so occasionally when our regular assistant managers are off or vacation, the manager from our holding unit (basically a med-surg unit) will stand in. Her background is in ICU and probably med-surg. Now you would think that having a background in critical care would enable her to work as charge in the ED right?
Well no-one likes when she's on because not only does she lack the sense of urgency and quick thinking that it takes to work in the ER let alone an incredibly large and busy one but she also lacks the skills.
If it is very busy (which is pretty much always) our regular assistant NM's will jump on at triage or in the resus bay and help out. But she cannot and never does.
When triage is slamming she will pull a nurse from an area (make us, who are already overwhelmed take that RN's patients, so that nurse can go help triage while she just walks around doing nothing but answering her phone and overseeing and this makes us even more overwhelmed and confusion. Not to mention the patients are wondering why they keep switching nurses. And how aggravating is it to have one assignment for the first 5 hours of your shift only to be told to drop it for a new one????
One time I had to cover an entire side with a vent down the hall.
She admitted that she cannot place IV's all that well
The only thing she can do and may help you with is doing some SBAR forms so you're patient can go up to their room. And this is only when it is obviously busy and she can't help you in any other way.
If the floors are stalling and not taking patients she will tell us to hold our patients and give the floors some time. Like really do you see the waiting room??? and we each have like 8 patients???
It's almost as if she's scared to do any hands on bedside care for fear of making mistakes.
I remember one horrible night in the resus bay and you could see that she was visibly flustered, not even knowing where to start. After about 30 minutes she ripped off her white lab coat and was like ''OK I will handle this patient'' Like really? You should've done that an hour ago!
Me thinks this will become a problem down the line.
Last edit by All4NursingRN on Aug 24, '12
Aug 24, '12
Unfortunately, many nurses leap at the first opportunity to enter the ranks of management without appreciating all the ramifications. This is one of the reasons that (many years ago) JC standards were changed to require managers of specialty departments to actually have evidence of specialization in that area... well duh.
This scenario is setting the hospital,and that nurse, up for enormous liability. No nurse should ever attempt to deliver any type of care unless he/she is competent to do so... no matter what their rank in the hierarchy. Can you meet with your manager to discuss this situation?
In the meantime, I would suggest that you and your colleagues work out a plan of action to account for these situations. For instance, it is always better to request specific types of help rather than just hollering for "some help". You also have to understand that it is very unlikely that the 'extra bodies' are going to be able to function independently in your specialty area. I know it's challenging in an ED, but if you can flip into a 'team mode' and utilize non-ED nurses to take care of tasks (for which they are qualified), it helps to lighten the load and maximizes their usefulness. You could assign them things like 'vital signs', 'meds', transfers, etc. It's not ideal, but I know it works.
Aug 24, '12
It's simply not realistic to expect someone who is essentially, a "float" from another unit to function in the same way that your regular person does. How competent would you all be if you were pulled to another unit requiring different ways of thinking and different skills? This sounds like a case of lateral violence to me. Someone from another unit is being pulled in to help ... and instead of working WITH her and finding ways for her to help you that are within her field of expertise, you tear her down for not being an expert ED nurse.
As the above poster recommended, your unit needs to develop a plan for how to function when your normal assistant manager (or whoever) is not present -- a realistic plan plan based on the resources available. Stop tearing down the help you are being offered and start figuring out ways to make the most of it.
Aug 27, '12
llg thank you for your response, but I don't think you understand what I wrote,, nor do I think you fully read what I wrote, because I stated that the manager does NOT help at all.
I am not talking about a staff RN who was asked to float. I am talking about a manager (who is part of our unit) who is not qualified to manage our unit because she has no prior experience and it shows dramatically.
My unit cannot develop any plan unless management develops and approves of it. After all she is on management and they take very few suggestions from staff.
Tearing down help? LMBO! I WISH I could call her management style help!
Aug 27, '12
Oh ... I see. I misunderstood. I thouht the Manager coming to help was coming from another unit to cover the absence of your Assistant Manager.
Aug 27, '12
I wonder if her promotion was more of a "it's not what you know, it's who you know" kind of thing...? And if that's the case, it depends how far up the "who she knows" chain it goes as to whether you can do much (if anything) about it.
That's what I'd be sniffing out.
Aug 27, '12
This is a tricky situation.
If she manages the holding area, does the ED proper have its own manager?
If you do report to a separate ED manager, I would talk to this person and express your concerns. What you're saying is that the person they are assigning to cover a vital position is not up to par clinically to do it and this puts undue stress on the staff (it seems the assistant managers in your unit are actually doing patient care when needed, which isn't the case in all ED's).
You could go on to suggest that one of your senior staff nurses could be assigned as temporary assistant manager to cover these periods as this would be safer for patients and more beneficial to staff who otherwise are left to pick up the slack.
Having open and honest communication with leadership should be encouraged and promoted in all workplaces.
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Aug 27, '12
Thanks Edmia, and thanks llg!
Honestly speaking as a staff nurse I feel way too intimidated to speak out against the manager in this particular situation. The rapport between management and staff isn't all that great in my department to begin with. This manager is personable and nice but like you said Edmia, her lack of skills are straining us and most staff (from the aides on up to the MD's) just roll their eyes (so to speak) when she is filling in as manager, because we know it's going to be one of those shifts where we're going to suffer on our own and have to rectify our own issues as the shift rolls along.
Our ED can be very intimidating, so on a bad day w/up to 150 total patients at any given time/400+ patients seen in 24 hours, non stop traumas, strokes, notifications, with a waiting room bursting at the seams and a line of ambulances. Large, continous volume of patients, mid to high level acuity. Even our regular managers get flustered and overwhelmed, so I can imagine for her it's too much, so much that she either ignores certain issues (like finding ways to decompress the ED, move staff around, and making sure the nurses all get relieved for break) or she just cannot (or will not) roll up her sleeves when we're drowning (particularly in the resus bay and ambulance triage areas)
Most of the senior ED RN's hate being charge, so unless they force them to rotate the charge, that's out of the question :-(
Last edit by All4NursingRN on Aug 27, '12
Sep 7, '12
Was the holding manager ever oriented by the regular ED assistant managers? Perhaps that would be a good place to start. Critical care experience does not necessarily equate or translate to the ED or vice-versa- two very different worlds.
Sep 8, '12
I'm confused. At my institution, Nurse Managers are just that Nurse Managers. We ARE NOT clinical (anymore). We don't get included in HPPD data. However, Nurse Managers should be able to handle the flow on the unit. On the other hand Assistant Nurse Managers are included in HPPD, numbers for staffing, etc. They keep up clinical competencies, just like our staff nurses. So depending on how your institution classifies Nurse Managers and Assistant Nurse Managers my discussion would be different depending on the classification.