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Knaves, Fools, and the Pitfalls of Micromanagement

Nurses Article   (9,843 Views 50 Replies 2,029 Words)
by RobbiRN RobbiRN, RN (Member) Innovator

RobbiRN has 25 years experience as a RN and specializes in ER.

17 Articles; 10,375 Visitors; 181 Posts

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Our environment is extremely fluid with rapidly changing priorities vying for limited resources. Staff nurses need enough autonomy to nimbly focus our collective energy to do what is best for our patients. Unfortunately, detached, zealous micro-managers who distrust their employees, are not only finding failure, they're creating it. You are reading page 3 of Knaves, Fools, and the Pitfalls of Micromanagement. If you want to start from the beginning Go to First Page.

OldDude specializes in Pediatrics.

6 Followers; 1 Article; 29,117 Visitors; 4,768 Posts

I believe the pressure in the current paradigm comes from higher up, and ground level and mid level managers have their own jobs on the line. They used to act as more of a buffer-- being on the floor, knowing what we do, and being willing to defend us at higher levels. But the pressure from the top is taking them out of that role as the system fosters a paint-by-number definition of success or failure.

Beyond ground management working a shift once a month, upper management should shadow us for a full 12-hour shift once or twice a year to see how it all plays out in the real world.

I disagree...everyone up the chain should pull a full shift 12 times per year.

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brandy1017 is a ASN, RN and specializes in Critical Care.

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Wow! The micromanagement you describe is over the top. I'd be looking for a new job! That's one thing we don't have to worry about where we work because we have so few admin staff left! lol

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4,827 Visitors; 471 Posts

Memories! Bad memories I'd add, so now they have new grads doing chart audits? You summed it up perfectly, I remember the infection control 'auditor' apprising me that I had not placed the tape on the back of my yellow gown correctly, I had a bit of my hair sticking out.

I quit working in acute care @ 2014 and they only regret I have is not doing it 10 years sooner. I honestly have to wonder if those who are 'timing' everything have ever even observed the ER/MS/Tele floors at all.

It will get worse, I feel for new grads but more so for the patients. They are going to need to be tough to 'buck the system' enough to actually care for emergent situations, help colleagues with things like IV starts while knowing they may not measure up on getting that 'rounding, med side effect, discharge etc...' documented in real time.

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RobbiRN has 25 years experience as a RN and specializes in ER.

17 Articles; 10,375 Visitors; 181 Posts

I disagree...everyone up the chain should pull a full shift 12 times per year.

I agree in theory, but they can't work a shift -- literally. Nursing administration used to come from nursing. That's changing. Once you get past your immediate department manager, some of them are coming from non-nursing, business or other management backgrounds. They have no experience in patient care. They are not licensed or qualified to do what we do, but they are empowered to control our work environment and judge our performance.

I would still like to have them do that "undercover boss" routine, put on some scrubs, and try to keep up with me for 12 hours. . . at least once.

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BrandonLPN has 5 years experience as a LPN.

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And somewhere, someone with a masters degree got a pat on the back because they cobbled together some study and a pretty PowerPoint stating how beneficial it would be if all patients with a potential long bone fracture got their pain meds within 30 minutes. And then someone else decided it would be "best practice" if all c/o extremity pain be treated as a potential fx because there's a 0.005% chance. And then another one decided compliance rate should be 100% because that's the only acceptable level.

And that's what's wrong with nursing.

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I know...compassionate, quality, patient advocacy, is such a draw off the system and really gets in the way. Too bad there isn't a way we could just overlay virtual patient care into the matrix so we could always self actualize our goals and performance criteria and sit around and pat each other on the back and tout how satisfied everyone is.

The depressing reality is that these sentiments are actually held by a number of people.

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OldDude specializes in Pediatrics.

6 Followers; 1 Article; 29,117 Visitors; 4,768 Posts

I agree in theory, but they can't work a shift -- literally. Nursing administration used to come from nursing. That's changing. Once you get past your immediate department manager, some of them are coming from non-nursing, business or other management backgrounds. They have no experience in patient care. They are not licensed or qualified to do what we do, but they are empowered to control our work environment and judge our performance.

I would still like to have them do that "undercover boss" routine, put on some scrubs, and try to keep up with me for 12 hours. . . at least once.

Oh yea, I realize that, but as you say, they should still have to go be there for 12 hours, 12 times per year so they could savor the wisdom of their policies.

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Or just be there on off shifts to observe their staff in action. I have worked nights for over 10 years and have NEVER had a manager present on any unit. If we need anything we call the nursing supervisor. Yet my manager does my annual eval! But that is just "how it is" in many places.

I have had managers who answered call bells and helped out, but they were the exception. They are often dealing with the requirements of the number crunchers above them.

Patient care suffers and nurses find jobs in other areas, the cycle resumes and more patients are unhappy and more nurses burn out.

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I so agree with you! While we work 40 hours plus, nights and on call. The department manager gets to work 9-5 PM M-F. Many of them walk around like they somehow deserve the "good treatment" and somehow the rest of us are beneath.

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The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.

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RobbiRN has 25 years experience as a RN and specializes in ER.

17 Articles; 10,375 Visitors; 181 Posts

The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.

Great success story. Many managers and board members are decent people, and they might make better decisions if they had a more realistic view. Your courageous decision to confront the board on your own was well rewarded, and rightfully so. Nursing is full of hard-working, intelligent, dedicated people who regularly go the extra mile. The majority of us don't need the top brass pushing us to increase patient satisfaction. We are driven to care for others; it's why we signed up. But, I suspect, as a profession, there is an overall lack of courage to confront management the way you did -- which leaves us collectively vulnerable and exploitable.

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TriciaJ has 37 years experience as a ASN, RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

10 Followers; 33,141 Visitors; 3,171 Posts

The hospital where I used to work was going to cut our staffing per request of the board. I decided to buck the system (there were a group of us but the others backed out) and went to the board meeting and challenged them to come work with us for a day to see how it really is before they cut us. One person agreed. He made it for 4 hours and left saying "I don't know how you do it with the staff you have, there will be no cuts!" And there weren't. Sometimes you have to ruffle a few feathers and granted, I knew when I did what I did I was risking my job. But I did not lose my job.

You deserve an award. I do think the upper echelon should periodically have to strap on skates and follow us around for a shift. You eat when I eat; you pee when I pee. You don't have to do any actual work; just try to keep up.

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