ACNORN

First, I'd like to say don't feel alone with this problem. I have worked in several management positions in different facilities and this issue has been present to some degree or other. The staff usually don't appreciate the challenges of another's job. Everyone usually assumes they have the most to do, they believe they are working harder than everyone else, and their is little tolerance to have one's "routine" interrupted. I have a few suggestions: 1. Have staff meetings for all of the nursing staff to attend at the same time (RNs, LPNs, aides, receptionists, and anyone else who reports to you. By having separate meetings based on job class, you may be creating a culture where good teamwork and respect for the work of each team member is not valued. 2. Ask your staff for ideas on how to fix the problem. 3. Ask your company to provide communication training. Unless the nurses are purposefully trying to be rude, they obviously don't understand the negative message they are sending by not making eye contact and responding to the receptionists. 4. Ask your company for customer service training. If the nurses and aides perceive the receptionist's frequent communications about a patient request to be an annoyance - then it is likely due to frustration on their part that their routine is being interrupted (i.e. nurse trying to pass meds and has to stop to help with a patient who needs to go to the bathroom because the aide is already helping another patient). The staff need to understand that part of their job is responding to the needs of their patients and seeing things through the eyes of their patients. Assuming your patients are not crashing and a stat intervention is not needed, what is more important to their patient - getting that med right on time or not being incontinent in the bed? The nature of our work is prone to frequent interruptions. Quite frankly, patients don't care about our routines and schedules. The staff have to understand that and accept it. 5. Re-evaluate your staffing pattern and mix. If there are more requests for unlicensed type of work and the nurses are having to stop doing things that licensed staff need to do, maybe you need more aides during certain shifts or certain periods of the day. 6. Have the staff spend a day or two working with someone in a different job class (nurses working as a receptionist or aide, aides working with the nurse or with the receptionist, the receptionist working with the nurse or aide). Its expensive as far as your productivity, but it helps to let people experience the work of others and have their perspective broadened. 7. Do something nice for your receptionists and aides. Nurses week is always May 6-12th. I make sure the aides and unit clerks have a recognition time too. Showing them appreciation for their job can help. In my facility we have a Perfect 10 program whereby any of the staff can nominate another staff member when something that exemplifies good team cooperation or when something out of the ordinary is done. The recipient of the nomination gets progressive awards - free meal in the cafeteria, Blockbuster gift certificate, movie theatre gift certificates for two, a nice facility golf shirt and coffee mug, etc. We give the awards out at the monthly staff meetings which gives staff an incentive to attend. Hope these ideas help some.

I am outraged/embarrassed that we even have this discussion in my profession. Doesn't anyone see that sleeping on the job is STEALING? Your employer has HIRED you to perform WORK for a designated shift. Those of you who have such a poor work ethic need to do some other type of work where someone's life is not on the line. And those of you who enable this unethical behavior by covering for them are just as bad. I'd fire all of you. I can't believe this. This discussion is horrifying. How would you like to be the patient entrusting your life to people who think this is OK? Its not OK ever !!!

Two very astute points llg & Glad2behere. We know that nursing leaders and advanced practice nurses have an entirely different skill set (in addition to their clinical one). I have seen many companies put good clinical nurses in managerial positions that they weren't ready for and when they failed, it was remembered that they needed to recruit a "higher caliber" candidate. Yet they don't really see any initial differences because we are all RNs. Seems like we need an additional designation that is legally required. llg, are all college professors paid low salaries or are the nursing profs. on the lower end of the scale in academia? Just wonderin'.

I agree that we have to be assertive and make sure that we are paid what we are worth. The only problem with the comparison is that in other businesses you don't have the majority of revenues coming from the government with caps on the payments. Short term hospitals have DRGs, and all the post acute providers have PPS reimbursements. If consumers directly paid for their healthcare (which I'm not suggesting is the answer) and we didn't have built-in controls on the revenue side then we could operate more like the free market systems of many other industries where the harder and smarter you work the more money you can make. Since a major segment of the labor costs in a hospital comes from nursing care, if we all made major bucks, without the reimbursements of hospitals going up also, the hospital would go broke. I have seen the financial statements and know this to be true. Pharmacists in our area are demanding 75K to 100K as a starting salary because they changed their regulations of requiring a doctorate degree to be a pharmacist. I thought about whether nursing could do something like this, but there is a significant difference in the numbers of pharmacists employed versus nurses. I guess hospitals can afford to pay them the big bucks that the market demands because there are usually only a handful of pharmacists needed in the first place. The other factor that the pharmacists have that we don't is the influence of the retail drug store sector. Their salaries went up because the Walmarts and CVSs of the world are paying pharmacists 6 figure salaries. On the other hand, there are usually only a handful of nurse educators and nursing administrators.....If highly degreed and highly talented nurses could choose a job in the free-market sector, I bet our salaries would go up too. The bottom line is we need to create a situation where the hospitals feel they need to compete for the nursing leadership talent in their market as much as they already feel they need to compete for staff RNs and pharmacists. Hummm.......something to think about. I appreciate all the perspectives and comments of everyone. This is one of the more thought provoking discussions I've seen. Glad2behere, don't let this discussion dissuade you. You no doubt are just the type with spunk that we need to help make things better.

My thoughts exactly. I appreciate all of the encouraging remarks. I took advantage of a discussion with our CEO about the nursing supervisor vacancies that we currently have to discuss the disincentives of nurses pursuing leadership positions. I have a feeling the message was heard loud and clear.

I don't think my company is probably acting any differently than the others. I have to say we are very proactive with trying to retain staff RNs. And I have to compliment my company that the incentives for the staff get approved and implemented pretty darn quickly. All the time we are having to come up with more incentives to keep the staff nurses we have and new incentives to recruit new ones as we have vacancies. Everytime we have a meeting to discuss a new plan, it is quickly made clear that the exempt status RNs will not be eligible. Then I am seeing the big dollars they are throwing at the staff to keep the shifts covered, yet I am not allowed to work extra as staff (except for free) to make any extra money because they view me as RESPONSIBLE for the recruitment and retention - like I can compete with the travel nursing industry and the salary wars that are going on in our market. I asked for a secondary job class so I could work extra as staff when needed to make a few extra bucks, keep my skills up, help morale, and help out in my own facility. The answer was a firm NO because it is believed that it would add an incentive for me to purposefully leave staffing vacancies for myself rather than working on getting and keeping all the positions filled. Yet I am not supposed to work a PRN job anywhere else either in case I am needed at this facility. The staff nurses are viewed as being out of control and ever increasingly greedy and management is expected to have an attitude of being above all of that "show me the money" mentality. Yet we see the hourly rate of our staff exceeding our own and they get to go home at the end of a shift and forget about the place. I just don't see the facilities in our area maintaining the salary equities between staff and management (with mgmt rightly being significantly higher) to make it an attractive position to have/pursue. I guess I need to just give myself the old pep talk again and get over it.

Glad2behere, To pull in 130-150K I'd say you would have to pursue a Administrator position, or corporate VP of some healthcare company (again depending on location and the local pay scales). I have to remember that I live in an area where the cost of living is drastically lower than the east or west coast areas or many other areas for that matter. For me, I get a nice size bonus each year for meeting some organizational goals set for me. However, I have not been included in at least two across the board increases for RNs. I love the type of work I do and would no doubt lack fulfillment if I was in a staff position. The purpose of this thread is not to discourage people from pursuing leadership positions, but to open a dialogue about something that I've had a hunch about for a few years and to hopefully get others in leadership positions to think about it and help get this negative change reversed. I recently had a nurse manager resign because she said she could make more money as a staff nurse. When I hired my current nurse manager, I was able to negotiate a substantial increase for her starting salary because of the obvious inequities. That didn't help the nurse manager who resigned, but it sure helped the next candidate. I suspect that there is as much of a shortage of nursing leader candidates as there is a shortage of staff nurses. I hope the increased demand will help our situation as much as I see the demand helping the staff nurse salaries.

Glad To Be Here, I don't know enough about your background to give a thorough response, but as far as formal education a BSN plus a MSN, MHA, or MBA is a good start. If you have only had bedside positions, I would volunteer to be on some committee or task force - maybe a performance improvement team, clinical practice council, product evaluation committee or something like that. This will broaden your network, expose you to a different aspect of the operation, and show some initiative to those already in leadership positions. I would recommend joining some professional organizations. Since I work in a specialty hospital that focuses on critical care and rehab patient populations, I belong to AACN (American Association of Critical Care Nurses) and ARN (Association of Rehabilitation Nurses). Since I hold a nursing administrative position, I also belong to AONE (American Organization of Nurse Executives). After you join these organizations, you need to be willing to invest in your career and go to their national conferences. When I was first starting out and still today, I read numerous professional journals to advance my skills and expertise too. As far as salary surveys, many nursing journals periodically publish average salaries by position and by region. "Nursing Management" and "Nursing" are two journals that come to mind. Salaries vary widely based on the cost of living and local market data. As far as your Mother's experience, nursing management is more difficult than clinical nursing. It requires one to develop two distinctly different skill sets - Nursing expertise and management expertise. And you have to be able to readily use both skill sets interchangeably and sometimes simultaneously. I have been in terrible management positions and I have been in two great management positions that I loved. I thoroughly enjoy my current position. Is it hard - you bet. The last bit of advice I can give is to develop your interpersonal skills. I have worked with a slew of nurses who just couldn't see that being a great clinician is not enough. I have told many nurses that I don't care if they are the best clinicians on the face of this earth. If they can't work well with others, I don't need them. Hope this info. helps you.

Maxter, I remember having the same anxiety you have expressed. I went from being a bedside nurse to a clinical coordinator of a small 10 bed unit, to a nurse manager of 2 units in the same hospital. Then I moved many states away and took a chief nurse position for an 80 bed hospital. With each promotion, I remember having terrible dreams of my staff absolutely tearing me apart at our first staff meeting and had many fears about whether I knew enough to be responsible for all the policies and deciding what the standard of care should be, meeting the JCAHO standards, dealing with personnel problems, etc. You may be taking a position in a system that is a political minefield, but don't let you self talk limit your potential. Obviously one person in senior management sees the potential in you. If that person is successful in the organization, latch on to them and learn from their years of experience. If you trust that person, they can usually help you navigate through the politics and teach you the unwritten rules in the organization (and believe me, every place has many unwritten rules). If you do take it, I recommend assessing who in the organization is viewed as successful, who receives support from administration and the corporation, who gets things done, who comes back with a "YES" answer. Who has great people skills. Then associate with those people. Make some friends outside of nursing too (I have always made it a point to befriend the top HR person, plant operations too). Lastly, remember you are never alone in a healthcare facility. If you get into a situation where you don't know what to do, ask others who do know. Before I started a new promotion, I always felt terrified inside so I would go out and buy a few new really professional looking outfits so my appearance would portray confidence even though I was anything but on the inside. What was the name of that movie starring Melanie Griffith, Harrison Ford and Sigourney Weaver? Working Girl? As far as your family is concerned, that's a personal decision. I say go for it. If it doesn't work out, it will teach you many things and if you have had many successful positions already, one risk is not going to derail your whole career. Thats just my 2 cents.

Gardengal, thanks for your reply. Your answer is what I think is happening more and more. I work for a growing LTACH company and we are opening up smaller specialty acute care hospitals in many different locations and I have never seen such a lack of motivation among my colleagues to be groomed for promotions into leadership positions. I am the chief nurse (MSN, 17 years experience, CRRN) at one of our hospitals and I have always found it to be rewarding to identify leadership potential in others, mentor them, and prepare them for promotion opportunities. We are going to need several more nurse managers and directors soon and I don't know where they are going to come from. My staff would never believe it, but there are some who probably make close to what I do or more when you add up the base rate plus generous shift differentials, overtime, incentive payments for working certain hard to fill shifts, and our perfect attendance incentive - especially considering that I work 50-60 hours per week and get paid for 40. And of course, like you said, I have the on-call pager for the entire month of January and get called when staffing problems arise even when I'm not on call. We need to do something, or I'm afraid that we are going to have a serious nursing leadership shortage. And you know that other healthcare leaders would be more than happy to decide what is best for nurses.

I'm wondering if all of the salary wars, bonuses, incentives, etc. that are offered to the bedside nurses these days is removing one of the long standing advantages (higher pay) of nurses moving into leadership positions. I am finding it much more difficult to hire nursing leaders. Is it because it is too stressful to be in management these days, are nurses scared of the shortage and don't want to be responsible, or are they making enough money at the bedside so they figure - why have the headaches of management? When your facility gives RNs across the board raises or offers incentives- are the managers included or eligible? Don't get me wrong, bedside nurses deserve to be very well paid for what they do, but there is a certain advantage to being able to go home at the end of the shift and have no further responsibility for the operation. I'd love to hear the thoughts of other nursing managers. Thanks.

Hi Alkat, Staffing...............The age old problem........... First of all, I totally agree with all the comments of llg. I have recently had more of a problem with last minute staffing problems and had to get some things in place so that we had options when they occur. As it was, my nurse manager and I were all too frequently having to work as staff (for free) when call-ins happened and we decided that we were not going to be the 2 person voluntary staffing agency. It is much better now that we fixed some things. Here's what we did, hope some of these will help you out: 1. First we analyzed the staffing schedule and looked for imbalances in the number and skill mix of staff. We found major imbalances with fewer staff scheduled on Fridays, Saturdays, and Sundays (imagine that). So we corrected that first. 2. We took the PRNs who had not worked for us in a long time off our PRN roster and hired some new PRNs who could give us some hours. 3. We reviewed the attendance policy with our HR folks to make sure it was what we needed it to be. As it turned out, we did not need to change the policy but simply enforce it TO THE LETTER. There were several staff who were absent more often than not and we had to deal with them to get their attendance improved and to quit demoralizing those who had good attendance. 4. When we were in a situation were we had many open RN positions, we offered an incentive program whereby we paid the staff extra money for coming in and working shifts with critical shortages. RNs got an extra $100 for 12 hours, LPNs got $75 for 12 hours, and techs got $50 for 12 hours. If they called in during the same week, they forfeited the incentive pay (so they could not game the system). Of course if they qualified for OT then they got that too plus any shift diff. they would normally get. We would only approve incentive shifts on a posted list about a day or two ahead of time when we had already tried to cover it and had no luck. 5. Of course, we continued our recruiting efforts and implemented a $5,000 recruiting incentive for our staff who recruited a FT RN for us. This was extremely successful and did not cost more than the money we were spending on newspaper ads already. 6. Lastly, I'm just now implementing a weekend incentive position so that I have nurses who work only weekends (kinda similar to Baylor positions). Something else you might want to consider is having nurses write your newspaper ads. We used to have our HR folks doing it and we never got any response. No offense to them, they're great, but they don't think like nurses. I wrote the ads with bullet points in them outlining what we have to offer a nurse that is better than the competition. We consistently get responses now. You may want to consider an on-call program too. Hope some of these ideas help.

I have been reading all of these posts and I am so discouraged and depressed about the absolute divide between nurses who work in a management capacity and those who work in a clinical capacity. We are all nurses and should not see the other group as the enemy. I have to say that I have many staff nurses who are wonderful clinicians who rarely if ever call-in and feel like they let the team down when they absolutely must stay home. Then again there are others......... I guess since I'm on the management side of the fence (on most days), I can relate more to the feelings of utter frustration that the managers have when they go home on a Friday evening after working 10-12 hour days all week, you leave with staffing covered for the weekend and then a few hours later you get a bunch of last minute call-ins, you spend about an hour calling every nurse employed, leaving messages on answering machines in vain (you know you are being screened by caller ID), begging, pleading, making deals, offering an extra $100.00 bonus, you get no takers, the people who are already working don't want to stay over even a few hours (they're tired), so the manager (who is usually salaried) has to go in and work dog tired after having worked all week, and the manager is essentially working as a volunteer because we are salaried and don't get any extra money in our paycheck for working as staff. The manager resents the company and the employees who called in, but goes in anyway because if staffing is too short then patient care suffers and the nurses start resigning because the staffing is bad. When you get there the patients assigned to you are the highest acuity because the nurses are mad about staffing and are going to give you a dose of reality about how hard patient care is (as if we don't know). Then if a few nurses resign and it takes awhile to recruit new staff then the manager gets to work even more vacant shifts for free so that the remaining staff don't quit. Am I painting a picture here ? Now tell me who is being punished ? I really wish that we didn't have to use any "punitive" measures to cover staffing. We do require weekend make-ups for a weekend call-in, but it is on the nurse's usual shift and it is coordinated with the nurse. We also try to use a proactive approach by paying the employees an extra $100.00 for every quarter that they have perfect attendance. It doesn't stop the illegit call-ins, however. You should read the excuses on the call-in log (i.e. "I have to study", "my air conditioner broke", "I am out of town", and my personal favorite "I'm too tired"etc.). The staff EXPECT me to come in and work for free to cover call-ins whenever they happen regardless of whether I just left the place after 12 hours and they don't really care if I'm too tired. Is that a double standard or what !! If anything the staff nurses with good attendance and the manager are punished by having to work short too often. So tell me.....what is the answer? Other than the usual money schemes that do not work long term and we can't get approved anyway, our goal is to improve attendance. What should we do? Discharge half the patients on Fridays and let the call-ins happen?

Hi Wendy, Welcome to nursing management! I an a nursing director and have several shift supervisors who have gone through some of the same things when they started in their roles. I promoted them because I knew they had the nursing knowledge and people skills to handle the job. It sounds like someone believes in you too. My advice is this: 1. ask yourself what decision you think is right regardless of anyone's opinion. You may want to consider alternatives and ramifications of your decision. What is the best and worst thing that could happen? Who will be affected? Is your decision in the best interests of your patients? 2. If you feel you need to double check your decision with someone else, ask your supervisor, another charge nurse, or a colleague whom you trust. Don't be afraid to make some decisions on your own. 3. Accept that part of being a leader (which you are) means that you have to make the right decision versus the popular decision. Those of us who are seasoned managers have learned to have tough skins and know that there are going to be days when the staff are not happy with your decisions. If they see that you are willing to make the right decisions, they will eventually respect you and follow your lead. 4. Lastly, give yourself time to grow and learn and accept that you are going to make some mistakes in your new role. I have made many mistakes over the years. You learn from your mistakes and go on. And, to answer your question, I believe that most leadership qualities are learned. It helps if you have some innate assertiveness to your personality, but it has taken me many years to be comfortable with confrontations and decision making and a whole bunch of other traits as well. I hope this encourages you. My last suggestion is to find someone who is a seasoned nursing leader who is willing to mentor you. I had the great benefit of several nursing managers and directors who saw potential in me and taught me how to be successful in nursing administration. I owe them a lot and will never be able to repay them, but I try to follow their lead and act as a mentor to others just as they did for me. Good luck.

szerch, Your situation is certainly not an easy one, but I've been in just about every role from staff RN up to the chief nurse. I learned a long time ago that I can't worry about making everyone happy all the time. You've been promoted to a supervisory position obviously because someone sees leadership potential in you. One of the things that separates the leader from the group is the leader's ability to do the right thing versus the popular thing. Those ICU buddies may not like all your decisions all the time, but if they are good decisions made in the best interests of the patients, your colleagues will eventually come to respect you and assume that you have good reasons for making those decisions. Welcome to management.