How much would you hate me if you were my manager?

[KalipsoRed21, BSN, RN]

I’m tired. I really don’t want to give a crap anymore. But apparently I just cannot help call out stupid and it gets me in trouble. I have tried the adage  ‘hold your thoughts for 60 seconds before speaking my piece’etc., but really it often comes out regardless.

Examples:

We received a merit raise at work. Instead of my manger simply saying, “Please come to me if you have any questions or concerns about your raises.” She felt it pertinent to go on a triad that speaking to one’s co-workers about raises is highly discouraged and unprofessional. So I immediately felt the need, in front of my co-workers, to correct her and ensure my coworkers know that the National Labor Relations Act of 1932 pretty much guarantees that any discussion I and my co workers have regarding our pay is most certainly NOT reprimand-able by any organization or manager ever. Well as you can imagine, she didn’t take that well. And while I’m upset with myself because maybe I could have been more tactful, I’m not at all sorry for what I said. Nor am I sorry to have said it in front of all my co-workers. Know the law before you say something stupid.

 

The clinic that I am working at went without a nurse for 2 months. The nurse prior to me was a new grad and had worked there less than a year. Every process that was in place prior to the new grad was lost. The clinic was sorta functioning when I got there in August. But there were huge failings (like messages from providers about patients’ biposies being positive and them needing to follow up with oncology not called to patients for 2 months) many other issues just as big, but it gives you an idea of the dysfunction.  I have been there since August, we got our latest staff member in December. There are now 2 RNs, an LVN, and an MA. It is a surgical clinic. We do minor sterile procedures from I&D to vasectomies. We have 10 providers (5 at most in one day and they don’t do us any favors like putting similar specialties on the same days), and 7 specialties (breast oncology, surgical oncology, general surgery, urology, plastics, colorectal, vascular surgery, and GI coming soon). We set up these sterile procedures, need to exchange foleys, provide bladder installations, trouble shoot ostomies, remove staples, voiding trials, etc. But we are suppose to also answer phone calls, address patient messages, review pre/post surgical education, schedule surgeries, obtain and follow up on cardiac clearances, telephone screen for colonoscopies, review labs prior to upcoming procedures, order and manage supplies, refills, prior authorizations for medications, and FMLA forms. At one meeting they told us their volume was 500 people last year. But since I’ve worked there they have had 15 to 50 patients a day. 
Any day I think we might get to catch up, or review the processes we have, or organize something, they pull staff to other departments and it is just me. So all I can do is try to get through phone calls (the patient needs) and I never end up getting to the organization part….which makes a full clinic difficult and cumbersome because we haven’t established a plan. My manager has been helpful in instituting some pathways for some of our paper work BUT I honestly feel that she and the other managers have NO idea how much this clinic needs because they now think we are fine and should be functional. 
This irritates me. The other staff have not learned everything so they still are at varying degrees of helpfulness when we are running clinic. My manager decided to assign some of our duties, so when others are off I don’t have a clear picture of what they have done, or, in some cases, how to even do their assignment. 
So when my manager brought up at the last meeting that we needed to make doing these hand hygiene questionnaires twice a week (a system wide goal); I kinda went off. I don’t see how making a questionnaire a top priority is going to help us at the moment. I feel we are still in deep recovery and really she could stay down in my department every day for a month, with all 4 of us, AND THEN we might be fully functional and able to dot our I’s and cross our T’s. This stupid questionnaire is an I or T. 
Of course I said as much at the meeting and she looked at me like I had slapped her in the face. 
 

I have never worked in a clinic before. This paper work and scheduling is all new to me. My manager told me when I started, “I’ll organize it and you do the work.” I have tried to do that. But new responsibilities come up every day and we haven’t even gotten into a pattern with the processes we have identified and implemented! 
 

Finally, today is my latest blunder. The ER called to have a patient that they couldn’t catheterize come to the clinic. No urologist was at the clinic so I told them no. On the same day my manager sent me the on-call schedule for the urology department. It says on the very top of the schedule 3 of the 4 hospitals in the system I work for. The hospital/associated clinic I work for was not listed at all on the schedule. The NP (who was this clinic’s RN 3 years ago) suggested I could ask the head of the urology department to clarify which call schedule the hospital I work for should follow. So I did. When I got the emailed response I thought I’d be helpful and send it to the nurse manager in the ER. Because they use the same call schedule as we do. Well hell if I didn’t open a dang can of worms in doing that. So now I am apparently in trouble for circumventing the chain of command. (In the back of my head I am like why am I in trouble? You dumb butts should have ALL of your facilities listed on your call schedules?)  I now see I should have emailed my manager the response I got from the head of the urology department. (I didn’t even think to do that.) But, as much as I like this job compared to my many other nursing positions, I am not sure I can continue to stay with the lack of organization in my department not to mention the system seems to be poorly organized it’s self. 
 

So if you were my manager, how much would you hate me? Would you be ready to manage me out? Should I even keep trying or just go ahead and peace out? 

 

[klone, MSN, RN]

As a manager of a clinic, I am as frustrated by reading all that as you clearly are. Regarding the first part - I am firmly in your camp with regards to free sharing of pay rates.  I am the FIRST one to speak up and let organizations know that conversations about pay among staff cannot be forbidden, and in fact it's illegal to try. 

The rest of what you describe just sounds like chaos and disorganization. It sounds like the typical "people who don't do the work and are so far removed from it trying to create workflows and policies about the work and they have no idea what they're talking about" which is unfortunately SO common.

OMG the hand hygiene audits! Yes, we have those too. Instead of piling more busywork onto staff, I just do the damn things myself each month. FFS.

If I were your manager, I would likely tap into your working knowledge of the flow and utilize you to try to make things more organized. But I've come to learn that my management style is not the norm. So likely, your manager considers you a thorn in her side. I don't know that I would go so far as to say your job is in danger, but I'm guessing she would not shed a tear if you gave your notice. Only you can decide if the headache is worth it to stay there.

[KalipsoRed21, BSN, RN]

klone said:

As a manager of a clinic, I am as frustrated by reading all that as you clearly are. Regarding the first part - I am firmly in your camp with regards to free sharing of pay rates.  I am the FIRST one to speak up and let organizations know that conversations about pay among staff cannot be forbidden, and in fact it's illegal to try. 

The rest of what you describe just sounds like chaos and disorganization. It sounds like the typical "people who don't do the work and are so far removed from it trying to create workflows and policies about the work and they have no idea what they're talking about" which is unfortunately SO common.

OMG the hand hygiene audits! Yes, we have those too. Instead of piling more busywork onto staff, I just do the damn things myself each month. FFS.

If I were your manager, I would likely tap into your working knowledge of the flow and utilize you to try to make things more organized. But I've come to learn that my management style is not the norm. So likely, your manager considers you a thorn in her side. I don't know that I would go so far as to say your job is in danger, but I'm guessing she would not shed a tear if you gave your notice. Only you can decide if the headache is worth it to stay there.

Thank you for your comment. I am just frustrated with nursing as a whole in this regard. We can expect people to follow rules if they don't apply well to the situation. We can't delegate to others without a working knowledge of what they already know and what they need to know. Always just seems to be "why didn't you do this?” Or "why didn't you ask for help?” And I'm like, I did and they said they don't know how. Just an exhausting abusive circle. My manager is trying, which is more than I have seen from most managers, but it seriously gets annoying when someone asks you to climb a mountain in no time at all, they don't have a map, but are happy to tell you that you are taking to long and you should have taken a different route.