really well, so I struck up a conversation with the surgeon. At its completion, the surgeon said I did a good job and thanked me! I beamed!

While cleaning up, my mentor said, "I know (The Nazi Surgeon) said you did a good job, but there were some areas in which you could improve".

I resigned the next day and took up a position with another hospital where I had been previously offered a position.

Good luck, SilverBells!

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Specializes in Dialysis.

You can knit pick/ micromanage all you want, it will only serve to drive you crazy. Also, if your facility uses an EHR, you could look for trends on reports. But that information is only as good as the person entering it. I've actually heard nurses discussing if they should give MoM or suppositories (or whatever the facility policy is), as they didn't want to deal with the "cleanup". I've also seen nurses and aides almost come to blows over giving said meds-"you gave that so we'd have to clean it up or follow up," etc. Ridiculous, like you can time that particular function!

@SilverBellsjust manage what you directly can, and make action plans for the rest.

I have stepped down as a DON more than once, when I saw that attitudes wouldn't change and I was going to be the one thrown under the bus. Hang in there, and if necessary, ask "perfect manager" how she does it. She may give you some tips to help

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

Do you actually believe that if a patient gets sent to the hospital it means the nurse manager should step down?

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Realize that residents will be sent out frequently. You were notified because that is the process.

Your responsibility now, is to review the medical record. Talk to staff, and develop a plan to prevent the issue from happening again.

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Specializes in Rehab/Nurse Manager.

Resident is reportedly fine. Sounds like staff had initiated bowel protocol on the third day of no bowel movement but unfortunately interventions weren’t effective (we don’t get bowel movement alerts until day 3). Staff tried everything before sending him in (senna, colace, miralax, prune juice, suppositories, enema). Fortunately an enema in the ER was effective so he came back with instructions to follow up with in-house provider. So it was probably a case of bad luck and he probably needs to have bowel meds regularly scheduled. The only error I really made was not reviewing bowel movement alerts one day because there were a ton of other more acute issues, so this is just something I’ll have to incorporate into my routine. I’ve always thought if this was an issue, the floor nurses should bring it forward, but they are not perfect either and have their own load of issues so it really takes a team approach

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Specializes in Rehab/Nurse Manager.
On 1/26/2020 at 10:58 AM, FolksBtrippin said:

Do you actually believe that if a patient gets sent to the hospital it means the nurse manager should step down?

Not really. There would be no managers left since it is not uncommon for a resident to require transportation to the hospital. My concern stemmed from the DON stating that bowel impactions are reportable since they are also preventable. Not only is the condition not good for the patient, reportable events do not put the facility in a positive light.

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Do they have Soap suds enemas as part of the protocol at your facility? Could it be pt wasn't able to hold the solution long enough for it to work? Is the staff properly trained how to do them? I ask because as a nurse in ltc years ago, I didn't know and a nurse showed me the WRONG way.

Did they have to digitally remove the stool in the hospital, maybe that is what it took? I don't remember having to do that in ltc, and I definitely don't do it in the hospital!

As the manager, make sure the nurses are vigilant about reviewing the protocol.

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