A while back, I had posted about my discomfort of being assigned to work the COVID unit. My main thing was that the COVID unit didn’t bring out my strengths, but sure highlighted my weaknesses.
Now, again, I am in a similar position. Because there are not enough patients to fill 2 rehab units...in other words, my normal unit is closed...I have now been reassigned to help on the LTC unit.
I find myself in a similar position in which working this unit does not highlight or emphasize my strengths. Just as a background, my strongest skills as a manager and nurse include documentation, writing SBARs and completing admissions. However, with it being a LTC unit, we don’t accept nearly as many admissions. Mainly, we accept “leftover” patients from the rehab unit who are transitioning to LTC. This also means there aren’t as many things to follow up on, and therefore, not as many SBARs to write or as many assessments to complete or orders to put in. Instead, the work is mostly on hands on skills which, while I can perform, I am not as efficient with and don’t enjoy as much. We also have a patient who has medical needs that I am not familiar with or comfortable meeting.
In other words, this is another change I am not thrilled with because tasks I am being asked to complete are not my areas of strength and I am being given fewer opportunities to complete the activities I do well at. Once again, I feel I would do a much better job in the admissions role, which I have offered to learn, but continue to be denied that role because for some reason they’d rather assign me elsewhere.
Anyway, any suggestions appreciated. It seems that they do not realize that by assigning me to these other tasks, I may lose my skills in writing SBARs and even my ability to write in complete sentences.
In regards to the last sentence...yes, I was attempting to include a little humor in the post ? I enjoy a bit of sarcasm every once in a while, but sometimes it's hard to convey that tone on the internet. Since several others thought I was seriously concerned, though, I will state that realistically my chances of losing my writing abilities due to providing patient care are nonexistent. I've been writing for many years, so it's not a skill I would just lose by doing less of it one day.
Now, realistically, you may be right about my performance being enhanced with increased direct care experience. I do sometimes wonder if I was possibly promoted too soon in my career, despite being good at many aspects of my current position. Nevertheless, after writing my original post, I have made more of an effort to engage in more hands-on skills. I worked the cart as a floor nurse a couple of times this week (although not for the entire shift due to finding someone else to cover) and have been more active in answering call lights, assisting with transfers, performing TB and COVID tests, etc. I have let some of my other coworkers take over some of the secretarial aspects of the job since I am already quite competent in those skills.
With that said, I've had a hard time letting coworkers take over completing floor admissions or entering orders since I still find errors on their end, or at least find things that haven't been addressed yet after reviewing the patients' medical records myself. As I suspected, many of my coworkers are not completing their admission assessments thoroughly. For example, I have had several document that a patient's skin is intact when in reality the person just had surgery and has a surgical incision that they failed to document. They have also failed to provide documentation on major pressure injuries, or if they do document a pressure injury, they simply state "Resident has pressure injury on the bottom" with no description, measurements, or interventions documented. Someone was hospitalized for an infected wound because the nurse doing her initial assessment failed to identify that the wound was even present on her admission and failed to verify that there were wound care orders. Many of them are also failing to complete a Drug Regimen Review on their first day, or if they do, they finish the assessment stating there are "no issues," even though I have found several myself. Some of these issues involve failure to address possible drug allergies and drug interactions, failure to clarify the dose or frequency of a particular medication, and failure to address medications that have been prescribed with no clear indication for them. All of these "failures" have the potential to put patients at risk, but most people seem to simply brush them off. I've also found that when other coworkers are primarily in charge of entering in orders, errors are made. By taking me off of some of these tasks and giving them to others, they are not being done nearly as well. It's not that I feel that I am the only one that can do these things efficiently, as there are a couple of coworkers who also do an excellent job. I don't mind it when they complete some of these assessments or other tasks instead of me because they seem to care and put the time and effort into doing them thoroughly. Unfortunately, there are too many other coworkers that don't seem to care or are unwilling to spend any time making sure these assessments/orders are done correctly, so it is frustrating when they get assigned those tasks.
With that said, I get it. I can't just say that I shouldn't be expected to complete any direct care tasks. That's unreasonable. It's possible, as you said, that my superiors have noted my weaknesses. However, at the same time, it's possible they simply view me as someone capable of doing multiple tasks. I've noticed that I also have the time management, judgment, and prioritization skills to work the floor as well. I've been in this position long enough that sometimes I forget that I was--and still am-- also very efficient staff nurse.
Other coworkers’ incompetence has nothing to do with whether you should be doing any certain tasks. In fact I’d say they should be given those more and coached on how to complete them correctly. That’s really the only way anyone learns, let them do it and coach them. Then if they continue making mistakes due to laziness or whatever, management can address it.
I’m getting the sense you are controlling. That’s not an insult, by the way. I’m exactly the same way and it’s difficult for me to delegate. You cannot do it all, you cannot run the whole facility by yourself. Step back a little, and when you do see these mistakes or lack of documentation, come up with a solution to the problem, such as a training session to cover these areas. When you see a problem and come with ideas to fix it, management will be much more open to your input. Also management may have noticed that some of the other staff members need these opportunities and have thus given them those tasks, and this whole thing about you not getting to do the things you like better could have absolutely nothing to do with you. Just a thought.
Other coworkers’ incompetence has nothing to do with whether you should be doing any certain tasks. In fact I’d say they should be given those more and coached on how to complete them correctly. That’s really the only way anyone learns, let them do it and coach them. Then if they continue making mistakes due to laziness or whatever, management can address it.
I’m getting the sense you are controlling. That’s not an insult, by the way. I’m exactly the same way and it’s difficult for me to delegate. You cannot do it all, you cannot run the whole facility by yourself. Step back a little, and when you do see these mistakes or lack of documentation, come up with a solution to the problem, such as a training session to cover these areas. When you see a problem and come with ideas to fix it, management will be much more open to your input. Also management may have noticed that some of the other staff members need these opportunities and have thus given them those tasks, and this whole thing about you not getting to do the things you like better could have absolutely nothing to do with you. Just a thought.
You're probably right about me being somewhat controlling. It's not necessarily how I would want to view myself, but I do notice that the longer I have been a manager and not a staff nurse with a regular floor schedule, the more I become almost "possessive" of certain tasks, especially if they involve assessments or charting. One of the reasons why I was promoted into my current position is because of my history of excellent documentation, so for me, it is frustrating to be taken away from that skill and let others do certain things when I know I would have done a better job. When I see something is missing or hasn't been addressed, I have difficulties unseeing that concern and have a tendency to just fix it myself, rather addressing it with whoever should have addressed it or caught it in the first place. It is hard for me to delegate an admission assessment to someone who historically isn't very thorough in their assessments or thinks it is acceptable to use vital signs from 2 years ago. I'd rather just do it myself in the first place so that I know it is done right. With that said, you're right in that it's unreasonable to expect myself to be responsible for everything so other staff members do need to learn how to do them correctly. Since I seem to do well with assessments, SBARs and progress notes, I'd probably be a great person to educate some of these staff members or a resource for questions. Meanwhile, I need to learn to let go of some of these tasks so I don't become so cranky, irritable or even angry when I'm asked to do something else.
So, sometimes especially when we are new to a facility or even position whether it's clinical or managerial , we have to prove that they made the right decision in hiring us. A lot of times the work is not what we would like or envision doing but rather the work that just needs to get done that no one wants to do. The past few weeks I've been working every shift and my overtime on the covid unit not because I just love covid but because it keeps one less person from being exposed, it's been stressful, it's been demoralizing due to all the deaths, but I've not complained about being there simply because it has to be done. Now that doesn't make me special, I'm just doing what so many of us have to do right now in this crazy pandemic.
If I remember right you are a unit manager, correct? The managers I have will certainly help with admissions, but they're more involved with running the floor both clinically and of course administratively. They're make sure labs are done, results are called, meds are ordered, physical/behavioral issues called to the doc, talking to family members over the phone, doing the assignments for the nurses and CNA's, helping nurses troubleshoot situations that arise. All of these things happen even on an LTC floor and it's a very busy job. Is that what you're supposed to be doing? Does that sound like what you want to do? It sounds to me like you might would've done better taking an Admission Nurse position versus a management position.
I would not make anymore noise about what you want to do right now, because either you're still having to prove your worth, OR they're trying to tell you that what you want isn't going to be happening.
You might want to start thinking about whether this job is for you.
Good luck.
TheMoonIsMyLantern:
Yes, my official position at this point is a unit manager, but because of the COVID pandemic, the rehab unit I used to overlook is closed due to low census. Although I am not new to my current role, both the Executive Director and DON have recently switched and seem to have different ideas on how things should be run. As of right now, because there are not two rehab units for two rehab nurse managers, they have requested that I oversee the LTC unit; the patients on these unit require more nursing care assistance rather than a manager to oversee them. Prior to this, though, I was doing many of the tasks you described above and doing well with them. I've gotten so used to management duties that I find it disruptive to my schedule when I am asked to do other things. Obviously, this is something I need to work on.
I agree that an Admission Nurse position would have been perfect for me, as it would have allowed me to complete the assessments and reviews in a thorough manner along with select patients appropriate for the facility. I am excellent at catching errors and making sure patients' records are thoroughly reviewed and appropriate orders are obtained. I also have great judgment as to what types of patients would thrive in our facility. Unfortunately, for some reason, they favored someone else for the position. I am personally not impressed with their performance as an admissions nurse. They were, however, great on the floor, which is where they should have been kept. They truly thrive as a staff nurse, but they struggle with the communication and documentation aspect of this Admissions Role. Unfortunately, upper management continues to decline my need for assisting with this role. I also frequently offer to complete admissions on the other floor as I am not impressed with that manager's admission assessments nor with the floor nurses' assessments and only occasionally have my offer accepted. Thus, I make it my duty and assignment to review charts anyway on my own to make sure things are not missing, because these other individuals have proven they cannot be trusted to do so.
For me, it is frustrating to watch tasks or positions get assigned to the wrong people or people that don't really seem to have an aptitude for what they are being assigned.
Specializes in Mental health, substance abuse, geriatrics, PCU.
I appreciate what you're saying and in many ways can relate. I understand the frustration of having to be the fixer because there are staff that underperform in certain tasks or roles. I have learned though that you can not catch everything and that sometimes you have to let people fail so that they can either learn from their mistakes or face whatever consequences management deems appropriate. You will drive yourself crazy trying to do everything and be everywhere for the facility, and your hard work more than likely will not be appreciated or rewarded.
I would encourage you to look at other jobs for a position that better suites your abilities and goals, I think your frustration with this job is not going to go away.
I appreciate what you're saying and in many ways can relate. I understand the frustration of having to be the fixer because there are staff that underperform in certain tasks or roles. I have learned though that you can not catch everything and that sometimes you have to let people fail so that they can either learn from their mistakes or face whatever consequences management deems appropriate. You will drive yourself crazy trying to do everything and be everywhere for the facility, and your hard work more than likely will not be appreciated or rewarded.
I would encourage you to look at other jobs for a position that better suites your abilities and goals, I think your frustration with this job is not going to go away.
Agree. It's nearly impossible (if not impossible) to catch everything that should be addressed, and some of the responsibility should lie on others. And management is more than aware that I often work 16-20+ hour days in an attempt to address everything and correct errors, but so far, no pay increase or any other reward. If anything, I'm sure some have expressed frustration because my late nights often mean I don't arrive until later on in the morning.
I do wonder if I subconsciously avoid certain tasks because my confidence in my writing/assessment/documentation skills is possibly on the borderline of arrogance whereas my confidence level in relation to hands-on skills (especially new ones) is probably too low.
Perspective is everything, and I keep seeing the OP frame things in a negative manner. How about instead of finding the fault in your new assignments, you look for a silver lining-any spark of positivity and keep that in mind. You might be surprised at how much better your day can be if you set yourself up for a good experience.
On 1/27/2021 at 10:05 PM, Sour Lemon said:
I think it would be fun to create a position just for you ...like maybe riding a pony down the halls and tossing flowers into each patient's room. I think I'd be amused by your reasons for not liking it ...and amused by any proposed alternative(s). ?
Specializes in ER/med surg/telemetry/ acute rehab/ Ltac.
I used to work in the ER, and had to take a break from the ED, and then I got a job working in a LTC/ Acute rehab. it was avery very rough LTC center , nothing like the ER and I wanted to see if I was up to the challenge, after recovering from a terrible auto accident that resulted in misdiagnosed, severe pubic rami fracture ( I worked 2 months in the ED without knowing it either).
The patient to nurse ratio was 20:1 on the acute rehab unit, and, 30:1 on the LTC side. Of course we used SBARS.
We had SBARS, preprinted, and I often stapled or paper clipped them together and we often used them as report sheets, quite useful.
What I enjoyed about the LTC unit. I worked with very very tough nurses, learned how to manage multiple, complex and often unstable patients in well, a supposedly "stable" unit.
Back in the ER, and acute care settings, I love a challenge, team work, collaboration, making a difference, which I do.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
30 minutes ago, SilverBells said:
Agree. It's nearly impossible (if not impossible) to catch everything that should be addressed, and some of the responsibility should lie on others. And management is more than aware that I often work 16-20+ hour days in an attempt to address everything and correct errors, but so far, no pay increase or any other reward. If anything, I'm sure some have expressed frustration because my late nights often mean I don't arrive until later on in the morning.
I do wonder if I subconsciously avoid certain tasks because my confidence in my writing/assessment/documentation skills is possibly on the borderline of arrogance whereas my confidence level in relation to hands-on skills (especially new ones) is probably too low.
You should not expect a pay increase or reward and you’re setting unrealistic expectations for yourself if you’re expecting that. Also as a manager it appears you are not doing your job efficiently if you are correcting all of these mistakes you say are happening rather than, ya know, managing the staff that are making them.
Solely based on the numerous posts you’ve made which all have a similar theme, I can definitely see where your confidence level might border arrogance as you yourself stated, and it’s likely even more noticeable in person. You’ve repeatedly admitted in several threads that you avoid things that you aren’t as confident with, instead of trying to improve on them.
You should not expect a pay increase or reward and you’re setting unrealistic expectations for yourself if you’re expecting that. Also as a manager it appears you are not doing your job efficiently if you are correcting all of these mistakes you say are happening rather than, ya know, managing the staff that are making them.
Solely based on the numerous posts you’ve made which all have a similar theme, I can definitely see where your confidence level might border arrogance as you yourself stated, and it’s likely even more noticeable in person. You’ve repeatedly admitted in several threads that you avoid things that you aren’t as confident with, instead of trying to improve on them.
I agree, and was trying to find a nice way to say so. OP also posted a while back about showing a patient favoritism, while ignoring her own patients. I suspect that there are other issues with this poster that we haven't even begun to guess, or that they are not admitting
You should not expect a pay increase or reward and you’re setting unrealistic expectations for yourself if you’re expecting that. Also as a manager it appears you are not doing your job efficiently if you are correcting all of these mistakes you say are happening rather than, ya know, managing the staff that are making them.
Solely based on the numerous posts you’ve made which all have a similar theme, I can definitely see where your confidence level might border arrogance as you yourself stated, and it’s likely even more noticeable in person. You’ve repeatedly admitted in several threads that you avoid things that you aren’t as confident with, instead of trying to improve on them.
Sorry, didn't mean to imply that I should receive a pay raise. I meant to agree with a previous poster that I can continue working 16-20 hour shifts in an attempt to correct everything, but the likelihood of me being rewarded is pretty minimal. Nobody necessarily seems impressed by me working until midnight or later most days of the week. In other words, I can continue doing what I'm doing, but the likelihood of being shown appreciation is pretty minimal.
Specializes in Mental health, substance abuse, geriatrics, PCU.
6 hours ago, SilverBells said:
Agree. It's nearly impossible (if not impossible) to catch everything that should be addressed, and some of the responsibility should lie on others. And management is more than aware that I often work 16-20+ hour days in an attempt to address everything and correct errors, but so far, no pay increase or any other reward. If anything, I'm sure some have expressed frustration because my late nights often mean I don't arrive until later on in the morning.
I do wonder if I subconsciously avoid certain tasks because my confidence in my writing/assessment/documentation skills is possibly on the borderline of arrogance whereas my confidence level in relation to hands-on skills (especially new ones) is probably too low.
It's okay to be confident but arrogance is very observable and very off putting especially to your clinical staff. I may catch flack for saying this, and I mean no offense towards those in management, but bedside staff are the most important staff in the building, without them the patient's wouldn't get care and ultimately no revenue would be generated. So, the paperwork and documentation is important, but patient care always comes first. I know you're putting in long days and that is commendable but the reason you're not being praised for it is because a 16 hour shift behind a desk correcting things is nothing compared to a 16 hour shift at the bedside. They are the ones who need the praise especially with this pandemic.
In an earlier post you questioned whether you may have entered management too early in your career. I think that may very well be the case. I think you need to consider a more hands on clinical position so you can develop those skills and really provide leadership and support to your team. In management your purpose isn't to have someone cheerlead you, you have to be the cheerleader for your clinical staff, if you alienate them and they don't trust you and don't feel supported then your toast.
I'm not trying to be offensive or hurtful.
Also, you gotta quit doing those 16-20 hour shifts unless they are absolutely necessary, it isn't sustainable. If you're salary and don't get overtime, you really need to stop it.
0.9%NormalSarah, BSN, RN
266 Posts
Other coworkers’ incompetence has nothing to do with whether you should be doing any certain tasks. In fact I’d say they should be given those more and coached on how to complete them correctly. That’s really the only way anyone learns, let them do it and coach them. Then if they continue making mistakes due to laziness or whatever, management can address it.
I’m getting the sense you are controlling. That’s not an insult, by the way. I’m exactly the same way and it’s difficult for me to delegate. You cannot do it all, you cannot run the whole facility by yourself. Step back a little, and when you do see these mistakes or lack of documentation, come up with a solution to the problem, such as a training session to cover these areas. When you see a problem and come with ideas to fix it, management will be much more open to your input. Also management may have noticed that some of the other staff members need these opportunities and have thus given them those tasks, and this whole thing about you not getting to do the things you like better could have absolutely nothing to do with you. Just a thought.