Nursing Management Question

[Toquay]

I am curious how many supervisors, directors, etc were actual patient care nurses before going into management. I am curious as to how middle management nursing feels about the ongoing concerns with staffing, more acute pt's, heavier pt flow, pay etc. I work in a dept that has seen many directors (7) and supervisors (about 8) in the past 10 yrs, the turnover is very high for these positions. It seems to me many in the middle management become the scape goats for higher ups in administration not addressing issues, and when things go bad they get axed. It seems the ones with longevity have learned to not rock the boat and become "yes" people to the system. I have never understood the us vs them mentality between management and nurses since it is supposed to be all about patient care. I always keep hoping that someone will make the difference once promoted but they are either gone or they forget what it is like in the trenches. Can someone in middle management shoes share how it feels to be between a rock and hard place?

Toq

I would be fired inside a day if I ever took such a position.

[joannep]

You are spot on with how you perceive it. Nurses aspire to middle management because they think they can change things, and make it better, but once you get there you realise you are never going to change anything. It is depressing, so you leave and find a different way of making a difference.

[Miss Mab]

Here's my take on the whole thing. I've been nursing for not all that long and have had 3 dept. managers in the same unit. Here's how I think it works:

There is this big pool of let's call them 'don't wanna work the floor no more's.' There are hundreds of them in each city. They each take some mangagement spot, fully intending to leave shortly thereafter(nine months to a year seems about average). They make busy, perhaps try to make some helpful new systems, then time's up! They rotate out and switch with some other manager somewhere. Trade jobs and repeat cycle. Repeat again and again for about 10 years and then settle into whatever job it is they wanted in the first place--DON, CNO, etc. Because NOW, they each have "10 years of management experience."

This is honestly how I think it works and I think if anyone was honest they'd just say so. There's no shame in it, it just is the way it is.

[pb57]

I think there is lack of respect between staff and management...they don't respect what and how I do my job as a staff nurse and I do not respect what they do. I wish it were different and I don't think there is a one day class to fix it...it takes time to earn someones respect.

[sheluke]

How does it feel to be middle management? Often painful.

Yes, I would agree many of us took one of 'those' positions with fully great intentions, wanting to make positive changes and improvements and feel like I am in touch with the 'real' nurses and other staff to be a solid voice to the upper echelon.

Unfortunately-what many of us discover is that we are not often in the loop of actually making decisions, but more often are expected to operationalize decisions already made, often without regard to if we have the staff to do so, or the other resources available (right training, $, etc)

I'm sure there are some (I could name a couple 'colleagues') that want to do as little as possible and move on up or over and up or whatever...however that's one of the reasons I am still where I am-disillusionment aside, I fear that if I leave my wonderful and dedicated team, they will have someone 'worse' (ie someone who is just climbing and doesn't necessarily at least look out for and appreciate the team)

So, I rejoice in small victories, try to focus on the things I and the team can control (staff flexibility in hours, assignments, recognition program, etc) I do believe sometimes the small things still count.

But there are certainly days I consider who has staff openings in the hospital...

[Rnandsoccermom]

Been a RN for 22 years, 12 of those as a staff nurse. I am currently a night shift supervisor. I will be working pm shift the day before Thanksgiving and a 12 hour night Thanksgiving day. I have to work Thanksgiving weekend Sat. and Sun. 12 hour nights. The "bosses" will have a 4 day weekend-not me.

There are 4 supervisor positions were I work and 2 in house registry supervisors. When one of us calls in, one of us has to work, we don't get to call agency to replace us. Neither of the in house supervisors are required to work weekends-they both have other jobs. I work every other weekend.

There is no bed coordinator, no pharmacist, no lab tech, no central supply, no staffing person at night where I work. All of that is done by me-including starting IV's. I have to take the heat for every decision I make regarding all of this.

Last year I called in 3 times, on my evaluation I was told I call in too much and that I needed improvement.

I stick up for the staff, I am not always a favorite with the bosses, but I also know what is safe clinically and what is legal in my state regarding nursing practice. I will lose my job before I lose my license.

Is there anything else I can do for you?

[Daytonite, BSN, RN]

i became an rn in 1975 and worked as a staff nurse until around 1987 (so that was about 12 years of staff nurse experience) before i became a nursing supervisor in a hospital. i was afraid to go into the position too for probably the same reasons you are. the way it happened was that i had just gotten my bsn in 1986 and became an rn in 1975 and worked as a staff nurse until around 1987 (so that was about 12 years of staff nurse experience) before i became a nursing supervisor in a hospital. i was afraid to go into the position too for probably the same reasons you are. the way it happened was that i had just gotten my bsn in 1986 and apparently as i was going through my bsn completion program my leadership skills really were noticed. i was asked to come to the nursing office one day after working my shift. was i worried! a situation or two had occurred in the previous week or two that i could be on the hot seat over. you have to understand that as a leader you do sometimes have to make decisions that others just aren't going to like. anyway, to my surprise i was kind of ganged up on by a couple of the assistant coordinators who told me there was a house supervisor position open and they really wanted to put me into it. i almost fell off my chair. at first i was flattered. then scared. i told them about my fears of being in a supervision position. you know what they did. they answered them and kind of chuckled. they all had the same misgivings too. it turned out to be the best opportunity of my life. it was a wonderful leadership staff who took me and two others new to supervision and trained us. they cared about the nursing staff. but they taught us how to make decisions.

you need to understand that you are never alone in most decisions. there are facility policies and procedures to back you up. if you didn't know them as a staff nurse, you certainly will become familiar with them as a supervisor or manager. there is also a hierarchy within supervision and management. there is always someone else in a higher position than you to go to for consultation-always. important decisions are never made alone. we always consulted another supervisor, manager or coordinator. when i went on to become a manager major decisions involving discipline, hiring and firing were never a sole decision by me ever. there were a group of other people involved in that. basically, again, i had to know the policies and procedures and was pretty much the first step in getting them enforced.

you keep as close contact with your staff as you want. i've seen supervisors and manager who get into those positions and wipe their hands clean of staff contact. i wasn't that way. i was on the unit and closely involved with staff. i let them know i was there and constantly asking how they were doing. i listened to the taped shift reports. i made patient rounds myself. that is a personal choice that you make. the fact is that when you get into supervision and management positions the supervision and management of your performance is hardly noticeable to you and many notice that right away. those with poor character will slack off and they may become those bums that sit in their offices with the doors closed to the staff. it's really pretty much up to you.

please re-think this. in a leadership position, there are some changes you can make to the way a unit is run that you cannot do as a staff nurse. it also will allow you to use some nursing skills you touched on in nursing school that you haven't been able to use yet. at least give it a try. you can always transfer back to being a staff nurse if you don't like the job. however, being in supervision or management will give you a whole new interesting perspective of nursing that you haven't seen before. at least give it a try so you can learn what it's like.

now, i've been on both sides of the fence. yes, it's easier to be an indian than a chief. but, i know the skills of an indian much better, i think, so i feel more comfortable with them. but the skills of being in supervision and management are skills too. that's what you are really worried about. you'll have to learn them. there are plenty of books out there to help you. be clear, however, these are skills as well. my brother was a manger for a large corporation and at family get togethers we often talked about management things. it was amazing how similar the situations were that we had despite that we were in two different industries. and, now one of my nieces is being trained as a manager in the banking industry and she and i talk periodically about employee disciplinary issues. same problems. different industry. what a hoot!

[llg, PhD, RN]

I think the OP is on the right track. The vast majority of people entering middle-level leadership positions have at least some bedside experience (at which they did well or they would not have been promoted) -- and seek the leadership role with good intentions. However, they soon find out that improving things is not as easy as they thought -- and it's sometimes very painful to realize that not only are you not well-supported by higher level administrators, but that staff won't support you either.

Most people in the middle muddle through as best they can, trying to minimize the pain for their staff and for themselves when they can -- focusing on preventing disaster and hoping that something positive will happen someday. Ocassionally it does, and that provides the reward needed to keep them going.

Then they get old and tired and have little left to give. So they move on in life.

[RN1989]

Toquay, you already know the score, not sure what answers you are looking for except the ones you aren't going to get. I'm one of those been there, done that managers hoping to make a difference. Being a manager is like being a politician - you have to pick and choose your battles very carefully. You have to give up on getting one thing done because admin won't let you do something else that has higher priority unless you agree to let go of the other "causes". The staff hate you because they think you are so mean to them and won't help them but admin is threatening you because you are sticking up for the staff and the patiens. I get sick of being required to get all the office work done, all the pt complaints taken care of, and after a 12+ hour day I'm expected to work the night shift because the nurses are complaining about being short. Then I have to work a 12 hour day shift on the floor because they are complaining about being short and half to spend half the night in the office to get all that crap done before admin bites my head off. It is a never ending cycle. And yes, the good ones always leave because otherwise it will kill them. It is hard not to take things so personally when you give up so much of yourself to your job, the staff, and the patients. You either live at work to try to live up to the expectations of the staff, the standards you have set for yourself, and to do all the nitpicky things that admin wants. Or, you do the very minimal to get by with admin and try to ignore the staff's pleadings so that you CAN go home and have a life. And even this backfires because eventually so many staff leave because they think you suck, that admin puts this on your evaluation and threatens your job. It is a no-win situation. Only the really lousy managers or the ones that must have strength and stamina that I don't have, can stay at their jobs forever.

[ebear, BSN, RN]

RNsoccermom,

You forgot to say "I have the time".... BWAAAAA!!!!!:lol2::lol2:

ebear

[VivaLasViejas, ASN, RN]

Although I think Daytonite said it best, let me add this: I think too many of us middle managers try to 'run with the hares and hunt with the hounds', so to speak, and it causes many a downfall because neither the hares nor the hounds will permit this. You can't stay buddies with the staff and be an authority figure. And you can't completely align yourself with the 'suits' without alienating staff (and the 'suits' don't really consider you a peer anyway). It's quite a tightrope, and only the incredibly lucky (or incredibly emotionally intelligent) can walk it without overbalancing and falling off.:stone

[ebear, BSN, RN]

mjlrn97,

ABSOLUTELY TRUE!