Mozzie

Hi everyone, I recently went through a corporate survey and one of the corrective action plans had to do with documentation of who all has had disaster training specifically NIMS & ICS. The staff took some inservicing that was like a powerpoint (before I started) 2 years ago- However, hardly any of them went online to obtain their certificates for 100, 200, 700 levels. Can anyone cite what the standard is on what training is required and what they need (documentation wise) to prove competency? I'm frustrated because the corporate people are saying that we "need certificates" that are from the online courses. My sister hospitals have already done this and have their certificates. ~However - this is where the frustration begins ~ My boss who is the CQO and over regulatory affairs insists that the Joint Comission does not require certificates to be issued - She went on to say that the Joint Commission only reqires those in management positions have had some sort of training. All I have to prove their training from 2 years ago are: A powerpoint presentation and a sign in sheet from those managers that attended. - However, it doesn't prove their competency... I have looked that the Joint Commission Manual under Emergency Management and I can not find it in there. I have also went to their web site "Frequently Asked Questions" and do not see it in there either. Can anyone help me find this regulation? The only thing I can find in our Joint Commission Manual is that NIMS training is required before grants can be issued for disaster preparedness. Doesn't say what we need to prove training and/ or competency for NIMS & ICS training. I got thrown under the bus already by my boss on other things corporate found they didn't like. Just don't want to have to face it again. If anyone has any standards they can cite to either support my boss or what corporate is saying - I would be soooo appreciative and soooo relieved. Thank-you all for your help. Sincerely, Mozzie

I feel for you - unfortunately - I have seen this at all levels in the hospital. Staff nurses with their manager and now in a management role where someone who was hired into a management role lateral to me had a pre-existing relationship with our administrator in the department where they worked previously. I don't think an intimate relationship - just too close friendship. Saying anything will not do any good. At least if it comes from me. Right now - I am watching how the news goes through the chains in a different direction without having to say a word because the favoritism is so very obvious. Spending hours together in the administrators office, gossiping & etc. Always making rounds together - and the mentoring only goes in this one manager's direction. - Which really sucks at times when I run into trouble and can't even get 5 minutes on the phone with our boss. I don't know if it will work or not. I am just worried about keeping up with my stuff. Just know that you are not alone and eventually this will catch up with them.

No, I wouldn't do it. I have my BSN and an MBA - Even with this in hand - the pay and abuse is not worth it!!! If you can run - do it! There is a reason why the nursing positions are many - too many nurses with experience are bailing. Yes - the pay is good compared to other associate prepared or bachelorate prepared professions. But not by that much in my opinion. Also, you will most likely miss holidays with family - work wierd and long understaffed shifts with very ill patients (who should probably still be in an ICU - but are pushed out on to the floor) and be disrespected by just about everyone - no matter how good you are. The only reason I obtained my MBA is to hopefully transfer those skill sets to another industry that is away from nursing. That is, when the economy picks up. I wish nursing would be what I thought it would be - but unfortunatley - in my case - it was a disappointment. Sure there were some good times - but they were very far and few. Not enough to keep me in for a lifetime. As for 90% of my fellow graduates - they have left nursing. Most of which quit within 5 years of practice.

No it isn't right - however, I need to comment because I have seen this in the opposite direction in a small hospital where Med Surg nurses were expected to take on patients in OB - even in L&D and expected to do everything as floats. Yes - they were crosstrained. However, delivering babies wasn not something that they did every day, every week or even once a month. This in my mind is just crazy because OB is one of the highest risk areas of a hospital. However, if OB was to come to Med Surg to float on a busy or short staffed day- they were to be "helping hands" only. Or they would come down to "float" and then disappear. And they got away with it. This kind of stuff occurred in this hospital because the DON played favorites among departments and departmental managers - would only make decisions that would benefit OB & Surgery and Med Surg could just sink. If you have a good management team at your hospital - there should be some sort of common sense here. Needless to say - I left that hospital because it was just so toxic and way too political. Upper management decisions (or lack there of) was creating unsafe issues for the med surg nursing staff. Leaving there was the best decision I could have made.

Dear SMC, Thank-you so much for sharing. If I can return the favor I will - Just let me know. I have looked up this book and it looks like a great place to start. I agree with the policy thing - as I go through ours - I notice elements of some that apply to other policies that read differently - you are soooo right about being careful about policies - they can bury you if you are not careful. SMC - are you willing to be a mentor? Thanks again, Mozzie

Hi, I know that if a facility does not have quality they are facing risk issues and I am trying my best to connect the dots. I really need a mentor and it has been difficult to find at the place where I'm working currently. I started a position a few months ago in Risk Management which is under the Quality Department. I am also the Safety Officer (both Patient Safety and Environment of Care Safety). Any Medical Malpractice Cases - I work with legal on either locally or at corporate. The med mal stuff - I think I am getting okay and work well with the attorneys. However......... .......However, I am trying to learn the regulations that "govern health care facilities". They seem to come from different sources and address different issues. I do not know where to go for what. My CQO is very smart and knows them inside and out - however, I don't feel that she is doing very well at showing me where she gets her information. We are a Joint Comission hospital - and I have looked up a few regs on there and on our state regs. But there are other things for example that I can not find. Here is the first example: I went on environment of care rounds with a group of people. The manager asked me a question inregards to alcohol hand rubs located in a carpeted area (I guess there was question as to whether ornot this would be a fire hazard). My CQO received the question via e-mail and answered it - extensively - but did not cite the information.(BTW - the answer was yes, alcohol rubs can be located in carpeted areas as long as the rooms have sprinkler systems) - I eventually found this information on a CMS web site - but it was dated from 2005.And of course I question these answers because I don't know if they are the most current regs. Here is a second example: We built a new building for a cardiac rehab unit. We are only renting the space - we do not own the building and it is connected to the hospital in the medical office area right next to the hospital. However,this is a service line that will be billed under the same medicare number as our facility and there was question to how to handle any "Code Blues" - if they should occur. Now - I did not know the answer to this question - however - My boss knew that in order to run this service line that we as a hospital needed to respond to codes in that department because we are billing under the same medicare number. And of course it was the the right thing to do -which we all support. Anyways, this is a problem for me - I want to learn these regs and which regs pertain to what issues. Also, what reg dates do we go by? How often are they updated. However, I feel that this information is not explained well or withheld. ~OR~ maybe - there are other things going on that I don't know about. My CQO has been in quality for some time now - she and the case manager "job shared" the risk management role with responsibilities divided between the two of them. So my boss knows part of the job and the other person knew the other part. However, it has been difficult to put the whole picture together with some things. I really need someone to plug in to. Our new quality director is learning also - but her role is much different than mine. If anyone feels that they can spare some information to start with - I would be so greatful and would do what I could to return the favor. Thank you all for taking the time to read this. Sincerely, Mozzie

Hi I know that this is the quality forum, however there isn't anything for "risk management". It seems to me that quality and risk are very closely related. Anyways, I just want to know if anyone on here also performs risk management duties (I have seen where the quality & risk manager is the same person). If you were just starting out in risk management - what would be the first thing you would do to understand the expectations of the job??? How do you prioritize your day??? I have a job description - but it is really "wordy". I think from what I know about it - I will like it. I just want a good start. Anyone willing to share? Thanks, Mozzie

Yes, they are suppose to manage..... I too am a manager and ignoring staff is not something you want to do!!! She really does need to address any staffing issues and if you are constantly understaffed due to unfilled positions or FMLA or whatever - she may need to look at getting some agency nurses to come in here and there if the ER staff and perdiem staff can not pick up extra. However, on the flip side - as a manager, I can tell you that the schedule is constantly a challenge. Unfortunately, many nurses in my department have a request here and a request there such as I can only work Monday, Wed & Friday plus every other weekend - for example. Now this person is a 0.6 FTE. Thus, she is basically dictating her schedule to me. I don't think this is right either - especially if there are say other staff members with lives outside of work too who need the same days off. Your objective as a manager is to balance the staffing needs of the department with the wants/needs of every staff member. It is not an easy task to do. Then there are the vacation requests or PTO here and there requests. Here again in department - it is first come first serve. However, say as a manager I have an oversight and accidently schedule two people off at the same time - this is a challenge. So, when you attempt to ask someone if they can possibly pick another day off - all h@ll breaks lose - even if they didn't have plans. Managers are not perfect and when we make a mistake no matter how big or small - the mistake is misconstrued (sp) into something that is not true. And it feels like the error is blown way out of proportion - unfortunately. However, she does need to admit her mistakes instead of turning the conflict around and making it into someone elses fault/problem. Not a good thing to deny your own oversights as a manager. I'm a middle manager and when I go to my DON with issues / problems - this is what happens. So I feel your pain. Your manager also sounds l like an "introvert" meaning there is only so much people contact she/he can handle and then they begin to "shut down" for the day. That may be one reason whey she is trying to avoid being approached by staff. OR the other reason staff is unwilling to overlook her errors and resent her for everything - So, she tries to avoid contact instead of dealing with conflict --- I don't know.... Some things do need to be delegated off of the manager's desk to other staff that can handle the task. I know that as a manager delegating can foster some resentment there - however, I can tell you that there are tasks that staff below you as a manager can not be delegated and are extremely difficult and time consuming. Plus, these tasks may be projects the management team is working on and they can not share with staff what is consuming all of their time until the project is complete and ready to present to the rest of the hospital ......So it may look like to you and other staff that he or she isn't doing anything..... But they are. They just can not tell you what it is. As a manager it makes you want to do this: Now, as house supervisor - I don't know what is up there. I think she does need to make rounds and put out fires that are developing. Okay - enough of my rant. I hope this can shed some like from amanagement perspective.

Thank-you classicdame for responding. I will be interviewing for this position tommorrow. GULP! Please everyone feel free to give your on what this position entails. I am really interested in what others have to say both good and bad..... Siri - can you give some input? Thanks, Mozzie

Hi, I will be applying for a Risk Management position in a fairly large hospital near where I work. I have 14 years nursing experience with Tele, ER / Trauma, UR and almost a year of management under my belt. BTW - my experience as a manager has not been very good - unfortunately.... Anyways, can someone enlighten me more on what the job duties are? I have "somewhat" of an idea - however, our Quality person is also called our "Risk" person at the hospital where I work. Some places will call it quality and risk management. Can someone separate out the job descriptions between the two??? Anxious, Mozzie

Everything stated above is sooooo true!!! I made an unfortunate mistake of trusting my day charge nurse because I absolutely, positively had nobody to go to in order to vent. My DON was "too busy" to counsel me and I went to the nearest person that knew about the issues of the unit and what "we" were going through. Lets just say, it was the biggest mistake in my management career thus far (just about one year into it) and I am ready to get out!!! I am told that the first year of management is the "learning curve" that the new manager is to observe, and be counseled by their "upline". Let me just say that none of the counseling nor mentoring really happened and my DON gives me conflicting advice. I have spent this past year learning and stumbling on my own. Makes life as a new manager confusing. My year is almost up. I have learned a lot from my mistakes - however, I just don't see myself being able to lead this floor with a DON that gives conflicting advice and staff that are never satisfied. - Even though I am staffing them at a ratio of 1:5 max. I know this doesn't include acuity - however, after getting my data together (this takes time) - I was going to build that into the new budget. I have a business degree and I really wanted to help them out even more so - but at this point.....I am ready to just bail and leave it at the 1:5 ratio. The charge nurse that I trusted turned on me and my upline and has just turned staff against me and my decisions. Lets just say that unit meetings can get painful on the day shift. Okay, I could go on and there is a lot of fall out from this. Right now - I'm just struggling with the thought of staying in nursing at all versus just crossing industries in the business sector and be done with it versus just giving the one month notice and move on to some place that management mentoring takes place. If there is any place that supports this..... I wish I could elaborate more - but I think it is best to just end here. ~sigh~

I already feel so supported here - I mean, just with the responses thus far. I keep asking myself a lot of the same questions. Why did I go for the masters degree? Well, to be honest, - I would have to say that having this degree would allow me to go into management in a health care facility or move into another industry - perhaps. I am going to stick it out and see what happens. I really don't have anyone with me in the "trenches" sort of speak. The one manager has been at this hospital forever and a day. So she knows this place inside and out. Then, the other two are new to the facility and have close to the same amout of experience as me. - Just in different areas of nursing. The two newer managers hired in behind me. Right now, I feel that my DON is making an example out of me in front of them - with little things that become an issue on my floor. They have been there maybe a month or so. However, one of the new managers and the older one will ask me questions that I am expected to know (seemingly).....Then, in front of the DON - they are taking credit for things. My only "mentor" per se is my DON and she is busy trying to get the other two acclaimated to their units. So, right now - there is no mentor and I feel that I'm on my own. There is a ton to learn and I feel that I am not being oriented the right way. - I know what some of you are saying - welcome to nursing. Unfortunately, I've done this "baptism by fire" once before starting out as a staff nurse and now as a manager. I have also found out that the other two that are newer than me are getting paid more than me (go figure) - :angryfire - No, they are not masters' prepared nor do they have the management experience. I will tolerate this for now because it would make my resume look bad if I quit. But if things remain like this - I will do as many of the staff nurses on here have said (and some of my own employees prior to my arrival). I will give it a bit more time and if not happy - vote with the feet. Unfortunately, this kind of "orientation" seems to happen at all levels of nursing.......

Hi, I'm new to this site - please bear with me. Anyways, I have just accepted a new management position on a medical surgical unit. I was hired from the outside. I'm a BSN & MBA and started this position about 3 1/2 months ago. The staff are okay, but the other managers are something to be desired (they are new too). This is a typical Med-Surg unit, the turnover is heavy and I am doing my best to make sure it is staffed (with agency if needed) before I go home every night. I am putting in about 11 hours a day since I have started. The other managers that just started - well, I don't think they are twisting the time - but we will see. I'm doing my best to keep up with whatever that is sent my way. My DON will tell me one thing, then she will say something different in the next week. I am not sure if this is what I really want to do. First management job and I am just hating it. Perhaps, I made a mistake and should just look at working for an insurance company or something. I'm not getting any younger and going back to the bedside full time is not really what I have planned - However, I do help when needed on the floor. I'm sorry if this seems like ramble or rant but I am very overwhelmed and feel beside myself for feeling like this was a mistake and wanting to bail. I want to appear strong in front of staff, they need someone with strength to look up to, but I am just not sure if this is sustainable. Guilt regarding the thought of leaving this soon is building. I really need someone who has "been there" - "done that" for some advice. Perhaps, I just suck it up, I don't know - however, if I am feeling this way now - I have to ask what will it be like after a year??? Anyways, thanks for "listening"......... Mozzie