Butterfly62

All the surgery centers are, unfortunately, feeling the economic crunch. I run a surgery center and we are looking at ways to cut costs, to include closing one day a week. Staff won't lose their jobs, but it does mean that they'd lose 8 hours a week and that can be painful. Working together for viable solutions is in your best interest. Best of luck to you!

Thanks for your response. I did finally get the most difficult owner to listen to me and respond. He has an "in' with my staff and is very close to them. He was able to convince them to get on board and remind the staff that frequently going through nurse managers was no longer acceptable and things needed to improve dramatically. This was a very difficult process, but well worth it. I think things will get better. We may have some setbacks, but I'm hopeful! Thank you all for your great advice and Happy Holidays!

Thank you for your response. I did get to the 'ringleader' and FINALLY got the owners on board and they are now supporting me (after many tears and frustration). The ringleader has been addressed and has made improvements, although I think her ability to improve will only go so far because her personality is set where it is. I recently held a staff meeting to cover the rules, expectations, and code of ethics and it was a disaster with me being held responsible for other people's problems (i.e., my own staff's problems). They understand now that I hold them accountable for what they say/do as well as anyone else, to include myself and the docs. Things are much better lately, but I hope it's not just because it's the holidays. The new year will set the tone and I will tweak as necessary. Thanks for your great advice. It was extremely helpful!

Unfortunately, I work in a place where everyone works pretty much the same hours (ambulatory surgery; day hours only). So, I have the same staff every day. I've cut the hours where I could but, actually, the FT staff are doing most of the damage. I'm frustrated beyond belief!

Create a rotating holiday schedule for staff. One year they work: New Year's Day, July 4th, and Thanksgiving. Next year they work Memorial Day, Labor Day, and Christmas, for example. Trade these groups every year. That's worked the best for me. That way it is fair to everyone.

I have many years experience working for military hospitals. By your log, you would be a wonderful asset to the military medical community. You have the heart and compassion. As a civilian, it is a little bit stressful that being military because the formality of your job would be lesser. It would be a great, lifelong experience for you. Although it would not be without challenge, I believe the rewards will be many. Best of luck to you!

I have been a critical care nurse for 8 years and recently took a nurse manager position at a surgery center. The staff that has been working there for several years are unprofessional, unethical, gossip, backstab, and do little work. I have been working with them for months to improve. They do OK for a couple of weeks and then go back to their old ways, to include undermining me with other physicians and employees--making it extremely difficult for staff to take me seriously. I have met with the physician/owners and they don't want me to fire anyone. By the way, they have gone through nurse managers every couple of years for the same reasons. I love a challenge and know I can make positive changes here, but how do I do it without getting the staff to either change, or let them go???

The DON has a broader scope of management while a branch manager has the responsibility of just one section. And, yes, DON is a title still being used.

Personally, I would take the job offered by your current department. You are already familiar with the policies and procedures and with your background, you'd do very well. I know the case manager position sounds great working from home, but from colleagues I know who have chosen this path: it consumes you. You spend much time on the road, solving patient problems, and invest a lot of yourself in this type of position. Not that it wouldn't be a worthy goal, I just think the offer from your dept director is a better choice for you. I hope this helps and best of luck to you!

llg's comments are so true. Things can't be 'black and white' in nursing. Your way doesn't mean it's the 'right' way for everyone. You know the saying, "there are different ways to skin a cat?" The same holds true here. There's more than one way to do something that will accomplish the same goal. Take a step back. Start letting others teach you instead of you teaching them. You're a valuable tool in this field. Don't leave because of an evaluation. Take that feedback to step back and take a closer look. They may have noticed something that you haven't. Best of everything to you!

Your MSN/MBA will take you much further than your MSN because you're more marketable in a myriad of areas related to nursing. Speaking from personal experience, I see more nurses get promoted who also have a business background. If you want to stick to your MSN only, that limits your classification, which is fine. But with the growing area of healthcare and the merging of upper management responsibilities, you might want to think on a broader scale. Best of luck to you in your decision process!

I can personally relate to your problem as I am going through the same thing. You won't be able to get this to work without consensus from the staff. Meaning, you're going to need 'buy in' from them. To accomplish this, you're going to need frequent staff meetings to get everyone together. Let them know your goals: what you're trying to accomplish. Let them know your ground rules: you expect them to be efficient, timely, and competent. There is no tolerance for unprofessional behavior, such as gossiping, undermining, and disrespect. Let them know that they are an integral part of the team: they have worked here longer, they are in tune with what has happened in the past, as well as seen what has/has not worked in the past. Let them know that the changes you're trying to make are geered toward efficiency, patient safety, and process improvement only and that these changes, although tough at first require team involvement, team input, and support from your staff. Secondly, you need to make sure management supports these ideas and will back you up when needed. Management needs to also inform your staff that they support you and your decisions and that they would appreciate the staff 'buy in.' It's like this: you're all on a bus going in the same direction. If someone is not going in that direction, then they need to get off the bus. It's your bus! Hang tough, address issues one on one, hold frequent meetings to keep staff informed, and email/call peers that can help and support you. Best of everything. Don't give up. YOU CAN DO THIS! I can tell by your emails that you have what it takes!!!!

The grading scale for your nursing program is right on target with other nursing schools. They grade on a curve to weed out those who are not serious enough for a program that requires dedication and commitment. Stay on track. You'll do fine.

We have a surgeon who believes highly in education ,which is great. But I prefer to only have people in there who are active students in the medical profession. He will let ANYONE in there to watch surgeries. Of course, all the appropriate paperwork is signed, but I have a real problem with this. The last "visitor" was a 13-year-old girl who had to be escorted out because she was feeling faint. I am also the OR director, as well as the nurse director. Our policy and procedure on this basically states that the appropriate paperwork and scrubs will be worn. It does not state who can go in there, which is a flaw I'm going to correct. What it comes down to is this: this a privately owned practice by several surgeons. They seem to always have the final word. I feel like I can't win!

I work in a very small Ambulatory Surgery Center and some of our doctors allow visitors in the OR during patient surgeries. I feel this is unsafe and poor infection control practices (even though the visitor is wearing the appropriate gear). All the waivers are signed, etc. I feel it's wrong, though to routinely allow someone to watch someone else's surgery UNLESS that person is a student in the medical field or for research purposes. Does anyone know of any written guidance on this subject? Thank you!