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On a serious note I did work for an organization that allowed the Managers and Assistant Manager to do 4 10 hour shifts a week. One of you had to be there M-F and if you were off a day and something came up you had to be available. They knew we were putting in way too many hours and even on your "day off" you were still checking email and working on projects from home most of the time. It was nice though.

I used to work for HCA. They will say "sure, 12 hours M-F"...ok. Can you do weekends and holidays as well? By the way here are 3 more departments you can manage. haha kind of kidding.

We just started doing triannual coaching rather than monthly rounding and annual evaluations. Goal focused. More meaningful in my opinion.

We have recently changed our policy on this. We now triage patients before they are registered. If they classify as a level 2 or sometimes 3 we bring them immediately back. Also, if they present with something we cannot treat it is the expectation the provider does a quick assessment to make sure they are capable of self transport. However, currently we aren't charging them for the visit if we are just asking questions and calling for transport or sending them to the ED by private vehicle. We felt it was risky to send them without the provider actually looking at them first. So far this hasn't delayed any patients from getting appropriate care or generated unnecessary billing. We probably could still bill since we are doing an assessment on them but it doesn't seem like the right thing to do since we have no intention of treating.

I transitioned from inpatient management to outpatient management about 6 months ago. I had never worked outpatient a day in my career but it was a good opportunity. I think the most important thing to consider for a bedside nurse is its not always an "easy" job. Offices are more fast paced than you would expect when you are seeing 3-4 patients across every 15-30 minutes depending on the level of visit. However, if you get behind its not like inpatient. The worst that happens is the wait time increases and you get out late or miss lunch. Getting behind in the inpatient world could have bigger consequences. Its just a different way of thinking and different types of "busy". I enjoy both worlds but it is nice that I don't typically have to wake up to 3AM phone calls about staffing and bed crunches. Definitely some perks.

Just for follow up. I checked with my state board. There are no specific rules in my state that differentiate between what an NP does vs. a physician. As long as they are trained and competent they may provide the same service. Billing for services I still need to look into.

that is a good point. It really does depend on the region. When I was working at an academic medical center many director level had DNP or were working on it...mainly because it was free to employees and academic medical centers often have better support around student employees. Its less important at smaller regional medical centers. Most of the director levels have a MSN where I am currently working. I don't know of any with DNP but most also have MHA or MBA. More education is never a bad way to go. I think you just have to look at what you want to do. I don't see a DNP advancing my career with my current experience but someone with 20+ years looking for a CNO position may have different opinions.

thank you for your feedback. We typically only staff with LPN and QMA which limits some of our ability to do more advanced procedures in the clinic. I have been in urgent care for a short time, most of my background is inpatient so this is a new world for me.

I think it depends what you are wanting to do in your career. I would like my options to be open outside of nursing if I ever choose to go that route. An MSN can be a business degree but the entire curriculum is around nursing. In combination with an MBA it can give you a leg up if wanting to apply for a position like COO or some sort of other operational leadership position. Having a nursing background I find is always helpful. I don't know what I want to do in my career but I do believe an MBA gives me more options than a DNP.

I am fairly new to the urgent care world. Do you currently work urgent care? If so, what certifications do you require? (example ACLS, NIH stroke, etc.)

I graduated with an MSN about 4 years after my BSN. It has opened a lot of doors for me professionally that I don't believe I would have been able to pursue if I hadn't completed the MSN. At least not so early in my career. The MSN program can be as valuable as you make it. In general I found the MSN program to be pretty easy. If you wanted to skate by, most of the programs are online so its not difficult to do but if you want to learn something, do the readings and take the assignments seriously. Now I personally do not have any motivation to go back for a DNP. I am going to pursue an MBA soon.

Hey all - I manage a small wound care center. Currently our staffing is all physician based and are looking at supplementing with a nurse practitioner or PA. Does anyone currently practice as an NP in a wound care specialty center? What credentials do you have and are you able to practice independently and do everything thing the MDs do in your clinic? I figure a NP would be more likely if you can find someone with the WON experience.

Congratulations on advancing your career! I got into management after being a bedside nurse for about a year. My first role was an assistant nurse manager and I had the privilege of working alongside the bedside nurses about 75% of my shifts while spending about 25% on other stuff...usually education or management related. I think this is a great first step for those who are interested in leadership. Don't let others discourage you because you only have 5 years of experience. Leadership is more than experience. I would take a 5 year RN who has great leadership qualities as a manager over a 25 year RN who does not. Experience certainly helps but I have managed units that I have had no experience in...its certainly easier if you do but its doable in today's environment of nursing management. I would caution you against taking a job as a manager because you feel you are "doing nothing" with your degree. You want to make sure you are entering an environment that is supportive of your growth. I have worked at magnet hospitals in the past who have groomed new leaders into great leaders. I currently work at an organization that does not do this and is hard on new leaders. Fortunately I have the experience as a leader that I can be successful but you don't want to get yourself into that situation as a new leader. Be sure to ask questions about how the organization supports new leaders. They already know you are green because they have your resume. No reason to try to make up for that in an interview. They chose to interview you! Good luck!

You are quick to judge those of us who do work very hard and are stressed. Do I work the floor? not usually. No I do not like working the floor. When I do it prevents me from getting my other work done. I mostly do not like it because I do not feel as helpful as someone who works in that role every day so I would prefer to find someone who does so the other staff do not have to pick up my slack. It sounds like if your depiction of your leadership is true it is some bad apples. I cover 4 different units and have nearly 100 employees... if you think that I am "lazy" because I am a manager you can come see what I do every day. You may want to see how the shoe fits before you rush to judgment.

Is it personal or work related?

So if you are looking to become a manager I would encourage a MSN rather than just an MBA. An MSN/MBA is a good option though if you are considering moving up the ladder. MBA is quite common in director and executive level. My guess is the MSN you are looking at that is MSN/nurse leadership is not a dual degree program. It is probably an MSN with a focus on nursing leadership. Most programs are set up with MSN programs that have specific focuses whether that is in leadership, education, CNS, informatics...many options. The school really doesn't matter unless you are going towards the Nurse Practitioner route which would require accreditation to take the NP exam. There is no required exam for non clinical MSN but an accredited program would be the preferred because its likely not a good program if its not accredited and the goal is the knowledge not the degree necessarily. If you are going to continue on for a doctorate degree in nursing I would not encourage an MBA... unless you are going to pursue a PhD in business. it would be a waste of your time/money otherwise in my opinion. If you are looking at leadership I would encourage you to look at DNP programs that have a management focus. PhD is really a research degree which can be applied to management but DNP would really make more sense in my opinion. It sounds like you have a lot of ambition and that is awesome!!! I would encourage you to do a little bit more investigating about what will help you most though before you spend a lot of money and time on the wrong degree.

It sounds like a great opportunity but I would also be concerned with the amount of hours you will need to put in given that it is essentially a new company that is coming in and changing the culture AND building a new building. If you are good with the time commitment it sounds like a great opportunity!

I don't know the average but based on my past experience its usually around 50 people 30FTE you would have an assistant nurse manager. I have 1 assistant nurse manager that I always seem to have to put into staffing just because of how we do productivity. I have around 80 staff across 4 departments. It's too much. At my previous job I had about the same amount of staff but had a full time assistant nurse manager. We were much more effective. Ho hum.

I was talking about my original post... we have since cleared this up in a later post... "Nurse God" I like that...mods can I have my title changed?

I agree. So many places operate so differently. It sounds like you are in what was called an assistant manager at my current job or an assistant unit director or a team leader or a supervisor... every place has a different title for levels of management. Some have a more "team management" approach where the manager/director may have a large number of FTE and several assistant managers. Some have managers with lower FTEs but little support from assistants. And some unfortunately have manager with a large number of FTEs and little support. It's all relative...

I think you are confused about the context of my post in relation to the OP. I don't think an anonymous forum is a good place to discuss if what a manager did was right or wrong when the object of the conversation is so subjective. I am not saying that what the manager said was the inappropriate venue. Sharing real life examples can be an effective tool to influence staff. However, using it as a "scare tactic" is not effective. We shouldn't have to scare our staff into doing the right thing. If that is the case either A. I am not an effective leader, or B. I have staff that need to be counseled out of the system.

Man... where do you work? It sounds like I need to get a job there as a manager. My 50+ hour work weeks busting my butt certainly do not compare to your experience at any of the hospitals I have worked at. Walk a mile in the managers shoes and it may not be so "cushy" as you think...either that or you have a really crappy manager.

It really depends on the organization and span of control. I have worked at a few different hospitals in my career and they have all been different. I would love to be more involved in my units but I cover 4 different units with over 100 employees and would never have the time in my day to do all of the things that the above poster does for each of my areas. I feel more effective when I have a smaller span of control but unfortunately its not my reality.

NPs usually practice more like physicians in regards to job role. However, NPs are used in a variety of ways. I have seen them more in a care coordination role instead of primary care role. They practice in nearly all settings from PCP offices to inpatient hospitalists. To answer your question about an abundance of pediatric nurses... it really depends on the region you are in. I have worked in 3 different regions now and tey have all been different in terms of openings. What I have seen is that many nurses coming out of school think they want pediatrics then realize that its not for them. Its not all fun and games...it can be really sad but also very rewarding. Kids are great to work with but it takes a specific personality. Good luck. I truly hope you find the right path.

OT and nursing are completely different but I agree with the above poster...I am not sure how they would have more flexibility. It seems like you have a lot of enthusiasm but as someone who has counseled college students I would encourage you to not get too far ahead of yourself. NP and RNs roles are about as different as RNs and OT. They are completely different job roles so you will want to research what all of these professions do on a day to day basis and maybe even look for some shadowing opportunities. I would hate for you to get 3 years in a program and realize its not what you thought it would be. Its exciting to think of all the possibilities that are out there but make sure you make an informed decision. Good luck!