New Nurse Manager Advice

[FutureCNO]

Good morning everyone!

I am currently accepting a position as a nurse manager of a unit. Admittedly, I am nervous but excited at the same time. It is a major step in my career as a nurse and hopefully a nurse leader. I know there is a plethora of knowledge and experience within this forum and am asking for any and all advice I can implement to make the transition go as smoothly as possible.

Of note, of course, there are rumors that the unit I accepted to manage is a "horrible unit". I am not phased by this. I am looking forward to the challenge. Apparently, the unit suffers from high turnover, lack of engagement from staff, no teamwork and is in the need of an effective leader. Any tips, suggestions, or thoughts on tackling these issues? Dealing with unengaged employees? Difficult employees?

As soon as possible (after required orientations and such) I plan to hold a meeting laying out the expectations, visions, implementations of interventions to get to the goals we set as a unit and also I would like to meet with each individual and declare my commitment to their success and the success of the unit.

[brownbook]

Ideally you are able to be out on the unit helping out. I have found over and over again when staff is swamped, telling me I have to call in more help, (when I have already called and no help is available), that if I get out there, say I can help, does wonders.

Be specific as in I'll do the paperwork/assessment on the new admit, I'll get the blood started on bed 7, I'll enter the doctors orders, something I can see obviously needs being done. The crazy part is most of the time I only takes about 1/2 hour and the chaos has setttled and staff says they are okay now. And they understand when I say have to get back to my office to confirm staffing for the next shift or any other urgent task that must be completed.

I'd rather occasionally stay overtime myself than have to sign, or deny, overtime for the nurses.

Ideally you can, (hopefully very rarely), come in on the night or weekend to help out if they get swamped, or just say hi and get to know the "off" shifts. Bring donuts, or fresh fruit, nuts, humus and wheat crackers, etc. (I'd eat the donuts.)

[FutureCNO]

Thanks for your reply brownbook. At my current position I do that now. I am not the type to tie a rock to my employees legs and say "ok stay afloat." And your right. I get a much more positive response and a willingness to work harder if they see me right next to them "in the trenches". My hope is that I can lead by example and have others follow suit in the new unit. Unfortunately, that is not always the case from my experience. There are always those who I consider the "downers". They bring down the unit during the shift. And I have had those difficult conversations with them and have tried to see their perspective and have tried to assist them to become positive contributors to the unit but the rest of the team still suffers.

I know in my next role I will face the same hurdles. I just hope that I can ignite the spark of teamwork and togetherness on the new unit to help reduce the turn over, improve quality of care and overall have better patient outcomes.

[SummerGarden, BSN, MSN, RN]

Thanks for your reply brownbook. At my current position I do that now. I am not the type to tie a rock to my employees legs and say "ok stay afloat." And your right. I get a much more positive response and a willingness to work harder if they see me right next to them "in the trenches". My hope is that I can lead by example and have others follow suit in the new unit. Unfortunately, that is not always the case from my experience. There are always those who I consider the "downers". They bring down the unit during the shift. And I have had those difficult conversations with them and have tried to see their perspective and have tried to assist them to become positive contributors to the unit but the rest of the team still suffers.

I know in my next role I will face the same hurdles. I just hope that I can ignite the spark of teamwork and togetherness on the new unit to help reduce the turn over, improve quality of care and overall have better patient outcomes.

You sound like you will be fine. You sound like you know the right steps to take and you have experience. The only advice I can give, having worked on a bad unit before and having seen a amanger enter the unit and do some of the right things but fail miserably, is to take it slow. Some of the major things you will want to change will not go over well if you do them too fast. The staff must have some level of trust and acceptance of you in order for you to be effective at making changes that will be sustainable and show improvement under your leadership. Good Luck! :)

[K+MgSO4, BSN]

Don't plough in with meetings setting out vision, expectations etc. Observe the current situation, be able to give positive feedback on what is currently happening.

Remember that you cannot change everything at once. Meet with your education team and leadership group (ie you charge nurses). Look at your audit data, incidents, complaints etc. Make a list of priorities with this team. Focus on one thing at a time, embed it into practice, give feedback to staff on it. Once you have this done go onto the next issue. Get you leaders to drive the changes as well so it is not just coming from the boss. Also speak to this group about the changes you want to bring in....these guys need to be on board and backing you up 100% or it will fail.

Be consistent and fair with staff performance issues. Don't haul person A into the office for being late but person B always sneaks off 20 min before end of shift. Document you meetings with staff so when you have to take it to the next level you have specific records