The Enemy... The Nurse Manager

3ringnursing, BSN · Feb 11, 2017

Being middle management sounds tough - stuck in the middle, on call 24/7, and not paid nearly enough. My supervisor is in the same boat: back in school working on her doctorate, 2 young girls grade school age, a fairly new marriage, sick aging parents and in-laws, and constant meetings. That's just what I know about. I also adore her because I know she does everything she can to protect all of us. I do many things I don't like on her behalf without complaint because I know when I need her she is there for me in return.

I've been an RN for 24 years, and didn't always have this appreciation for my supervisor - my own short comings, or well deserved? I can't say for sure now, but with some maturity under my belt, and having job jumped many times in my career, I am now at my forever place and intend to stay until retirement. Maybe I see things for for how they are now whereas I didn't before when I was younger, so I realize work like any relationship is a give and take.

I wish I had some advise for you, but making others realize our own plight is never easy, because people usually only see their own. If you are in a position to assign a couple of nurses more responsibility/autonomy for assistance so they can see the situation as it is you may gain some allies and much needed help, if your upper echelons allow it. That's what my boss did with myself and another coworker, and I have to say nothing makes you see the other perspective faster. Then work on ways to bring others on board somehow. I know, sounds easier said than done, but if there is a way this may make some changes in the us -vs- them feeling on the unit.

Good luck to you - it sounds like your heart is in the right place. There was never a harder lesson in life for me to learn than realizing not everyone will like me no matter what I do - even if I passed out dinners and blankets to the homeless in my off time, and rescue puppies. That just plain sucks, but it is reality and sometimes a bitter pill to swallow.

JWG223 · Feb 11, 2017

Do you know what it's like to not have anyone like you? To know that everyone hates you? That's my life as a nurse manager. They now see me as the enemy. I have to deny vacations, write people up, give not so good performance evaluations, tell people how to do their job better, short the unit. How often do you make rounds on your unit and say "Hey, *Sarah*, I heard about the night you had last night, and I read the chart on Mr. So and So, and wanted to let you know you handled that great!" How often do you take the time and money to buy the unit pizza or donuts? I've done that, and I am not a manager, and I still found it IN MY PERSONAL BUDGET to do that for some of the units I've worked on. If all you ever have it within yourself to "hunt down an interaction" for is to be negative, I'm not surprised you get the push-back you do. Hunt down the positive just as doggedly. They think I am sitting in my office everyday doing nothing when I am drowning in work. Blah!!!! I spend almost all my time in meetings. Sometimes I literally have 30 minutes outside of meetings. So then I work at home or on my days off. When I am in my office, sometimes I close my door. I literally cannot get a thing done when my door is open because people always come in to talk. I cannot send people away because I don't want to unapproachable.
What they don't know is how hard I fight for them. They forget about all the new equipment I fight for. They forget all about the changes I have made so they have it easier. I talk about these in our staff meetings but very few people come. I send out weekly emails but people don't read them. Noone reads their E-mail, and noone cares about the new IV pump. In fact, people resist change and view that sexy new IV pump as a pain initially, 9x out of 10. People do not CARE about you lobbying for a new SCD machine or whatever unless they have complained about that exact piece of equipment. I hate to say these things, but they are true. Right? Wrong? I can't help you. Just the facts.
I was so happy to take this job. It has proved to be the hardest job ever. I have senior leaders handing never ending tasks down to me and staff level employees complaining so much. It's exhausting. Was I like that as a staff nurse?
Balancing the schedule for 70 people is nuts. No one gets 100% of what they want. That makes people very angry but someone has to work! You will never get around that. Make sure you are 100% fair. They may be mad at you, but they WILL respect you. Adults are a lot like children in that they can sense when they are being treated unfairly, and nothing gets that trust back. Be fair, first, last, and always. Especially with holidays and schedule stuff!
People complain and gossip but refuse to get involved. They won't come to staff meetings, they won't join committees, they won't offer solutions. Because it's not their job to offer solutions. It's yours. Thats the mindset, anyway. Is that right? Maybe not so much. But when's the last time you wandered out on the unit and restrained the violent patient covered in poo? Okay. So there IS a delineation in tasks you are expected to deal with. At the end of a 12-16 hour shift, a staff meeting ranks somewhere below whale crap on people's totem pole. Instead...bribe 'em with food or something. Not right, but if you want attendance, holding a free breakfast/supper after night shift for the night people, and after day-shift for the day people, is a good as any way to do it. You will still get those who sit in the back and refuse to engage. But they ARE making notes, and often, it's those in the back being quiet who are going to say "Hey man, she's going to bat for us. I've been here 20 years, and I've seen them come and go. She's a good one", or "Screw her.", and they are going to be what your reputation lives or dies on. So don't worry about staff involvement at the meeting necessarily. Worry about it AFTER the meeting, when you're not standing there.
I love my job and I love the team. However; it is so exhausting. I am on call 24-7. People tend to forget that too. I respond to calls and messages all day long.
I just want people to meet me in the middle. When have "people" ever met someone in the middle? Do patients meet your staff "in the middle" on compliance issues? I think not, unless you have a very atypical patient population. That's just the nature of things. People do not like to meet in the middle. They want to meet somewhat on THEIR end of the spectrum. All too often, we let this slide until it comes time for the stick. Sometimes it's not a hill worth dying on, and sometimes, we could have left the stick at home if we'd just brought a few shavings of carrot.
I try to get to know the staff members, send thank notes monthly, ask people what they think. Noone cares much about a note. They care when you walk up to them, smile, know their name, and show that you've actually looked into their actions and found them to be exemplary and offer them thanks for doing an above and beyond job. Would you send someone a note telling them they did a poor job? No. You'd face to face it (I'd hope...). So don't expect a note to be satisfactory for the opposite.
I can't seem to get ahead. I think a big part of the problem is that I came from this unit. People wonder why I got the job. I'm sure some people even hate it. No matter how hard I try, I can't get them to understand that I work for them. I want them to grow and succeed. I want us to be a great unit that everyone wants to work on. No prophet is appreciated in his(her) own town. This is very true, and you will always have people who honestly might BE more qualified for your job...but they didn't get it. They may well always be against you. The trick here? Always be fair. They may not like you. They may envy you. They may think you suck at your job. But if they see that you're fair, it's really hard to hate someone who treats you the way you should be treated if you're able to see it.
Any tips??? Any advice???

It sounds like you really care, and you're struggling with balancing the good-cop, bad-cop both with the same face, deal. My advice? Use the carrot more than the stick. I've worked for people in my life that I'd get one over on if I could, because screw them, that's why, and I've worked for people that if I felt like I hadn't done my best, I should be truly ashamed of myself. Guess who I worked harder for? Hint: It wasn't the one who carried the biggest stick.

Above it all, be fair. Noone respects anyone who isn't fair, and on the same hand, it's very hard to truly remain at odds with someone when it's plain to see that they are treating their team RIGHT, without exception or favoritism.

My boss? Currently? I have worked for her for almost a year and a half. I have seen her on less than a dozen occasions, and most of that was incidental (we passed each other in the hall, we went to the same meeting, etc.). She has said 2 sentences to me that were positive the entire time I've been at my job. She has, however, treated me flawlessly fair. She has respected me. She has ALWAYS gone to bat for my team, and I am very pleased to work for her. My last good boss was very similar. She never came out onto the unit when I was around hardly, but when she did, if she had something negative to say, it followed only after a long discourse of positive, and she was ALWAYS trying to teach and better someone when she gave them a hard pill to swallow. She always used it as a teaching moment, and write-ups or punishment as it were, was meted out only at the bare minimum of institutional demand. As in, she would get reprimanded for not doing at least what she did in punitive action.

I am of the opinion that a government which governs least, governs best, and thats how I like my bosses. Leave me alone. Don't bother me. Don't have to really praise me or do things FOR me, either. You hired me because I'm competent and good at what I do, and am very self-directed and effective. SO let me DO. And my boss has, and does. That is how you make ME happy. And you're going to have to learn what makes each and every one of your employees happy. The paperwork is the cake of your job. It's the peopling that is the chore.

Teen5 · Feb 11, 2017

I have read all you have said and all it tells me is you are really, really good at your job.As you say these nurses worked along side you and maybe wonder why you got the job.They will just have to get used to it or move on.As for you well done and keep up the great work you do.If I were you I'd try a little bit of the cold shoulder for awhile,not good to be too friendly in your position.All the best xxx

sunny time · Feb 11, 2017

really???? give us a break, all it means is she has thin skin and can't take the heat. let her go back to the floor and build up some emtional tolerance. Or go get a job where she doesn't have to deal with the staff.

Supernurse17 · Feb 11, 2017

Come out to the floor and take care of just one patient all day and you will understand

nfpeterse · Feb 11, 2017

Often where there is that much failure to participate folks feel they cannot be heard. They often will not communicate about issues because of potential back lash. I would sit down with upper management, and indicate you want some time with staff to get to the issues that may exist but are not apparent. I did that when I took over a large unit that was not functioning well at all. I used a forced field analysis technique, where a stated management goal for the unit was agreed on. In my case, it was to restore the units harmony and efficiency.

Then the staff were to note the impediments to the goal in writing, stated in non judgmental terms. Then a similar approach is used to ferret out solutions to each impediment.

Not sure how open your management it, but the fact that your door is open and people are stopping by all of the time, indicates to me they want contact, they don't hate you, they may be reluctant to be fully open identifying the problems due to backlash, politics, or other unidentified issues.

I had full support of upper management as the unit had functioned poorly for years. I have done a number of these kinds of turn arounds, where things festered a long time. You have to move the personalities out of the process, and the anger the tmay be present and keep people focused on what is the problem and what are your suggestions for solutions.

silent_rn · Feb 11, 2017

You may need to change your management or leadership style. Because it's evident that what you are doing is not effective. Try to identify the problem in your unit, and let your staff know that they are a part of the team. You could probably start from small stuff, like bringing something to eat for the whole team.. Provide positive feedbacks for a well done job or create a monthly staff recognition.. Etc. Maybe it's about time you need to be more visible to your team than staying at your office most of the time. You may need to delegate some of your workloads if that's possible. ..

Gray Fox · Feb 11, 2017

On being a nurse manager - the most important lesson I learned is to let go, engage the staff with the goal of creating a self directed work team. Let them take responsibility for things like scheduling and orientation. Encourage each of them to find a special project - either short term or long term - that matches their goals and interests. Investigate some of the shared governance models and see what would work in your unit.

nursenichol · Feb 11, 2017

Been there, done that. It is a stressful job. It's frustrating being sandwiched in the middle and no one cares about the manager. The only advice I can give is to get out now while you still have your health. The stress takes its toll on your heart and mind. I determined that the cons outweighed the pros and after 8 years in management, I left. I took a position as a staff nurse at a new facility. I am so happy now.

Concerto_in_C, BSN, RN · Feb 11, 2017

Nurse managers are among the reasons I quit full time nursing and became a contract nurse. I don't have manager anymore, I have an agent who kisses my butt because of the revenue I bring her. I'm no longer an employee but a businessman.

I dislike hospital leadership. When something goes wrong with a patient they throw young promising nurses under the bus and report them to state boards to protect hospital revenue. The legal department at the hospital is there to protect the hospital, not the nurse that's just getting started in the profession. The nurse manager is part of this hostile administration. She is not one of us. She is not in the trenches with us sharing the hardships.

Once I became a contract nurse the hospitals and their leadership can kiss my butt. They have no jurisdiction over me. They can't make any move against my license. My agency's lawyers work for me, not for the hospital, and they made it clear when I was in a contract in September and things went sour.

The only way my agency turns against me and reports me to nursing boards is a criminal case like diverting narcotics or assault or sexual harassment. They will never stab me in the back because a patient had a bad outcome.

Some patients will always have bad outcomes no matter what we do and don't do. The spend a lifetime ruining their health through their bad habits, bad diet, lack of exercise, they smoke a pack of cigarettes before going to ER, and they expect the physician and the nurse to fix them in 3 days. And woe on us nurses if we don't deliver a satisfactory outcome!!

sunny time · Feb 11, 2017

no you are wrong. the hospital can still turn your license in to the BON and you can still be prosecuted. don't ever feel safe no matter who you work for. a patient or family can turn your license in. you are very foolish to think you are safe. get malpractice insurance and chart carefully. your company will not stand be home you if you are let go by the hospital through your company. I know I have been there as the supervisor at the facility wrote me up 3 times without my knowledge and I was let go. I said when was I written up and what was the reason? the company did not know but I was unable to use them for a job. I had to go to a different company. Think again, Nurse, you are not safe.

Ronda601 · Feb 11, 2017

Have you actually been a nurse? Then you know why nurses have "that attitude". In 20 years I've seen so many bad managers and I can tell you so many "true stories". I've been told "I can teach a monkey to do what you do but I can't teach a monkey to smile." I've been told it's fun to fire people. I've gone to disciplinary meetings where it didn't matter what I said. Everything was neatly evaluated typed up and action taken before I opened my mouth. I've been called out to answer for the behavior of so many patients who behaved badly then somehow it became my fault. Example. Patient not mine never laid eyes on but the blond in blue totally ignored my requests for pain meds. All I was doing was running up down hall for my patients. Never talked to her. It goes on and on and on. You represent the hospital. You can be you without ever being me and tell me how to do my job. You don't want to do what I do. I love what I do. You tell me how to do it, you don't know what your talking about. Best advice. Say as little as possible. Be kind. Ignore the borderlines who want to control you and everyone else.

And give people the schedule they need. There are few other rewards.