New Nurse Manager in acute psy

  1. Hi, I have been a nurse for 6 years and currently holds a MSN. I have worked mostly in critical care and know nurse manager in the VA system. Working in psy is very new to me. I was reading from other staff how difficult is it to get rid of lazy staff. Well I am working on it. I have staff who cannot function and taking a look at the performance evaluation they are 95% outstanding ratings. I took over a unit that has no structure. I did my first evaluation last month and I give a staff high satifactoy in patient care and this staff demanded that an outstanding rating. I did inform him he must show proff of outstanding performance. Before it was given to them. You have staff who thinks that in acute psy vitals signs every shift is too much. Basic nusing assessment is lacking. One staff told me that finger stick is stupid because patients are non compliant out side the hospital. I have staff that give medications from memory because she knows the patients. I have staff who will not follow MD treatment plans because doing it their way is easier for them. I have staff who were allowed to sign and initial their managers name on overtime paper work. I being the new kid made some changes and the above will not go on. They have a very big problem with change. They are looking for ways on how to get rid of me. One staff stated I came and make all these changes. My response I only following policy. The situtation is very bad. I pulled a night staff for unsafe practice for not making an assessment on a vet that had a possible GI bleed and did not call the MD. This staff still thinks she did nothing wrong. I am trying to make a difference. The good part of it I have the support from my leadership for change. I would like to hear from the community.
    Last edit by devonn1 on Mar 1, '05 : Reason: Forgot to introduce myself
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    About devonn1

    Joined: Mar '05; Posts: 4

    14 Comments

  3. by   zenman
    Unfortunately, if you don't have support from higher up and from HR, you may be doomed.
  4. by   TitaniaSidhe
    Okay, I have worked in acute psych in the VA system for a loooong time. I understand your position but allow me please to perhaps shed some light on the possible thoughts of your staff. From what you have stated I am assuming you have no prior psych experience? This will be a bone of contention among them if you ride onto the unit looking to make broad or sweeping changes, I have the feeling you will have very little to no cooperation from the staff beneath you & they will probably resent what you are trying to do rather than work with you no matter how right you may actually be...Yes you are their boss however you may need to earn their respect & coming in guns blazing is only going to piss them off. I do understand how difficult it is to get rid of the lazy or incompitent staff you may be seeing, & yes it is indeed very difficult, most especialy so in the VA system. Your best bet would be to enlisit support from some of the more experienced nurses working beneath you, they can if they like you, help you to ellicit change in the more difficult members of your staff. Yes, you shouldn't have to do this sort of thing, yes, it is bordering on rediculous b/c you indeed are in charge, however it can be easier in the long run to try to manage them in this manner. When you have staff that has worked in a system for 20-30 years & has consistently gotten away with not functioning up to par they will resent the hell out of you coming in & attempting to force them to comply. You will have one hell of a battle on your hands & it is difficult enough to manage the patients on an acute psych unit let alone deal with uncooperative staff as well. It is a fine line to walk being nurse manager, you have to balance the administration & the staff. You are in the middle of an us vs. them situation trying to walk a line. I do not envy you & for this reason I myself have consistently turned down the very position you now hold each time it has been offered to me. I will say I have seen some EXCELLENT nurses & NAs over the years & I have also seen some attrocious ones. You will, in my opinion, make more progress effecting change on the unit through earning the respect of the nurses beneath you, seeking out advise from some of the more experienced psych nurses whose skills you respect, & being more subtle with the changes you are attempting to enforce. Anotherwords not trying to change everything at once & slamming policy down everyones throats nor sicking the DCS on them or writing everyone up. Hell yeah if you do any of that sort of stuff they will make your life miserable very quickly & nothing is worse than having those employees who have been there forever in the system plotting to get you b/c they KNOW the system, the policies & how to manipulate it to meet their needs.

    I hope I have managed to convey my thoughts in an acceptable way. It is hard sometimes to adequately put things in words...I do wish you the VERY best of luck in your situation & sadly, I do not envy you. It is difficult.
  5. by   CharlieRN
    Currently in my state the state hospital is going to be closed because they could not do what you are attempting even when mandated by the legislature.
    When you have staff that has worked in a system for 20-30 years & has consistently gotten away with not functioning up to par they will resent the hell out of you coming in & attempting to force them to comply
    Literally the hospital is going to close because the staff would not accept the need to change and actually follow their own written policies rather than 'doing their way'.

    If I had to offer advise I would say "pick your battles", document the need for the specific change carefully, then educate the RN's first, then with them on board educate the nursing staff, explain explain explain, take questions, qive honest answers, be open to suggestions. Even if it is clear that there is only one solution to the problem you will get better results if you let the staff try to solve it and come to that conclusion, then if you tell them to do it your way. When you talk to your experienced RN's and present the problem to them, have your supervisor present. Make it clear that you have the support of those above you in the chain of command. Try to make it clear, without saying it outright, that any attempt to sabotage you will be career suicide.

    Oh, and do be really, really, sure that what you think needs to change actually does need it. Psych nursing is process focused not task focused. Letting someone get a good night's sleep may be more important than getting a set of vital signs. The way you listed a set of failed tasks causes me to wonder about your understanding of this. It might be helpful to look at patient outcomes to identify real areas of failure as opposed to missed tasks. Exactly why does an acute psych patient who is observed every 15 mins, and is in no physical distress, need to be awakened for vital signs?
  6. by   devonn1
    I shocked that you would think assessment of psy patients should be different. If you notice in psy today patients have many medical problems. On an average my unit have at least 2-3 medical codes per week 1oo% of the time these patient are transfered out to medical ICU OR CCU. I will contiune to force them to assess and document. Most of the nurses feels the same way you do let the the patients have a good night sleep. psy has changed. Most psy medication could have fatal side effects. On a daily basis most of these patients have to be treated for non psy problems. Some of the the DRGs in my area: cva, HTN, post MI, post open heart, and i can go on. Like i said psy has change

    Quote from CharlieRN
    Currently in my state the state hospital is going to be closed because they could not do what you are attempting even when mandated by the legislature.

    Literally the hospital is going to close because the staff would not accept the need to change and actually follow their own written policies rather than 'doing their way'.

    If I had to offer advise I would say "pick your battles", document the need for the specific change carefully, then educate the RN's first, then with them on board educate the nursing staff, explain explain explain, take questions, qive honest answers, be open to suggestions. Even if it is clear that there is only one solution to the problem you will get better results if you let the staff try to solve it and come to that conclusion, then if you tell them to do it your way. When you talk to your experienced RN's and present the problem to them, have your supervisor present. Make it clear that you have the support of those above you in the chain of command. Try to make it clear, without saying it outright, that any attempt to sabotage you will be career suicide.

    Oh, and do be really, really, sure that what you think needs to change actually does need it. Psych nursing is process focused not task focused. Letting someone get a good night's sleep may be more important than getting a set of vital signs. The way you listed a set of failed tasks causes me to wonder about your understanding of this. It might be helpful to look at patient outcomes to identify real areas of failure as opposed to missed tasks. Exactly why does an acute psych patient who is observed every 15 mins, and is in no physical distress, need to be awakened for vital signs?
  7. by   devonn1
    I do have the support for change from my leadership. They want change.

    Quote from zenman
    Unfortunately, if you don't have support from higher up and from HR, you may be doomed.
  8. by   devonn1
    I know change for some people is not good. I will contiune to make sure patient safety is first. Psy patients are human and need to be treated as such. When I say it bad I mean It bad. They need to treat these patients like human being. I think i handle these nurses. I have spent many years in the military I will not stop until I get the results I need to ensure patient safety. The good thing iS I have the chief nurse and cheif psy MD wanting this change. My focus is not only to have the staff look at psy problems but the many medical problems these patiets have.
    Quote from TitaniaSidhe
    Okay, I have worked in acute psych in the VA system for a loooong time. I understand your position but allow me please to perhaps shed some light on the possible thoughts of your staff. From what you have stated I am assuming you have no prior psych experience? This will be a bone of contention among them if you ride onto the unit looking to make broad or sweeping changes, I have the feeling you will have very little to no cooperation from the staff beneath you & they will probably resent what you are trying to do rather than work with you no matter how right you may actually be...Yes you are their boss however you may need to earn their respect & coming in guns blazing is only going to piss them off. I do understand how difficult it is to get rid of the lazy or incompitent staff you may be seeing, & yes it is indeed very difficult, most especialy so in the VA system. Your best bet would be to enlisit support from some of the more experienced nurses working beneath you, they can if they like you, help you to ellicit change in the more difficult members of your staff. Yes, you shouldn't have to do this sort of thing, yes, it is bordering on rediculous b/c you indeed are in charge, however it can be easier in the long run to try to manage them in this manner. When you have staff that has worked in a system for 20-30 years & has consistently gotten away with not functioning up to par they will resent the hell out of you coming in & attempting to force them to comply. You will have one hell of a battle on your hands & it is difficult enough to manage the patients on an acute psych unit let alone deal with uncooperative staff as well. It is a fine line to walk being nurse manager, you have to balance the administration & the staff. You are in the middle of an us vs. them situation trying to walk a line. I do not envy you & for this reason I myself have consistently turned down the very position you now hold each time it has been offered to me. I will say I have seen some EXCELLENT nurses & NAs over the years & I have also seen some attrocious ones. You will, in my opinion, make more progress effecting change on the unit through earning the respect of the nurses beneath you, seeking out advise from some of the more experienced psych nurses whose skills you respect, & being more subtle with the changes you are attempting to enforce. Anotherwords not trying to change everything at once & slamming policy down everyones throats nor sicking the DCS on them or writing everyone up. Hell yeah if you do any of that sort of stuff they will make your life miserable very quickly & nothing is worse than having those employees who have been there forever in the system plotting to get you b/c they KNOW the system, the policies & how to manipulate it to meet their needs.

    I hope I have managed to convey my thoughts in an acceptable way. It is hard sometimes to adequately put things in words...I do wish you the VERY best of luck in your situation & sadly, I do not envy you. It is difficult.
  9. by   CharlieRN
    I shocked that you would think assessment of psy patients should be different. If you notice in psy today patients have many medical problems. On an average my unit have at least 2-3 medical codes per week 1oo% of the time these patient are transfered out to medical ICU OR CCU. I will contiune to force them to assess and document. Most of the nurses feels the same way you do let the the patients have a good night sleep. psy has changed. Most psy medication could have fatal side effects. On a daily basis most of these patients have to be treated for non psy problems. Some of the the DRGs in my area: cva, HTN, post MI, post open heart, and i can go on. Like i said psy has change
    This is a psych unit you are talking about? Patients with the DRG's you have would not meet medical clearence to be admitted to our facility. We have a code once every couple years.
    If indeed your patients are as physicly ill as you say, then indeed they need to be assessed as medical patients. If their primery problems are medical, so should their treatment be. But if these clients would be at home if they did not have a psych problem, then they do not need medical treatments and assessments they would not get at home, particularly at the cost of increasing their psychological stress. In the absence of a medical problem which would call for more frequent assessment, vital signs once or twice a day should be plenty for a patient with a primery psych dx like major depression or psychotic d/o. These are people who are usually quiet able to complain if they are felling physicly unwell. On the other hand a patient with an acute Psych problem may need phyisical observation and interaction with staff as often as four times an hour. The point of the interaction is to assure and document safety, provide reassurence and assess and document mental status. Doing that well should give your staff enough to do, without the need for nursing busy work.
    Last edit by CharlieRN on Mar 13, '05
  10. by   Hukilau
    Let me put this as gently as I can:

    You don't know what you're talking about. (Sigh... I was afraid it would come out like that.)

    You have no psych experience and you immediately think you know what this unit needs. I am sure change is needed. I am sure there are some terrible practices among the staff. But you simply cannot understand the dynamics of the situation, and apparently neither can your superiors for putting you in such an impossible situation. I don't expect you to accept any of what I say. I can only hope that you get so discouraged you quit. That would be best for you and the unit.
  11. by   TitaniaSidhe
    I have to say I agree in that the OP does not seem to understand Psych one tiny bit but yes I can see how you would be a military nurse being as how hell bent you are on policy & procedure. Just b/c a psych patient is medically ill does not mean you can discount their psych illness. MANY times to we send our psych patients out for medical treatment to have the medical staff discount their psych illness, reduce their meds, have the patient regress, act out or become violent/psychotic, then have the medical staff ship them back as "unmanageable." This is cruel & just plain stupid. Talk about lack of judgemnt. As far as shoving policy & procedure down your staffs' throats & thinking you have it made b/c you have support of Administration well, good luck as you will need it. If you really are on a true Psych unit, which I am beginning to doubt although I have seen far worse placements of Nurse Managers within the VA system by Administrators with NO judgement, experience in Psych or insight...you are definately going to have pretty much all the staff literally hating your guts & just scheming of ways to set you up or get rid of you by any means they can. Over the years I have seen some professional staff & many of the unprofessional staff literally find a psych patient they have know for many years & have very good rapport with, they can & will manipulate the patient to be agressive or assaultive toward you simply b/c the patient will feel loyality to the staff member. Now mind you I am not by any means condoning this behavior or agreeing with it I am simply telling you of some of the things I have seen happen & why they have happened. An acute unit can be a very physically dangerous area to work...it is pretty essential that you have support from your staff in case something should kick off & a patient comes after you. If your staff hates you they may well just sit back & watch you get beaten. I have seent his happen as well...yes it is wrong but as I said it happens. You can listen to what I am saying & heed some advise of many of the others on this board, & there are MANY here with excellent advise as well as wisdom, or you can keep running head strong with your "policy & procedure" & the you will do what I say b/c "I'm in charge" attitude but I think it would display more wisdom to listen to what many people here are trying to tell you in several differing ways. It would definately make your job easier & accomplish the results you are looking for more quickly & painlessly.
  12. by   jrjrj
    I am confused about your posting. Are you asking a question? or are you looking for validation?
  13. by   Hukilau
    I am now wondering if this was a bogus post to begin with. Maybe some kind of class project in a nursing management course. No one could be as hopelessly out of touch as the OP portrayed himself to be.
  14. by   TitaniaSidhe
    I have to chuckle Hukilau b/c I am telling you there are some people in administrative positions in the VA system that really leave me wondering how they managed to tie their shoes in the morning let alone make it in to work, they are that out of touch & yet they still get promoted into positions of authority. *sigh* sadly it is possible it was a valid post, gads I hope not, but I think based on some of the people I have seen over the years yeah it's possible.

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