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.
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.
No offense taken. I get where you're coming from. I do understand that a 16 hour shift at the bedside is much different than one at a desk. Thing is, it is not uncommon for my my shifts combine the two....covering for nurses who are gone (or for shifts they simply could not fill) while being expected to complete my manager duties at the same time. So I still have shifts that are both physically and mentally demanding. With that said, I agree the 16-20 hour shifts probably need to stop. Unlike the floor nurses, I have the flexibility to leave when I want (within reason) and there is really no reason for me to work from 8am until midnight or later every day or even multiple times a week. It could be that they are pulling me away from some of the tasks I speak of, such as admissions, as they are usually the reason that I stay very late.
As much as I don't like to admit it, I probably could use some more floor/clinical/hands-on experience. I'm not physically incapable of performing these tasks at all, and before my promotion, was doing them on a daily basis. It's just that since I've gotten to my manager position, I've gotten less comfortable with them for whatever reason.
It's just curious as I have no idea what our new Executive Director and DON have in mind. My previous DON, who promoted me to this position, appeared to be satifsfied with my performance. I wouldn't say that my new supervisors/superiors are dissatisfied, as I haven't actually received any complaints from them and do receive acknowledgement for my work, but they seem to have other things in mind. I am not sure.
There is one individual that I am wondering if they are trying to slowly migrate him into my current role, as he has been given many of my similar tasks. He's always stated he prefers the clinical side of nursing, but, from my perspective--and he'll even state it himself--it appears they seem to be "grooming" for a more administrative role. I actually think he would be fabulous, but I don't understand the need to continuously push someone into a role they aren't necessarily interested. It's possible, though, that he's started to express more interest as they continue to give him more responsibilities.
Not to play the "age" factor, but I do wonder if age is starting to come into play here. As of now, I am the youngest person who has ever fulfilled the nurse manager position; I was still in my 20's when I was promoted. Everyone else who has ever had the role was about 20 or more years older than me. Even the evening supervisors, who primarily function as floor nurses, are significantly older than I am. I've been successful in my position, but it does make me wonder if they are wanting someone older for the role.
Specializes in Psych, Addictions, SOL (Student of Life).
On 1/30/2021 at 12:30 PM, SilverBells said:
In my facility, an SBAR is a form that we use to notify the provider of any changes in condition for a resident or of other concerns that need to be addressed, such as unclear medication orders. They actually are not very hard to complete. Unfortunately, there are very few coworkers that are willing to take the time to write them, or, if they do, they do not fill them out completely. Many of them will simply write "resident states bottom is sore," and leave it at that. They don't include information such as how the bottom looks or interventions they used to relieve the pain, which is not helpful to anyone.
It's very possible that the organization is in fact looking to see what your mangerial skills are. A good unit manager can help to lift the skill set and Staff ownership of problems and successes. You could start by taking one nurse at a time and going over their skill set and and practice problems. Help that nurse become proficiant and encourage them to help their co-workers. Soon the hole unit will be working in more proficiant way.
On a side note, I never worked harder that when I worked LTC. On a daily bases I did admissions, wound documentation, IV starts and catheter inserts/removals and negative pressure systems. Oh and I completed plenty of SBARs as that was something CMS (Center for medicare/medicaid services) was looking at during survay.
I don't know what state you are in but here in California an LVN cannot assess a patient. They can only observe and report to the RN. If this is the case in your state then you should be doing skin checks and other assessments so that you can report to the physician. We never called a pressure injury on innitial assessment. We called it a red area. The physician was to see the patient in the first 24 hours ad diagnose and stage the area in question and then give wound care orders.
Specializes in Community Health, Med/Surg, ICU Stepdown.
Do you think you would prefer a job with a set schedule and set duties? I think it's great you were promoted to management, but if you feel obligated to work 20 hours to have everything done right because there is no next shift to pass undone tasks to and no closing hours, maybe it's not the right role? It sounds like you might like a job such as admissions nurse where you do similar tasks each shift and not as many hands on tasks. There is no shame in that! Everyone has their likes/dislikes and strengths/weaknesses.
I'm in no way telling you what to do of course, just worried that 20 hr shifts and feeling responsible for so many things may eventually damage your mental and physical health. I think you understand that you can't pick your tasks in any job, so that's good.I have seen postings for admission nurses a lot where I live. Not sure how the pay compares to management. It might feel weird to take a step "back," but if you end up happier and with a better work/life balance, who cares?! I hope you find what's right for you. You sound conscientious and you care about your patients and their care.
Do you think you would prefer a job with a set schedule and set duties? I think it's great you were promoted to management, but if you feel obligated to work 20 hours to have everything done right because there is no next shift to pass undone tasks to and no closing hours, maybe it's not the right role? It sounds like you might like a job such as admissions nurse where you do similar tasks each shift and not as many hands on tasks. There is no shame in that! Everyone has their likes/dislikes and strengths/weaknesses.
I'm in no way telling you what to do of course, just worried that 20 hr shifts and feeling responsible for so many things may eventually damage your mental and physical health. I think you understand that you can't pick your tasks in any job, so that's good.I have seen postings for admission nurses a lot where I live. Not sure how the pay compares to management. It might feel weird to take a step "back," but if you end up happier and with a better work/life balance, who cares?! I hope you find what's right for you. You sound conscientious and you care about your patients and their care.
Thanks. I am reluctant to step back from my manager role right now, but I need to think about why that actually is. In other words, is it because I actually like the job, or is it for some other reason. I know I enjoyed the position pre-COVID, but some of the changes have made it less enjoyable. With that said, there's always the chance that these changes are temporary, so it might be worth just sticking it out until we get through this pandemic. However, our executive director and director of nursing have changed, so my role may never be the way it was before COVID started again.
I do agree that an admissions nurse role would be something I would enjoy and I actually would love not staying until 11pm/midnight or later on a regular basis. At the same time, the admissions role at my current facility is not something that is being offered to me, so I'd probably have to change employers if that's really what I want to be doing.
Again, I don't necessarily understand the reasoning for the role assignments...e.g. the person currently in the admissions role is struggling with communications to staff regarding incoming admissions, her admission assessments aren't nearly as complete, and she actually fails to complete major parts of the admission (such as the Drug Regimen Review) whereas I excel the admissions yet they keep assigning me to various other roles (COVID Unit Support Nurse, LTC Support Nurse, now I'm being asked about being a Treatment Nurse).
BUT...at the same time, it's not really up to my discretion. So my options right now are probably to accept the fluctuating changes in roles that aren't necessarily up my ally or look at a different facility.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
1 hour ago, SilverBells said:
Again, I don't necessarily understand the reasoning for the role assignments...e.g. the person currently in the admissions role is struggling with communications to staff regarding incoming admissions, her admission assessments aren't nearly as complete, and she actually fails to complete major parts of the admission (such as the Drug Regimen Review) whereas I excel the admissions yet they keep assigning me to various other roles (COVID Unit Support Nurse, LTC Support Nurse, now I'm being asked about being a Treatment Nurse).
BUT...at the same time, it's not really up to my discretion. So my options right now are probably to accept the fluctuating changes in roles that aren't necessarily up my ally or look at a different facility.
I still am not sure why you appear to feel you are entitled for the admission role. You said you were temporarily assigned to help out on this unit - if they've already got someone in the admission role then I don't understand why you keep bringing it up. You are there to help out, temporarily. Way better option than being laid off when your unit closed.
I also am concerned, though could be wrong, that part of why you are staying late is because you are again overstepping your boundaries, you admitted you are "possessive" of these tasks, and are almost looking for trouble by going through charts that you don't necessarily need to be in, finding these charting errors you speak of, and then fixing them.
The more you post the more I also wonder if these charting errors are true errors, or if maybe you are very particular and, again by your own words, possessive so you think if it isn't done the way that you would do it, then it isn't done right.
Regardless you should to suck it up and make the best of the situation.
I still am not sure why you appear to feel you are entitled for the admission role. You said you were temporarily assigned to help out on this unit - if they've already got someone in the admission role then I don't understand why you keep bringing it up. You are there to help out, temporarily. Way better option than being laid off when your unit closed.
I also am concerned, though could be wrong, that part of why you are staying late is because you are again overstepping your boundaries, you admitted you are "possessive" of these tasks, and are almost looking for trouble by going through charts that you don't necessarily need to be in, finding these charting errors you speak of, and then fixing them.
The more you post the more I also wonder if these charting errors are true errors, or if maybe you are very particular and, again by your own words, possessive so you think if it isn't done the way that you would do it, then it isn't done right.
Regardless you should to suck it up and make the best of the situation.
Agree. There is a reason that OP wasn't selected to be admissions nurse, and why her follow up offers to do it are rejected. She is being given an indirect message from her boss to stop. She should stop the over the top behavior, or she may find yourself worrying about other issues
I still am not sure why you appear to feel you are entitled for the admission role. You said you were temporarily assigned to help out on this unit - if they've already got someone in the admission role then I don't understand why you keep bringing it up. You are there to help out, temporarily. Way better option than being laid off when your unit closed.
I also am concerned, though could be wrong, that part of why you are staying late is because you are again overstepping your boundaries, you admitted you are "possessive" of these tasks, and are almost looking for trouble by going through charts that you don't necessarily need to be in, finding these charting errors you speak of, and then fixing them.
The more you post the more I also wonder if these charting errors are true errors, or if maybe you are very particular and, again by your own words, possessive so you think if it isn't done the way that you would do it, then it isn't done right.
Regardless you should to suck it up and make the best of the situation.
Sorry, not necessarily that I'm entitled to any role. Just don't understand the role placement going on because, as I mentioned, the person currently doing the admissions role is currently lacking in some areas. Thing is, anytime anyone mentions something that she should be doing--but isn't--the response is usually, "This is a new role for her. Instead of criticizing her, we should be showing her things and helping her out." Only problem with that statement is she has been shown or told several things more than once and still continues to not deliver.
But yeah, you are right about me staying late reviewing charts to make sure things aren't missing. The problem is, if I don't do that, it won't get done. The nurses doing the initial assessments don't seem to make time, nor does anyone else. The lack of thorough, detailed skin assessments, including descriptions of wounds, is problematic. Marking off that a patient's skin is intact when they have a surgical incision isn't accurate or helpful. Listing that a patient has a pressure wound with no indication as to the stage or measurements or questioning whether or not there are wound care orders present is also troublesome. There is no excuse for using vital signs that are 2 years old to complete an assessment. Someone with a history of long-standing persistent atrial fibrillation probably does not have a regular heart rhythm. Also, If I happen to notice a medication has not been entered properly, then it really is on me to correct it since I have knowledge of the error. It is also crucial to ensure that all medication orders, including PRNs, include thefrequencyof when the medication would be taken and so many do not do that; when confronted, they will often say, "Oh it's not a big deal," without comprehending that all medications have a maximum dosage. Those are just some of the many things that I notice by taking on the role of active chart reviewal and admission completion.
Sorry for the rant; it just doesn't seem like they are making good uses of their resources.
There have been instances where the individuals originally putting in orders and doing assessments have done so using discharge summaries that are over a year old. Without my careful review of the patient's chart, many medication errors would have been made.
I am very protective of the tasks that I do well at, especially when I see others underperforming. I like things to be done right so errors are not made.
Agree. There is a reason that OP wasn't selected to be admissions nurse, and why her follow up offers to do it are rejected. She is being given an indirect message from her boss to stop. She should stop the over the top behavior, or she may find yourself worrying about other issues
You may be right about this. There could be multitude of reasons why they are not delegating the admissions role to me and having me complete fewer admission assessments when the workload becomes too much for the admissions coordinator. I'm not sure, but the fact that they have emphasized multiple times that they don't want to just hire someone, that it needs to be the right person "with the right personality," makes me wonder if they are indirectly stating that my personality is lacking. It's also possible that their statement regarding personality is a generalized one that they would apply to every job hiring and does not have much to do with me. I do know that there is a person that they clearly stated would fit the role well, but chose not to pursue because she does so well where she is currently at. With that said, they probably have their reasoning for their decisions. Just because I offer to learn a role doesn't mean they need to take me up on that offer. Also, just because my work habits/preferences suited my previous supervisors, doesn't mean my new ones aren't looking for something a little bit different. Unfortunately, I could find myself in some trouble if I keep pursuing only certain tasks; it's possible I may receive feedback that I'd probably rather not hear (such as that my personality is lacking), or I could find myself not being assigned any work at all if I'm unwilling to do anything that is not related to charting, documentation, putting in orders, or completing assessments. With COVID-19 changing things it, they're probably wanting people that are able (and willing) to migrate interchangeably between tasks and help wherever is needed.
With COVID-19 changing things, they're probably wanting people that are able (and willing) to migrate interchangeably between tasks and help wherever is needed.
This exactly. And when you show resistance to doing tasks that you don't like, others see it. Be more open to learning more hands on skills, and it will benefit you in many ways
SilverBells, BSN
1,108 Posts
No offense taken. I get where you're coming from. I do understand that a 16 hour shift at the bedside is much different than one at a desk. Thing is, it is not uncommon for my my shifts combine the two....covering for nurses who are gone (or for shifts they simply could not fill) while being expected to complete my manager duties at the same time. So I still have shifts that are both physically and mentally demanding. With that said, I agree the 16-20 hour shifts probably need to stop. Unlike the floor nurses, I have the flexibility to leave when I want (within reason) and there is really no reason for me to work from 8am until midnight or later every day or even multiple times a week. It could be that they are pulling me away from some of the tasks I speak of, such as admissions, as they are usually the reason that I stay very late.
As much as I don't like to admit it, I probably could use some more floor/clinical/hands-on experience. I'm not physically incapable of performing these tasks at all, and before my promotion, was doing them on a daily basis. It's just that since I've gotten to my manager position, I've gotten less comfortable with them for whatever reason.