Managers can I change your opinion of them?

I read threads about managers and how ineffective they are I would like to see if I can change readers minds about how their manager is performing and what barriers there may be. Nurses Announcements Archive Article

It is a very lonely world out there for managers. I became a manager of a dialysis facility in august 2010.

I was promoted from within, not the best way to start out in your new role! why-because everybody has certain expectations of you which you cannot live up to. You start out with the best possible rationale which quickly turns into realization that in the big bad world of management that 'behind the scenes' is not as it seems when trying to look in.

Everything and I mean everything works very slowly, to get even the simplest task takes for ever to implement. To get a huge project under way takes forever and ever amen

An example of this is when you know an employee is not performing at their job description you cannot just fire them! (this is not what i want to do just for the record this is just an example-and not a very good one!)

No matter what we read on here 'normally' and if you work for a company who is actually cares about their employees there are huge hoops to jump through to fire somebody.

In my company you have to have a paper trail it starts with

  • a first negative anecdotal
  • a second negative anecdotal
  • a step one corrective action
  • a step two corrective action
  • a step three corrective action
  • suspension pending investigation
  • termination

If you don't have all your ducks in a row then you cannot ... I repeat, cannot fire/discipline an employee.

You can however depending on the severity of the issue progress the employee through the steps faster and if a danger to a pt then jump to suspension pending investigation.

This whole process can take 6 months which is a long time when there are severe concerns about an employee. Everything has to go through human resources and approved once you get into the step actions. HR will advise how to proceed and will consult with lawyers.

Why you ask-this is to protect the company from litigation and also as I learned recently help to reduce the unemployment payouts!

Meanwhile the bad behavior continues and the other staff think that an unproductive, mean, non-compliant work colleague is getting away with behaving badly or has poor performance! they think if he/she can do it then so can I.

They start to lose faith in you as a manager because 'there is no point in going to see her she does nothing'. When in reality you are working your butt off to try and improve bad situations.

It takes 100's of hours sometimes to get one piece of work completed because of the red tape and the hoops.

You cannot tell the rest of the staff what you are doing as this would not be fair, so you have to smile and hope they will one day have the results needed.

When I first became a manager I would stress every night that i had not completed my work. s an RN I hardly ever left work for somebody to complete I went home in the evening satisfied I had done what was expected! now I left piles of work half completed and something to look forward to when i got back in the next day. Now 8 months on I no longer have nightmares about uncompleted work, it is all part of the job description.

My day is never boring and never predictable, I do however miss the patients because I really never have any time to work on the floor I know my skills are going rusty I know I could not perform as a nurse in the same level I did before because I am now a paper pusher, a therapist, a sounding board, I am a boss, but am bossed from a higher level, a financial expert, a scheduler, a kindergarten teacher, a referee, a swing door, a borrower, a lender, a sponge, an executioner and a friend when somebody needs a shoulder.

I read threads on managers and I have to ask am I like that? do i do that? And what is the bigger picture?

It is such a huge topic and I would like to deal with each role individually.

Nothing and I mean nothing is as you see it! A poor performance which has a impact on a team may not be just that the staff member is trying to be troublesome or nasty or not able to complete a task!

We all have the problem that we tell an 'ugly story" about somebody else to justify why they are behaving in such a way, and we already have that story in our heads, if we just asked or discussed we may find out the true picture and it will probably be different that what we had told ourselves.

Many times I have staff telling me a story about another staff member sometimes I just listen and other times I ask the other person to come see me in the 'dungeon'-because if you pop in my office, it is ok but if I ask you to come into the office and see me, then I become the executioner immediately!

When you ask what is going on and if everything is ok, then a quite different story emerges.

A huge lesson I learned early on as a manager was to hear all sides of the story and not act before you have considered both! another huge lesson I have learned is, if an employee is having an issue with another employee I ask questions like, "What do you think the solution is?"

I am encouraging the staff to come to me with solutions not just problems. After all, nobody woke up and made me god! I don't know everything and I don't have all the answers I am just a person like you!


Added 4/14/2011

I would like to add when starting this blog article I was trying to reassure people that you cannot just get fired in good companies-but it does look like I am trigger happy when I re-read! So I apologise that was not my intention.

However, I did need to correct some very bad behaviour which needed immediate action very soon into my job and that how I know how hard it is to make sure things are dealt with fairly and correctly.

Our management nurses don't work any holidays. We are a 90+ bed facility, on 1rst shift, Monday through Friday we have 4 staff nurses. We also have a DON, ADON, 2 Nurse Managers and 2 MDS and Admission nurses. So, 4 staff nurses and 6 management nurses. The DON is the only one officially on-call for after hours emergencies. Not a very efficient ratio for staff care in my opinion.

Unfortunately the paperwork requirements make it so that many organizations are top heavy this way. In home health sometimes we would have 4 nurse managers and only 2 or 3 RNs out seeing patients. This is a tremendous cost to the facility.

I will say that you are only mentioning 1st shift so I am sure there are nurses on the other shifts too. The two nurse managers don't do any patient care? I am guessing they are in charge or supervisors, but how do they not do any patient care? What is their role? If they are so essential they should be alternating holidays. I would think that the DON and the ADON would share the on-call responsibilities too.

My experience in LTC is limited- casual PRN work for a small nursing home. But even at 1/3 the size we had a DON and a ADON. The ADON did most of the paperwork, rounded with the doc if she was there, and pitched in as needed. The DON occasionally worked as a staff nurse if no one could be found to cover. I guess we had a pretty good team.

Specializes in Geriatrics, Dialysis.
An example would be when I worked in sub-acute (I lasted four days). I had a 15 pt med pass and no clerk. I remember hearing laughing in a conference room around the corner. I took note of who exited that room 3 hours later. The DON, ADON, case manager, infection control RN, Clinical educator, scheduler, MDS. I remember thinking how bizzarre that it was me and one other nurse on the floor for 30 pt, same scenario on the floor above. It just seemed a little top heavy to me at the time. I had no break....they had lunch delivered.

Exactly! I know just what you went through. It's frustrating beyond belief to work your "donkey" off trying your best to provide adequate if not great patient care while the management brigade is having a 3+ hour meeting in the next room.

Specializes in critical care.

Your post reminded me--- I HATE HAVING A CLOSED DOOR!!!!!!

However, I am constantly being scolded that for joint commission, CMS, and the fire marshall it is a violation. Some environment of care nonsense. I am sorry but, really? It sends the message that "I am too busy for you" or "I want to be left alone" or "I am doing something private" ugh! If I am needing privacy I will shut the door. I do not understand the basis for the rule and I feel like it alienates people, so every chance I get..... I OPEN the door! FYI doorstoppers are contraband......If it is a fire safety thing why can't I shut the door when the alarm sounds? This is procedure for patient rooms...

Unfortunately, I don't think nurse managers have much control. It's upper managemant who doesn't really have a clue. Most nurse managers have experience as floor nurses. I do think some of them have been managers for so long they have forgotten what it's like in the real world of nursing. You couldn't pay me enough to be a nurse manager. Someone is always upset with you. If it's not a nurse on the unit, it's upper management for asking for too many things to make your unit better. I have complained abut managers here too, everyone can always be better, myself included. I know that most nurse managers work hard and do things that I don't know anything about. It would be nice though if we could all just work better together. We have the same goals, pt. safety, pt. care ect. Sometimes it really isn't personal although I'm sure it seems that way. As floor nurses we want better working conditions and better care for our pts. Most of us will continue to work on that and I think most nurse managers will too. Good luck to you.

I am a nurse manager who has to close the door.

I am very hands-on with patients, staff, and work on the floor as needed. I have to keep the dang door shut because I cannot file state reports, audit the MARS, look into investigations with the mounds of paperwork attached, file incident reports, etc, with the constant stream of people going in and out.

Do I stop when I have a patient or family or a stressed employee at my door? Yes. Do I have my work cell phone constantly ringing? Yes. Do I often end up working 60-70 hours a week? Yes. Am I the first there in the morning and the last one there at night? Yes. Do I work weekends and neglect my family due to deadlines because I had to instead deal with employee relation issues? Yes. So I keep my door shut!!

Also, I take to task employees who work a solid 8 with mandatory breaks who have issues with my smoke breaks. Hmmm- salary means I don't get lunches (unless I wolf something down I brought in over some reports at my desk), I don't get to work a straight 8 and I am on call 24/7 so I earn my smokes in peace. :smokin:

Specializes in Geriatrics, Dialysis.
Unfortunately the paperwork requirements make it so that many organizations are top heavy this way. In home health sometimes we would have 4 nurse managers and only 2 or 3 RNs out seeing patients. This is a tremendous cost to the facility.

I will say that you are only mentioning 1st shift so I am sure there are nurses on the other shifts too. The two nurse managers don't do any patient care? I am guessing they are in charge or supervisors, but how do they not do any patient care? What is their role? If they are so essential they should be alternating holidays. I would think that the DON and the ADON would share the on-call responsibilities too.

My experience in LTC is limited- casual PRN work for a small nursing home. But even at 1/3 the size we had a DON and a ADON. The ADON did most of the paperwork, rounded with the doc if she was there, and pitched in as needed. The DON occasionally worked as a staff nurse if no one could be found to cover. I guess we had a pretty good team.

To answer your questions the two nurse managers don't do any patient care at all, they are strictly paperwork nurses. There are no managers after their day ends, promptly at 4:00 pm I might add. They do not alternate holidays, they simply don't work any [neither do therapy and office staff] so on holidays the staff nurses are on their own. There is also no "supervisor" on other shifts, the senior nurse in the building does their regular job plus any supervisory duties that may arise. As for the on-call responsibilities, the DON is the only "official" on call, but good luck reaching the DON or the ADON after hours. I have never had either one answer a phone call. The only upside is the staff nurses are extremely talented and capable of handling almost anything.