I work in a subacute rehab facility. I'm a relatively new nurse with less than a year experience. Recently a position opened up at my facility for a unit manager and my supervisor and some coworkers recommended me to apply for it. I applied, went through the interview process and was hired into the position.
I know that I was hired for the position because I am a good, prudent, capable nurse. I also have non-healthcare related management experience.
I have seen numerous posts in the past saying that you aren't truly competent until a couple of years of clinical experience. I have been in my position for about a month and am doing fantastic, I feel confident, I know when I need to utilize my upper management team for support or opinions. My DON has complimented me and told me today that she is more impressed with me each and every day in the new position. A big part of why I was interested in the position is because I think that the experience looks great on a resume.
Is it possible that clinical competence/critical thinking just comes earlier for some?
Do you think moving into a management position early on in the career, and in a subacute setting looks positive on a resume, or could it be a negative in some instances? I am interested to hear other opinions as I build future educational and career goals for myself.
And what does a realistic grasp of the bedside entail in a sub-acute facility? Running a code team and dialing 911? Making sure some gets a cardiac diet instead of carbo-controlled?
Dealing with family, customer satisfaction, and staff issues can all be dealt with by any type of manager and require very little clinical judgement.
'Buy-in' involves soliciting advise, opinions, and insight from the top and bottom of the organizational structure, which also includes the 'eye rolling passive-aggressive cats', and making it work in a way to generate successful outcomes for patient as well as an efficient and organized health care team. When executed properly, this process also develops trust, commitment, and confidence in your subordinates and provides insight to upper level managers who are more than likely out of the loop.
Leadership and management may share many commonalities but are in fact, two different things.
Leaders create 'buy-in' by aligning their goals with those of the lead to achieve the leaders vision or a mutually beneficial outcome for all. In this way, leaders create force multipliers who can think and operate independently because they understand their role in the grander scope of things.
Managers are more concerned with the performance of daily operations, writing people up and 'my way or the highway' mentality. Morale and the employee's welfare are not a concern for them nor their superiors in so much as the job is being done. Passive-aggressive eye rolling cats are created in this manner because people and their input becomes undervalued and irrelevant.
And what does a realistic grasp of the bedside entail in a sub-acute facility? Running a code team and dialing 911? Making sure some gets a cardiac diet instead of carbo-controlled?
Dealing with family, customer satisfaction, and staff issues can all be dealt with by any type of manager and require very little clinical judgement
I respectfully have to disagree with what you've said here. I know all facilities are different but the floor nurses at my facility have to use a lot of clinical judgment and critical thinking. The acuity in the "subacute" rehab setting seems to be ever increasing. We take care of patients with multiple IV drips, g tubes, lots of s/p surgeries, we regularly have multiple patients only a week out from stemi and nstemi. Sometimes I walk in and the unit looks like a med surg floor but the nurses have 15 patients and much less resources than they would in a hospital. I regularly send patients out for blood transfusions, respiratory failure, AKF, and the list goes on and on. And they are only able to go out and get treated for these things because there is a nurse providing close and careful assessment of those patients. There are no doctors on staff 24/7. They rely on us to be their eyes and ears and to notify them when a patient is going south. And they do. ALL the time.
And what does a realistic grasp of the bedside entail in a sub-acute facility? Running a code team and dialing 911? Making sure some gets a cardiac diet instead of carbo-controlled?
Dealing with family, customer satisfaction, and staff issues can all be dealt with by any type of manager and require very little clinical judgement.
'Buy-in' involves soliciting advise, opinions, and insight from the top and bottom of the organizational structure, which also includes the 'eye rolling passive-aggressive cats', and making it work in a way to generate successful outcomes for patient as well as an efficient and organized health care team. When executed properly, this process also develops trust, commitment, and confidence in your subordinates and provides insight to upper level managers who are more than likely out of the loop.
Leadership and management may share many commonalities but are in fact, two different things.
Leaders create 'buy-in' by aligning their goals with those of the lead to achieve the leaders vision or a mutually beneficial outcome for all. In this way, leaders create force multipliers who can think and operate independently because they understand their role in the grander scope of things.
Managers are more concerned with the performance of daily operations, writing people up and 'my way or the highway' mentality. Morale and the employee's welfare are not a concern for them nor their superiors in so much as the job is being done. Passive-aggressive eye rolling cats are created in this manner because people and their input becomes undervalued and irrelevant.
You obviously have never worked nights/weekends in a teaching hospital.
Even that intern has at least 4k hours of clinical rotaion before and they still bungle it up. If anything this shows how lacking our NP is at 700 hours. Your argument supports the need for more experience prior to NP, not the other way around.
I have literally been in the ER as a resident physician came down and gave orders to the nurse for a patient who was DKA. That wasn't even night shift. It happens and we trust them because they have M.D. at the end of their name.
You're right, N.Ps should probably have more clinical hours but my argument was that an NP does not necessarily need a decade of RN experience to be competent. Maybe my analogy with the resident physician is pushing it. My points is, if you know your limitations, you can learn on the job. OP should embrace the new position, take on challenges and grow.
Even that intern has at least 4k hours of clinical rotaion before and they still bungle it up. If anything this shows how lacking our NP is at 700 hours. Your argument supports the need for more experience prior to NP, not the other way around.
What argument are you talking about? Have you even read the thread?
I work in a sub-acute rehab facility with 58 beds between 2 nurses and 4 aids. With that volume, clinical judgment consists of, are these VS=WNL for the Pt, ABC's, and 'something doesn't look right, all done within 5 minutes'. The only critical thinking part is, do I call the Doc right now (in the middle of the night) before sending out the Pt or do I wait until morning to call him after the Pt is at the ED.
But let's get realistic, an EMT with less than 6 months on the job can figure out when a Pt is trending south. Critical lab values come back with 'critical' on them. If you send someone out with abdomen pain and they come back with a Dx of gas instead of a paralytic ileus, no one takes away your birthday.
I work in a sub-acute rehab facility with 58 beds between 2 nurses and 4 aids. With that volume, clinical judgment consists of, are these VS=WNL for the Pt, ABC's, and 'something doesn't look right, all done within 5 minutes'. The only critical thinking part is, do I call the Doc right now (in the middle of the night) before sending out the Pt or do I wait until morning to call him after the Pt is at the ED.
But let's get realistic, an EMT with less than 6 months on the job can figure out when a Pt is trending south. Critical lab values come back with 'critical' on them. If you send someone out with abdomen pain and they come back with a Dx of gas instead of a paralytic ileus, no one takes away your birthday.
That sounds very different from how things work at my facility. So I guess you just can't compare different facilities?
blondy2061h, MSN, RN
1 Article; 4,094 Posts
I do. And I'll be the first nurse to call the attending when I'm not trusting the resident.