Nursing management necessary?

[Sarah2018]

Can we nursing exist without hierarchy?

It is disgusting.

My charge nurse doesn’t help us by participating in work when we are busy or when we have staff shortage. Think of it like your brother/friend is watching you cleaning and washing and lifting heavy weight repeatedly but he does not help. It is not his work.

Who is more moral, the one who helps you or the one who supervises you without helping ?

Also, nurses are health care professionals which means we shouldn’t have a nurse in charge who does not care for the patients and take patient assignments and we shouldn’t have a nursing supervisor either roaming around and doing nothing.

Professionals are autonomous and we are professional. Doctors do not have a supervisor or in-charge and they always care for patients. The CEO of my hospital is a cardiologist and he still treats patient and perform procedures while nursing director never care for patients.

What do they do all these people, charge nurses, team leaders, nursing supervisors?

The hospital installed a new calling system for outpatient clinics and my charge nurse made us nurses to monitor what ticket given to what patient and feed the information into an excel sheets. It is unfair, we care for patients and we don’t need extra assignments. Also she asks for manual writing for all patients who attended any clinic with arrival times despite having a an online system( because she is not through with it)(because no direct care for patients). It is disgusting. Why are those mangers there at all?

[klone, MSN, RN]

Doctors do have accountability and have to answer to someone. The CMO, the credentialing board, etc.

[kcochrane]

Guess it depends on the charge nurse. When I was charge in acute care I took on a partial patient load along with my charge nurse duties. There was no way that the nurses I was in charge of could have done their assignment and taken care of what I needed to do as charge. Some charge nurses will not and prefer to just do the minimum. This exists everywhere at all levels.

It is hard at times for others to see what charge, supervisors and managers in general do. Until I became a nurse manager I had no idea. I would love to help out more on my floor, but I have my own tasks and someone I answer to when I don't get my work done.

Like Klone pointed out, doctors do answer to the CMO.

[FolksBtrippin, BSN, RN]

It sounds like the OPs charge nurse is delegating things that should not be delegated to floor nurses.

That may wind up putting a bad taste in her mouth for management in general.

Also, if you didn't have the opportunity to take a leadership class in nursing school (ADN or diploma) you might have no clue what management does and therefore have no real appreciation.

[herring_RN, ASN, BSN]

I was blessed to work with nurses who mostly helped and supported each other much like OldDude did "In the night shifts of yore." from 1977 to 2014.

The last couple decades I was often charge nurse. Beginning in 2004 charge nurses did not have an assignment. We could help others and did. We could go off the unit to transport patients when need be. We could take over the assignment so nurses could go on a break when there was no break relief nurse.

For a couple years we were owned by a corporation that favored manager loyal to the corporation rather than patients. The best supervisors and managers quit or became direct care nurse and charge nurses.

Once all top management, from CEO to unit nurse manager went on a weeks "working" conference at a Hawaiian resort. During nine days with no upper management we provided safe, effective, compassionate nursing care. Staffing was excellent because the clerk in the nursing office and staff nurse as temporary supervisor didn't hesitate to keep rather than send home a nurse after discharges or call a registry for sufficient staff. When the ER called with an admit we had enough staff.

I don't think that could go on too long because of management responsibilities for hiring, ordering supplies, and personnel matters, BUT we did great with regard to patient care with no top management.

After all the only reason a patient is admitted to the hospital is for NURSING CARE. All else can be done as an out patient.

[klone, MSN, RN]

Being a manager is seriously THE HARDEST job I've ever done, ever. Just like there are floor nurses who only do the bare minimum to get through their shift, there are also managers that do the bare minimum. But yes, they are necessary. And if they're good, you will appreciate them and what they do for you.

[OldDude]

11 minutes ago, klone said:

Being a manager is seriously THE HARDEST job I've ever done, ever. Just like there are floor nurses who only do the bare minimum to get through their shift, there are also managers that do the bare minimum. But yes, they are necessary. And if they're good, you will appreciate them and what they do for you.

You are one of the exceptions to the worthless manager syndrome. I can tell by your posts your are engaging and supportive or your staff. The managers referenced here or those who may have been excellent nurses but once they become managers they just spend time pressing a ham at their cubicle, rearranging the photos on their desk, and implementing policy.

[JBMmom, MSN, NP]

2 hours ago, klone said:

Being a manager is seriously THE HARDEST job I've ever done, ever. Just like there are floor nurses who only do the bare minimum to get through their shift, there are also managers that do the bare minimum. But yes, they are necessary. And if they're good, you will appreciate them and what they do for you.

I find it ironic that your username is Klone, since having Klones of you with your work style would probably make nursing jobs throughout the country a better place to be. I finished my MSN in management only to realize that I could never be a manager, it's thankless and tireless and when done well it's the key to a good running unit. Thank you for all your work and effort, you have lucky nurses working for you!

[benharold1, BSN]

Managers are definitely important to the seeing protocol and efficiency on a unit. However, a bad manager that is not supportive of the staff can be a nightmare. Often these managers lose staff and the company money with constant staff turn-around and cost of new staff and orientation.

The nursing profession is in need of staff nurse supportive managers instead of lemmings who answer the call of upper-level management driven by profits and no clue of what it takes for patients to get truly safe, quality care.

[klone, MSN, RN]

On 5/8/2019 at 3:09 PM, JBMmom said:

I find it ironic that your username is Klone, since having Klones of you with your work style would probably make nursing jobs throughout the country a better place to be. I finished my MSN in management only to realize that I could never be a manager, it's thankless and tireless and when done well it's the key to a good running unit. Thank you for all your work and effort, you have lucky nurses working for you!

Aww, thanks! ❤️

[Forest2]

On 5/8/2019 at 10:15 AM, OldDude said:

In the night shifts of yore, when I graduated as a GN on a Friday and went to work in a busy pedi ER the following Monday, I had the soooo fortunate experience to be accepted into the best group of nurses I have ever had the pleasure of working with. Every nurse stepped up and helped every other nurse all shift and every shift. We never saw a supervisor at night and we didn't need one. We problem solved, adapted, and worked through critical thinking on our own. The unit was self contained and operated without the need for supervision. The ER manager assigned a "charge" nurse but we never new who it was because there wasn't a need for one. The only time we saw the ER manager was when there was the millennium scare when 1999 turned into 2000. He was there for about 30 minutes at midnight and left when the world did not end.

Beyond that, if the place is busy enough, it's a good idea to have someone in the "control tower" to keep things organized but in many cases, as you have experienced, "managers" just withdraw from the overall patient care mission and that is frustrating for their peers still out there swinging the hammers.

When I first started nursing there was no physician in the house on night shift, not in ER, not anywhere and we had no supervisor. We all did what we needed to do because we were responsible adults. The ER nurse had the pharmacy keys in case we needed something, but that was a rarity. It was a 75 bed hospital.

[Forest2]

On 5/8/2019 at 11:53 AM, Sarah2018 said:

Now my hospital is working to fix the grade for nursing staff. Bedside nurses and those who deliver care to patients will be higher in professional grade and will receive more money than nurses in the managerial pathway like charge nurses and supervisors. Charge nurses and supervisors will be called nursing coordinator or nursing secretary.

Nurses will be autonomous professionals in reality.

I am happy!

WOW.

[Forest2]

Sounds to me that you have bad managers. Why don't you leave this job and transfer to another area of the hospital or another place completely? I remember being a administrator nurse and the floor nurses would say I never came down to help. But, they didn't see what was going on upstairs. If I did their job then who would do my work that was sitting on my desk waiting. No one because they didn't have the education, skill set or authority to do those things. I met with families who had complaints and got those things resolved, I met with other department heads to resolve differences and coordinate what went on in house, I did state reports, ran the infection control program, the safety program, hired and trained staff, performed discipline. And tons more stuff, I worked salary, so I didn't get more money if I worked more. I tried to keep my hours at 50 per week, so probably made less money than the floor nurses and had 10 times more stress. You don't know unless you have walked in their shoes, you don't know what you don't know. On the other hand, it sounds like you have pretty bad supervisors.