Nursing Management Getting Down & Dirty On The Floors

luvRNs, BSN, MSN, RN · Mar 16, 2010

Interesting thread. I spent a great deal of my later career in management and administrative roles, but prided myself on my visibility and presence on the floor. As a manager I held myself to the same standards as staff, BLS, ACLS, specialty certification and other required mandatory skills. Was on 24 hour call for my unit, and often went in when staffing was an issue. This included nights, and weekends. Because I WAS willing, staff would often do EVERYTHING they could to cover so I did not have to. It's called respect. The opportunity for patient care is also an eye-opener for the manager. It's where you truly learn what is missing or in short supply, and what is a care barrier for your staff. Dealing with chronic issues sometimes become second nature to staff, and they may not even think to bring it to your attention. Fixing some of these things became a 'win' for all.

That said, no one picks up the responsibilities of the manager when they are delivering patient care. There were also times when I told me staff I could not help. In those cases, I did all I could to call others to fill the gaps. Guess the key is balance:D

kcochrane · Mar 16, 2010

In my old facility I saw both. The NM that would not touch a patient OR take charge to save their life and NMs that would take a CNA assignment if the unit was short. One NM would take new admits for the first few days to assess them and their abilities before turning them over to her staff.

I do agree it is very useful for a NM to actually know what goes on with regards to the unit. But I do understand they are getting more also from all sides.

Kooky Korky, BSN, RN · Mar 16, 2010

My HN wore whites. She let everyone walk on her, including the AHN, who spent a solid hour in the cafeteria for breakfast with her pals, leaving the floor half-staffed, and another solid hour or more there again at lunch - same staffing. Other nurses couldn't get their breaks because she wasn't there to relieve them. When I got the power, I put a stop to it at once. You took 15 minutes for breakfast, 30 at lunch and 15 if you had to stay past the next 4 hours. Period. Only 1 or 2 could go together. I scheduled their breaks, which they hated. The other staff loved me for making life more fair.

Shows you the different managers' "styles", doesn't it?

Having been a LTC Manager/Administratorr, I know from both sides of the desk what it's like.

I did not generally take patients, as I did have plenty of my own work to do - meetings with bosses and peers, preparing and giving evaluations, preparing and teaching classes to all 3 shifts of my staff (no staff developers), dealing with family members and patient complaints, rounding with each and every doctor each and every day, sometimes on the weekends if that's when I could best catch them. I hired, fired, did orientation, and was employee health. (PPD's, Hepatitis A and B, back to work/workers' comp and wellness).

I did help with admits, discharges, special problems, lifethreatening emergencies whenever possible.

If there was a tough IV start, I usually deferred to those better at it than I. A serious clinical matter (like a Code) I was always there. If there were housekeeping issues, pharmacy issues, supply issues, personnel troubles (like employees who smelled bad or showed up late or too infrequently and many other matters) I had to be the heavy and confront these problems to try to tactfully and successfully resolve them. I made the schedule and the budget. I spent lots of hours with the DON and corporate higher-up's, their requirement. Lots of this time was outside of work, at their homes.

I had good staffing for my LTC. I showed up on weekends and holidays, all shifts. I held meetings on all shifts. I had the pulse of my facility. People kept on their toes because they never knew when I might pop in. I was much younger and had boundless energy. My wife was home with the kids and she had her mom next door for companionship and advice. Her auntie and several cousins were just down the block or around the corner, too. She had a live-in housekeeper, too, so sitters and overwhelming household issues weren't an issue. It was tough seeing them all too little, but I did my best.

I switched back and forth between vehicles and even coats so they never knew at work who might be arriving at 0300 and couldn't put out the alarm to wake up. I could tell anyway who'd been asleep. I also lived within walking distance, so lots of times, I walked to work - no car to spot or hear. And sometimes I even just stayed on the place overnight, becoming much more familiar with 3-11 and graveyard staff and procedures and residents at those hours - lots of sundowners. You can bet me, though, that aides rotated their dinner breaks, no resident was forced to stay up more than about 30 minutes - not 4 hours - past dinner if she wanted to be put to bed. Skin care was done - q2h all night every night. Sleeping did not happen for staff. Those who couldn't hack it quit before I could fire them, usually.

One very good thing I did - I didn't expect charge nurses to be guards or disciplinarians. If they had a c/o about an aide, they wrote it down or I would not deal with it. They had to have at least that much courage, also they needed to tell me a straight story, not be verbally changing every few minutes. Then I dealt with it, never letting on how I knew about it. Why? The nurses were my licensed staff. I had to trust their judgment or not hire them. The aides were ancillary, not professionals. They were supposed to do as the nurses told them. if they seriously, seriously had an issue with safety or rudeness from a nurse, they could call their first line supervisor, who would speak with me the next day if not super urgent. I needed to sleep, too, don't forget.

It was tough but we woked through a lot of problems and I ran one of the best homes in our group, I am very proud to say. I rewarded good behavior and tolerated no bad. If you lied, you were called on it and got a chance to tell the truth and 1 warning to never repeat it. Most shaped up. Those who could not take the embarrassment left.

I hear they're now telling the nurses to bake and serve cookies in the evening. I hope they have a dietary person doing this. I would tell my nurses to do it if everything else permitted. Meds, charting, treatments, falls, etc. all came first. I was muscled out when I just couldn't go along with the stupid PG BS, like the cookies uber alles - not to mention the staffing cuts. I don't believe in firing older staff or giving reprimands for being sick 2 or 3 times in a year, or working staff at a dead run, no time to think or pee or eat.

Hope this helps.

allnurses Guide · Mar 16, 2010

I've got a similar expereince to Snoopy in the UK, our nurse managers are always willing and often roll up their sleves and pitch in to help when we are short staffed, the same can also be said for our senior manager who is not in a nursing position but did used to be a nurse. I've made beds, moved patients alongside her.

I have the utmost respect for my management team, both nursing and adminstration because when it comes down to it the patients are the focus of our service and if mucking in and helping out is what is needed to get the jobs done then that is what happens.