I am on a unit that is very acute. This is an ICU with ECMO, MCS devices, and transplants. We take the sickest patients in our region. We were short-staff but have on-boarded 20 nurses. Our problem is how to navigate "the lack of experience". 

I currently work at an assisted-living as a ADON, which has a census of about 80 right now compared to when I started out it was at about 50. I absolutely adore my residents and the family. It brings me so much joy to be able to work with them. However, staffing shortages has grown beyond our control. Our turnover rate is so high. I have fought tooth and nail to try and get Agency in, but our owners will not approve it. The assisted living operates like a skilled nursing facility with high acuity but low ratios due to budget cuts etc. Hence why the turnover rate is rapidly growing. As an Adon I work the floors a lot doing the med pass which I don't mind but I'm still expected to maintain my managerial duties which includes a ton of paperwork etc. We are falling behind with everything. 

Myself and my DON are expected to fill all of the open shifts when nurses or aides leave or call out. To be honest Im exhausted with working my 40 hrs a week plus the weekends due to short staffing. I have opted to resign but it breaks my heart to have to leave. I feel like nurses are not appreciated enough. Are there any other managers going through this? What did you do to change the work culture? 

Given that the electronic MAR generates at the beginning of the month what are the expectations for having Orders renew Q30 days etc.?

I can't find a specific regulation that speaks to this aside from the obvious per facility policy; but I'm certain we don't have one (yet)  this transition has been anything but smooth   

given that the electronic MAR generates at the beginning of the month what are the expectations for having Orders renew Q3 days etc.?

I am not getting any clear answer from the powers that be in my facility except that the doctor states in his progress note that all medication's were reviewed.  
 

I'm pretty sure our corporate thinks the doctors signed the orders every month but actually they only signed new orders and discontinued orders.  
 

Is the expectation that the orders will be discontinued and entered all over again every month or....

Would love some feedback sorry if this is gibberish long day

How do these differ from one another in career opportunities/advancement?

What roles/titles will I have access to as it pertains to each degree? 

I would appreciate any guidance you can spare about the career path I should take to return to work. I've tried getting mentorship through ANA but it's fallen through twice.

My situation: I left my Med/Surg job after 9 years when my maternity leave expired because I didn't want to work bedside anymore. I have 4 years of Charge experience.

I'm interesting in leadership (Assistant Manager or Manager) as my next role, and I have my sights set on applying at a Magnet hospital/organization. I'm currently in an RN-BSN program with 1 class left (anticipated graduation is Dec 2024). I plan to pursue my MBA in September, and then a BSN-DNP after finishing with the MBA. 

Should I apply for Per Diem Med/Surg positions at the Magnet hospital to get myself familiarized with the organization, and then apply for Management once I have my BSN?

Should I apply for Management at the Magnet hospital in a non-bedside nursing dept while finishing my BSN? (I have no classes or job from May-Sept).

Thanks in advance!

I go to Western Governors University and work as a Registered Nurse in Washington (so I have a compact license!) Pennsylvania and Rhode Island have passed legislation to become an NLC state but have not yet enacted it, as of August 2023. Massachusetts has pending legislation to join the NLC. Alaska, California, Connecticut, the District of Columbia, Hawaii, Illinois, Michigan, Minnesota, Nevada, New York and Oregon do not participate and do not have pending legislation. So if you are working not in Alaska, California, Connecticut, District of Columbia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, Nevada, New York or Oregon and are interested please let me know! 

Preceptor must be a Master's prepared (or higher) RN with an active license in the U.S. Preceptor must hold an unencumbered license in the state where the Host Site is located or hold a multi-state license in another state, which allows Preceptor to practice in your Host Site state. Must have 2 years or more experience with health informatics.

Examples of experience with health informatics may include:

Use a health information system, manage and analyze data to support clinical decision making , involved in the design, development, implementation, or evaluation of applications and technologies ensuring safety, quality, effectiveness, efficiency, and usability.
Students must also hold an active unencumbered license in the state where the Host Site is located or hold a multi-state license in another state, which allows the student to practice in your Host Site state (I have a compact license).

Why:  The WGU MSN Nursing Informatics program is preparing me to assume a role as a nurse informaticist by participating in Field Experience & Capstone clinical practice experiences (CPE) in a setting that uses a health information system (HIS). These experiences provide me with an opportunity to apply what I have learned during my nursing informatics specialty program in a real-world setting.

What:  These experiences are structured learning activities that help me develop the knowledge, skills and abilities to perform the role of a nursing informaticist. During the CPE, I will be analyzing an existing HIS, identifying a gap and proposing a system optimization to improve an organization's ability to measure and report Triple Aim objectives.

This is not considered research and is not a research project. This project is experiential and does not require implementation. All of the deliverables I produce can be provided to the organization to implement if and when they wish.

When: I am required to complete 140 hours of clinical/practice experiences; 90 hours in Field Experience and 50 hours in Capstone courses. My goal is to have these completed by [date].  As my preceptor, you are not obligated to spend a certain number of clock hours with me or that I shadow you.  You and I can agree to communicate in person or via technology at whatever times work for both of us. 

How:  The activities for this project will be completed in collaboration with my preceptor, and additional organizational stakeholders who agree to participate. This ensures the system optimization proposal is aligned with the organization's needs. I will complete the required activities in this clinical practice experience (CPE) for the system optimization change, improvement, or innovation proposal that addresses an identified need or gap. The deliverables from these activities will be used by me in my Field Experience/Capstone system optimization proposal paper. 

Cannot be a member of the student's immediate family or have a financial, business, or professional relationship in conflict with the preceptor's duties.

Preceptor must be an employee of the student's chosen host site.
Students must complete CPE hours outside of their own regular work hours. During your time with your preceptor, you are considered a student and not an employee.

This link has more information and I can answer any questions you may have...  

https://westerngovernorsuniversity.sharepoint.com/sites/MSNNursingInformaticsPlacementApplication 

Thank you so much for looking at my post! My email is tvorce@wgu.edu. 

nursing management can be and often is a very lonely position to hold. no matter how popular you are with the staff, you are still the manager (boss) and are subject to criticism. it can be and often is very disheartening as well as frustrating. not to mention the call, and the amount of hours we work. in an effort to get us off to a great start .... please tell us about a management experience that was your most challenging and one that was your most rewarding. please remember confidentiality - so keep your post pretty non-specific, if possible.

it is my hope that this forum can be a support system to nurse managers and clinical directors. please feel free to use it that way!

i am looking forward to meeting everyone (virtually) and having some really powerful, educational and wonderful discussions here. i will post my introduction after a while ... i am very interested in meeting you all first.

thank you - patrick (rnpatl).

I have a masters in administration and a post masters degree as a nurse educator. I have been in leadership for a while but find I am lacking some of the financial and business aspects needed to move to a higher level with confidence. I am just curious if any of you have pursued an MBA and if it has had a positive impact on your career and income and is worth it ?

What are policies based on and where would find this information?  I have never held a position where writing policies was one of my job duties so I don't really know what I'm doing or where to start.  

Ever since the pandemic patients are demanding a singleroom. Or they refuse to move to a shared room. This always results in aggression 

Does anyone know of a strategy that works

I know as someone with no management position my salary would at be the low end of the salary scale listed for the position. 

My question is with bedside RNs getting $10k-20k sign on bonuses, does middle management ever get a sign on bonus? 

Please let me know if you know of any resources in the NYC, Long Island area.

Thank you

I absolutely love the providers I work with- except for one.  She, unfortunately, struggles with mental illness (she has told us this), and I feel for her, but she keeps the office in chaos with some of her behavior and admin doesn't seem to want to do anything about it.  I am the quintessential middle manager- all the responsibility, none of the power.

I found out that my old job is hiring and I most likely could go in and pick right back up.  There were some downsides to it, but at least I knew what I was doing.  The two major things that are stopping me:  I have really good benefits now, and I feel like I would really let my team down by leaving so soon.  I'm really torn on what to do!  Suggestions or thoughts?

Hospital establishments are also dissimilar to other industry establishments in that units are open 24/7, 365 days a year, with staff working around the clock. Therefore, it is essential to have constant, dependable leadership and supervision, day and night. Each shift, for leaders and staff, is full of interruptions, patient volume ebbs and flows, high-intensity decision-making, and unforeseen patient interactions ranging from civil to hostile. Through all these changes, emergency department leaders need their departments and staff ready to provide comprehensive emergency care on non-emergent, emergent, and mass casualty scales at all times. According to the University of Massachusetts Global¹, transformational leaders "know how to encourage, inspire and motivate employees to perform in ways that create meaningful change. The result is an engaged workforce that's empowered to innovate and help shape an organization's future success.” Therefore, transformational leaders encourage staff to be a part of the solution to any problem so that they will be motivated to make the changes necessary to keep the department prepared, equipped, organized, and successful.

As mentioned, decreased retention has been a huge problem for emergency departments and the healthcare industry overall. Patient experience numbers are increasing while simultaneously seeing decreasing healthcare worker satisfaction. Burnout rises as staff-to-patient ratios increase, the ability to take breaks decreases, and growing stressful environments intensify physical and mental strain. Emergency department leadership's attempts to keep tenured staff positive and motivated while welcoming more new staff require all leaders to have a transformational approach. "Highly reliable organizations have high scores regarding employee engagement, patient satisfaction and patient outcomes which are correlative to transformational leadership, strong shared governance and eventually great retention"².  Leadership attempt to stay collaborative and in touch through routine staff meetings and staff rounding, but the focus of a transformational leader should include how to influence direct reports and other followers to find what motivates them on an individual level.

The emergency department I worked in for eight years prided itself in feeling like family, but unfortunately, after a few years, I noticed, whether due to burnout, personal life changes, or other career advancement opportunities, a large turnover of staff hit our emergency department causing the leadership to have a difficult time maintaining the current culture and feeling of work "family.” The role of the Clinical Nurse Coordinators (CNCs), charge nurses with direct reports and service line autonomy, in our emergency department provides a holistic approach to maintaining culture by role modeling overall leadership expectations on shift and taking the time to get to know the new staff personally, caring for each and every one individually to empower and motivate them. The idea of this trusted position role modeling behaviors to staff is explained through idealized influence, a concept encompassed by transformational leadership.

Idealized influence "is defined as having transformational leaders who behave in ways that result in their being role models for their followers. These leaders are admired, respected, and trusted since followers identify with the leaders and want to emulate them. One of the things leaders do to earn this credit is to consider the needs of others over their own personal needs. They can be counted on to do the right thing, demonstrating high standards of ethical and moral conduct, and avoid using power for personal gain"³. Transformational leaders who value idealized influence engender trust, admiration, loyalty, and respect among followers. Trust is at the foundation of these components, building loyalty as trust grows, with staff knowing things will run smoothly through trusting who is in charge. Transformational leaders realize how their actions affect outcomes and how knowing each staff member's personal strengths and needs allow the catering of decisions on shift.

From my years of leadership experience, leaders strive to create a safe haven where honest communication can be shared mutually, show trust in staff knowledge and decisions, create a non-judgmental learning environment, and take the time to recognize staff contributions. Through role modeling, these behaviors to staff, staff, in turn, treat each other with the same respect and extra attention. "Transformational leadership with an emphasis on "idealized influence" is a model of leadership that, when applied, will lead to successful healthcare teams and organizations in local as well as globalized operational environments. This, in turn, will lead to high-quality and responsive healthcare being provided, which benefits patient and organization, as well as other supportive and protective organizations and the community"³. The goal is to bolster an environment of inclusion, influencing and encouraging each other to grow as leaders and create an environment of success.

In conclusion, transformational leaders are passionate about bridging the gap of the "us versus them" mentality between leadership and staff to build a foundation of trust through collaboration, flexibility, and honest feedback, thus creating an environment supported by idealized influence. In healthcare, especially in emergency departments, transformational leadership is particularly important to run an erratic environment smoothly. If leaders decide to utilize a transformational leadership model, they will see improved department trust, staff retention, and team dynamics, thus leading to improved core measures and patient outcomes. Transformational leaders role model for and inspire future leaders, creating a transcended environment staff want to remain a part of and new staff seek out. The result is a team that nothing and nobody can stop.

References/Resources

¹ What is transformational leadership? Understanding the impact of inspirational guidance: UMass Global Administration

² Transformational Leadership: One Emergency Department's Journey: Sigma Repository

³ EMS Leadership Part 5: Idealized Influence Transformational Leadership in EMS: HMP Global

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?