Jump to content


Member Member
  • Joined:
  • Last Visited:
  • 103


  • 0


  • 2,589


  • 0


  • 0


stephva1008's Latest Activity

  1. stephva1008

    any leadership and management books?

    Crucial conversations.
  2. stephva1008

    Managers? How many hats do you wear?

    I think you do more hands on direct nursing care than most managers. I don't necessarily think that is a bad thing. When talking about your resume, emphasize metrics/outcomes. Maintained operating margin of 8-10%, managed 20 FTE's, Lean Six Sigma PI project saved the unit x number of dollars, Press Ganey scores in top decile for ___# of years, core measures.... With a smaller unit/hospital, you will wear more hats. If you go to a larger hospital, you probably won't be expected to work the floor, most of the managers at my hospital do only in a crisis situation. My duties involve: staffing unit, schedule, maintaining productivity numbers, managing/disciplining staff, recruitment/hiring, service recovery, tracking metrics/core measures, education (we don't have a unit educator either), serving as a magnet team leader, human rights advocate, research council chair, and various other hospital committees. So, just remember to focus on outcomes and numbers if you're working on a resume and emphasize what you've learned and how you've contributed to the bottom line and to quality patient care. You can be a great manager in a small hospital as well as a large one. Keep us posted!
  3. stephva1008

    Manager or CRNA?

    I work probably 50 hours/week when you count in time taking work home. I'm glad I did it, and I have no regrets. But that's me. I will say that, financially, you will have to work your way up to a salary that would compare to CRNA. A few years as unit manager with proven results, then director, VP, etc. This takes awhile in my experience. CRNA school is tough but once you're done, you're done, and you will have any job you want waiting for you with a good salary. It all depends on what you like to do ultimately. Keep us posted.
  4. It's tough to go through for sure. It's better to lay off some people than continue the further downward spiral for sure. What I would look at is your census. Is it bimodal? Can you staff by the census trends? For example, our unit census drops significantly during the summer. When we had to cut FTE's we converted a few staff to 9 month employees who have the summer off. It works great for folks with children home from school and we call less staff off in our low summer census months. Be creative. I would also encourage you to contact other like units that are in your compare group for staffing benchmarks. Call them and see how they staff. I've learned a ton by networking with colleagues from around the state and nation. Good luck - it's not a fun position for sure. Keep us posted!
  5. stephva1008

    First time being Interviewed for DON position

    They may ask you about managing FTE's...do you send folks home when you're overstaffed? Talk about a time where you had to discipline a subordinate. Licensing issues...what did you learn going through the last JCAHO inspection or CMS or whatever....How do you manage risk, how do you track quality indicators and who you benchmark against? Why do you think you are qualified to be a DON?
  6. stephva1008

    Fastest Way Up the Ladder

    I wouldn't say any track is detrimental to moving up the ladder. Even OB isn't just OB. It's L&D, postpartum, newborn nursery and, in some hospitals, women and children are under the same director. To move up the ladder you need to have outcomes. To start your management journey, sign up to be a shift manager or house supervisor after hours, then a unit manager, then director, then CNO. But you need to have outcomes and make your productivity and budget targets from a UM on up. Then there are other nonclinical departments like performance improvement, risk management, etc. I wouldn't imagine a CNO coming from a nonclinical area. A CNO needs to understand the average staff nurse and unit's struggles. But I'm sure it's been done before, lol. Welcome to the journey!
  7. stephva1008

    Is management for me?

    No, management was not something I ever considered, though I was an officer in the Navy Nurse corps, lol. When my current position became available and was offered to me, I turned it down initially! But my boss was persistent and I yielded eventually (my big thing was I wanted to continue grad school). I'm so glad I took the job, though there are "those days." My kids are both in school and I'm a single mom so the M-F day shift schedule was what clinched the decision for me. I screwed up royally my first year, that's where experience helps. I love being able to have the kind of influence you are describing. I did read some books but they didn't help me that much. The book that had the most impact on me is "Crucial Conversations." Highly recommend that one. Good luck in your decision-making process. Feel free to PM me anytime for questions, or, if you take a management job, to vent, lol.
  8. stephva1008

    Is management for me?

    Well, I am a unit manager of a child psych unit. What makes it rewarding is knowing that i am making a difference in the lives of my kids. Not me directly but my influence in the programming, the staff we hire, the quality. I am obsessed with safety and making our program innovative, and evidence-based. I am constantly striving to have a better program, a better unit for these kids, who average a 5 day length of stay. I love research and I love the fact that I can do it with the kids on our unit. That is always the reward, having that influence, directly on my staff and indirectly on the kids. Other benefits: flexible schedule, no holidays/no weekends. If I have to take the kids to the dentist, I can do that and come in late. I'm in grad school and plan to go on for my doctorate; with my schedule I can do this being a unit manager. I don't want to become a director or CNO; I like being as close to the patient level as i can and still be in management. I like being a change agent at that direct level. The pay is not a reward, nor are the fires you have to put out, the personalities you have to deal with among your staff. But you just get used to that. In the past few days, I've had to talk to 4 angry parents and deal with 3 staff performance issues. I've had to fire a few people. I have to cover night shifts when I have 2 sick calls and can't find coverage...it sucks, working for free those nights but I just take a personal day later in the week and it all evens out. You just get used to the chaos; when I don't have an angry parent or a staff performance issue, I'm pleasantly surprised. I expect these things day to day. All in all, I love my job and my staff...most days. You take the bad with the good, you have to be flexible and balanced and be proactive rather than reactive. Hope that helps! I never thought I would be in management but now that I'm here, I can't imagine doing anything else. Feel free to PM me for other questions...
  9. stephva1008

    Float Pool Staff Meetings

    I know email isn't personal but I do a weekly "huddle" email to address a bunch of stuff they need to know, like a mini staff meeting. Then every other month we sit down for a nurse quick meeting ftf. I come in early to get the night shift and then get the nurses between days and evening shifts. We do an "in person" huddle that is quick, not as long as a regular staff meeting would be.
  10. stephva1008

    patient acuity system

    I'm the nurse manager of a child psych unit and we use an acuity system that staff designed, so it's not just for critical care. We get more staff for 1:1 kids, kids who are a special 3 day intensive issue work program, etc. Administration has been trying to get rid of the acuity system but I won't budge. It's the reason we haven't have a sentinel event to date. If it's removed, I will not be staying in my current position. Ethically, I wouldn't be able to sleep at night.
  11. stephva1008

    Input on staff frustration from a management standpoint??

    I weighed in at the end; better late than never!
  12. As a manager, I take the HCAPS results with a grain of salt. Working in child and adolescent psych, we have to set limits with the kids and give the patient and family a survey at the end. Everyone gets a negative comment posted about them at times, even myself. But if it's a consistent trend I notice from the comments, then I can address it with the staff. I have one nurse who is difficult to work with according to staff, has been for years, and, no surprise, she comes up negatively on the surveys every month as well. So it's "another piece of the puzzle" of performance, in my mind. You can't fire someone in our organization based on HCAPS; that would be a freaky place to work if we could. I have to have a long history of documentation to fire an employee in most cases. Overall, our scores are excellent, even though we have kids court ordered to us and have to set firm limits with the kids. Initially they hate the limits but by the end of the stay, they give us good marks because we are setting limits with care and explanation. I don't hate the HCAPS and I think, in some cases, it can be good for the patient. How often have you been in a hospital when it is extremely noisy at night at the nurses station and can't sleep? Yes, you're in a hospital, you're a patient and it's not supposed to be like home. But you at least want folks to make an effort to be quiet at night, right? Obviously you need to enter the room to perform your job but do you need to hoot and hollar at the nurses station at 3 in the morning? If your scores are low in that area and it is disseminated to the staff to try and be a little quieter at night, then the patient benefits by getting a bit better quality of sleep (when you are not coming in to keep them alive and such). With all the healthcare changes, and moving to "pay for performance," there is a lot of $ at stake. As much as we don't want to acknowledge it, healthcare is a business as well as a service. I think it can be used as a tool to improve patient care. I do not think it should be worshipped as a golden calf, which it sounds like, in many places, it is. Sorry to hear it is driving everyone a little nutty. Even as a manager, it is taxing for us as we are held accountable by upper management. I'm sorry your managers are calling you out on stuff that is wrong or plain silly. They should look at the trends and not try and correct one staff whose patient or family is just unreasonable. That is wrong and I'm sorry they are doing that to you.
  13. stephva1008

    I'm no Dr. but what is your opinion ??

    In my experience, Medicaid will only pay for Abilify when other traditional antipsychotics (with generics) have been trialed and failed. I actually think his dose of Abilify is high, combined with a high scheduled dose of Thorazine (has a short half-life but is more used on a prn basis than scheduled, but that doesn't necessarily mean it's contraindicated) I would worry about EPS and/or weight gain. Has he tried Guanfacine (tenex)? Seroquel? I guess the real question is: Is it working? Is he less aggressive on all these meds? For an 11 y/o, I would expect him to be snowed on this but, if he's a big boy and/or if it's working, the benefits would outweigh the risks. We rarely combine antipsychotics but when we do, they need to do a MD to MD review with the insurance company. So I would expect that to happen here. At some point, he may have to do a drug holiday and start fresh. We do that a fair amount when there is polypharmacy to see what is really underneath. It's a nightmare for staff but can be helpful for treatment. Good luck. Does this kid have intensive in home therapy? It sounds like he needs it in addition to the behavioral school. What happens after school can carry over easily into the class. If they are not working with the family, any gains he may have will be quickly lost. A good in home therapist can do wonders for a chaotic home life. The sick kid tends to hold the rest of the family "hostage" by his moods and they forget how to parent and interact in a healthy way. Hope he gets the help he needs!
  14. stephva1008

    Lack of psychotherapy in Psych MSN?

    You will get more of that in a Clinical Nurse Specialist masters program. Psych NP's here make rounds in the hospital, doing mental health assessments and prescribing/managing meds. You won't see too many of them leading psychotherapy though in practices they can do a decent amount of 1:1 counseling along with med management, depending on the practice. Our psych CNS leads psychotherapy and also does family therapy. If you're interested in that, I would look into a CNS program... HTH! Good luck!
  15. stephva1008

    best practice in safe staffing for acute care psych unit

    I would be glad to help you and will email you back.
  16. stephva1008

    gift for new nurse manager

    If I were you I would get her a subscription to a nursing journal. Nursing Management is a good one. It's on amazon.com for a $59/year fee. Or some good leadership books like: Quantum Leadership by Tim Porter-O'Grady. This is a very helpful book for me. Other good ones: Crucial Conversations and Crucial Confrontations.