Stuck In The Middle With You

Eight of us sat in a small conference room on the 4th floor. The sun shone outside on a perfect spring morning. Birds were probably chirping, worms were likely smiling as they aerated the dewy soil, and the woodland animals that made their home around my small MEDDAC were surely commenting in cutesy Disney voices what a lovely day it was going to be.

Stuck In The Middle With You

But within the conference room, voices rose, comments intruded, thought processes were interrupted by a constant onslaught of questions and opinions, and the low, distracting mumble of sidebar conversations clouded the weekly meeting of clinic managers.

It was an introvert's nightmare, and being an introvert myself, my natural inclination was to either leave the room post-haste or dig a trench in the floor in the interest of cover and self protection. But with the regular nurse manager on leave and myself filling in as OIC (officer in charge), I had no choice but to stay firmly rooted in my seat amidst the chaos of rising voices, the flickering of frustrated eyes, and the threat of strategically thrown office supplies in the direction of whichever member fell out of favor fastest.

The meeting was as smooth, steady and effective as a sleigh being pulled by super-sized caffeinated squirrels on a bender, which was, from what I understood, about normal for the clinic managers' meeting. But nevertheless, there we sat: managers of the family care clinic, the pediatric clinic, the surgery clinic, and the specialty clinic, with several of the techies from upstairs sitting along the edges of the room in shadow-like attendance, and the chief of clinics presiding.

It was as I forced myself to hear past the wailing and gnashing of teeth that I realized the predicament the meeting attendees were in. All of them had been given some modicum of power. They ran their clinics, managed the employees, dealt with the day-to-day issues in their workplace, and often, they would step in to assist in the event that the clinic was short-staffed or needed help. But at the same time, a great deal of influence was being exerted on them from above.

They were a unique fusion of nurses who were still frequently at bedside, working in the trenches next to their employees, but who were also aware of what was going on two levels above their heads and the stresses of running a hospital as a business. As I listened to the managers talk, it was obvious to me that many of them knew--perhaps better than anyone else--what the problem was, where the solutions were and how to implement them. They could see past the tools and instruments used to measure performance and access to care into the bigger issue: were those tools accurate? Did they truly reflect what was done at bedside? Did they make sense with the reality of care--not the reality of a board meeting of directors who haven't practiced in 10 years--but the care that occurs every day on every floor of our hospital?

It was also obvious to me that, as middle management, they were largely unable to change many of the problems that plagued them. They were in the awkward position of having a great deal of responsibility with very little authority. Sure, they had tried to explain to this bigwig about why X, Y and Z didn't make sense when dealing with Issue A, but upper management in their infinite wisdom simply couldn't understand the practical advice coming from someone who stood in the balance between corporate nursing and the bedside.

And so ensued a long, arduous meeting about why this tool wasn't right for measuring this metric, why this system didn't make any sense and should be tossed out a window with the upper management in hot pursuit, and by the end of the meeting, I was quite convinced that the men and women in that room were the only entities standing between the hospital and total disaster. Eventually, the quibbling quieted into a friendly banter, the discussion of the issues died and the managers' meeting concluded.

I thought back on the managers I've had over the past couple of years. Suddenly, I understood why they always seemed so frustrated. I understood what they meant when they couldn't get something fixed as fast as we would have wanted them to. I understood what they meant when they had something that made sense that they simply couldn't get pushed through the system. They were experts in two areas: the daily drag of patient care and the hustle and bustle of hospital management. And yet, for the intricate knowledge they had of the very thing that drives good hospital ratings, safe practice and happy employees, they exerted little control over the latter--over the tools and policies used to interpret, guide and measure bedside practice.

"Clowns to the left of me, jokers to the right". For middle management, a truer phrase was never spoken. Thank you to all the nurse managers who advocate for their employees and try to make the upper management as relevant as possible.

As for this happy non-managerial nurse, I will try to be less of either the clown or the joker depending on which side of the boss I find myself from now on!

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SoldierNurse22

About SoldierNurse22, BSN, RN

I am a first lieutenant at Walter Reed National Military Medical Center.

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Specializes in LTC, assisted living, med-surg, psych.

A position with a great deal of responsibility and very little authority---sounds like my last job.

Another excellent story, SoldierNurse! You bring your subjects to life in a way that few can match.....it's so easy to imagine this meeting and the people involved. :yes:

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I had this funny feeling you might appreciate this, Viva. :cat: It crossed my mind as I was writing it that you would probably relate.

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Specializes in CICU.

Amen!

And, which is why if I am ever tempted to be a supervisor or manager again - it will more likely be at McDonald's than at a hospital...

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Specializes in cardiac, ICU, education.

I am going to forward this to every manager I know. One of the organizations I speak in recently sent out an email warning staff that after a large merger "We will need to cut 200 full-time FTE positions throughout the organization." Of course, the board and upper management will be deciding on who will get cut. I have a feeling it won't be too many in upper management.

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Great writing! I'm finding management rewarding and draining. I guess I'm feeling enough reward to keep going but, some days. . .

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Specializes in Psychiatric Nursing.

Great writing! I did nurse management for 15 years.

Those meetings you describe so well. The perspective!

The title is perfect!

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

It was also obvious to me that, as middle management, they were largely unable to change many of the problems that plagued them. They were in the awkward position of having a great deal of responsibility with very little authority.

This too is also why I have yet to accept a promotion in the past year. The irony, one of the reasons I originally wanted to go into nursing was because of the opportunities for promotion I was told I would have after x number of years by bedside and in positions of non-management unlike other career fields I experienced. Now that I have the opportunity to be promoted into management, I don't want a management title.

In fact, I have been asked multiple times to accept a Nurse Management position on various clinical floors over the past year and my response is always "No, thank you. I am happy in my current position." I am very much aware of the duties and responsibilities (and stress) of a Nurse Manager (Middle management, where I work) and the lack of authority they seem to have to really make a difference. I might change my mind at some point in the future, but right now there is no way!

I make good money and have a flexible schedule. I have stress too, but I am able to leave work-at-work when I get off. I am not on-call for any reason and I am able to give report to the on-coming shift and leave my troubles at the hospital doors. I am very very happy as a non-manager and know that will not be the case if and when I move into middle-management. BTW, like you, I too am grateful to the nurses that take such positions and I too support him/her the best way I can to make their job/shift a bit easier.

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