The Enemy... The Nurse Manager

[I.Am.A.Nurse.]

Do you know what it's like to not have anyone like you? To know that everyone hates you? That's my life as a nurse manager. They now see me as the enemy. I have to deny vacations, write people up, give not so good performance evaluations, tell people how to do their job better, short the unit. They think I am sitting in my office everyday doing nothing when I am drowning in work. Blah!!!! I spend almost all my time in meetings. Sometimes I literally have 30 minutes outside of meetings. So then I work at home or on my days off. When I am in my office, sometimes I close my door. I literally cannot get a thing done when my door is open because people always come in to talk. I cannot send people away because I don't want to unapproachable.

What they don't know is how hard I fight for them. They forget about all the new equipment I fight for. They forget all about the changes I have made so they have it easier. I talk about these in our staff meetings but very few people come. I send out weekly emails but people don't read them.

I was so happy to take this job. It has proved to be the hardest job ever. I have senior leaders handing never ending tasks down to me and staff level employees complaining so much. It's exhausting. Was I like that as a staff nurse?

Balancing the schedule for 70 people is nuts. No one gets 100% of what they want. That makes people very angry but someone has to work!

People complain and gossip but refuse to get involved. They won't come to staff meetings, they won't join committees, they won't offer solutions.

I love my job and I love the team. However; it is so exhausting. I am on call 24-7. People tend to forget that too. I respond to calls and messages all day long.

I just want people to meet me in the middle.

I try to get to know the staff members, send thank notes monthly, ask people what they think.

I can't seem to get ahead. I think a big part of the problem is that I came from this unit. People wonder why I got the job. I'm sure some people even hate it. No matter how hard I try, I can't get them to understand that I work for them. I want them to grow and succeed. I want us to be a great unit that everyone wants to work on.

Any tips??? Any advice???

[Sour Lemon]

That sounds like a job with a lot of responsibility and no power ...the worst kind.

I decided that staff meetings were a waste of my time before I even got off new grad orientation ...and I don't think I've been to one since then at ANY job. It's not that I don't have suggestions, it's that I know they will never be taken. It's a forum for managers to talk to US, not for us to talk to THEM.

I could go on about some of the other issues, but I'm already bored. I've already heard myself say it all too many times before.

I do wish you luck, but you may not find any. 

[Davey Do]

Welcome to AN.com I.Am.A.Nurse!

I appreciate your straight shooting way, telling it like it is, ranting a bit, and then asking for advice. I sense no hidden agendas here.

I can also appreciate your position as a manager, working long hours, spinning your wheels in superfluous meetings, and lacking support. These are some of the reasons I got out of the management area of nursing and am a floor nurse doing grunt work. I do my job and leave the work when I leave the hospital.

No matter how hard you try to prove the opposite to those you supervise, you're still one of "them".

The very best you, I.Am.A.Nurse in your endeavor work in a fulfilling position.

BTW: If the Mods don't move your thread, check out this forum:

https://allnurses.com/nurse-management-c194/

[VivaLasViejas, ASN, RN]

Been there, done that, got the claw marks on my back to prove it. People can forgive anything but a manager who's risen through the ranks. It's the most thankless job there is, and I feel your pain, OP. ((((HUGS))))

[Nurse SMS, MSN, RN]

This is exactly why I chose nursing education as a specialty rather than management when I went for my MSN. Managers are squeezed from both sides.

I did have one manager who I loved and who really motivated me. She was on the floor all the time. She wore scrubs to work and would keep an ear to the ground about what was going on with her staff and the patients. She helped do things like place a Flexiseal on an incontinent patient, turning and cleaning patients...the stuff nobody likes to do but still needs doing. She would go in and work with the night shift sometimes...not all night, but staying until 12 or 1. She would pick one of us and ask if she could follow us for part of our shift. It was like having a second pair of hands, let her get the lay of the land and a feel for our personalities, strengths, weaknesses and bedside manner. It helped her identify deficits in practice to pass on to the unit educator and it gave us time with her to both know her as a nurse and a person as well as a feel for where the unit needed support. Even if she was unable to make changes, we could see that she was a nurse first and foremost, that what we did mattered. She never denied people PTO. Ever. Were we short sometimes? Yes, but we all knew when it was our turn, we got the time off we needed. She was super good at building teamwork among the staff nurses.

I wish you luck. Management is both a skill and a talent. If you want to be respected by your nurses you have to show them you understand what they do and are in the trenches too. Most people are capable of understanding the pressures you are getting from on high. They need to know you understand the pressures they themselves are under and that you care. My advice would be to get out of your office and get on the floor as much as possible, even if it is just to come out and help turn a patient or answer a call light for someone once or twice a day. They will notice. Believe me.

[Jules A, MSN]

You sound like you are contentious which is a big plus. This is rudimentary but what I can offer as my experience with many NMs is the ones I respected the most and had the most staff support in return were the ones who had significant nursing experience. If someone doesn't have significant experience as a floor nurse in the specialty for me personally it would be difficult to gain my full support and respect because I'm weary of those who have no clue attempting to tell those of us on the front lines how much better things will be by adding another asinine task to our already ridiculous load.

My favorite were those who had the stones to say "Look I know this new XYZ directive sounds ridiculous but its coming down the pike so we need to suck it up and at least try and then if a miserable failure as we suspect it will be we can bring that data back to admin". This approach really gained not only my respect but my loyalty. Forget attempting to put a positive spin on a stupid idea it either makes me think that you think I'm an idiot or that you definitely are an idiot for buying into the latest Florida Wetland Condo offer admin is selling.

[Libby1987]

Why did you leave your bedside position and why were you happy to take this manager position?

[AliNajaCat]

The best nurse managers I ever had --all two of them, in all these years-- both were very clear on three huge points. One, neither was threatened by staffers who knew more about something than they did. They routinely praised us for our expertise and competence, and let us know that's precisely why they hired us and why they had the best-functioning units in the shop.

Two, they let us know, explicitly, that if any of us had an idea that she would let us run with it and see how it worked out. They always had our backs when management tried to make our jobs more difficult, but would go out of their way to entertain ideas bubbling up from staff.

Three, they both gave us very explicit and public support and recognition for our professional and personal growth, whether getting a new certification, taking on a new role, or a particular "win" in some way. They taught us more about what we did by letting us into their worlds, explaining their constraints and strategies.

These were two very different jobs, one in a great critical care unit and one in a business setting, with different goals and management structure. They were two very different people in other ways. But they both had our undying admiration and loyalty....because they made the first move to show us theirs. Caroline S and Laurie G, wherever you are, thank you.

[llg, PhD, RN]

Staff nurses will never fully understand the Manager Role unless they have been managers in the past. That's just a fact of life -- and is true of just about any position that is not the staff nurse role they know. Being happy in any role that is not the traditional staff nurse usually involves having to come to terms with the fact that many nurses will misunderstand your role and think you don't "really work for a living as a nurse like they do" because you are not doing the same job as they do. So, accept that and move on.

However, you can do some things to foster their support of you even though they never fully understand your job.

1. Let them see your work. Tell them what you are doing on a regular basis so that they can see you being their advocate. Instead of saying that you are doing paperwork, say that you are "preparing a report to try to get XYZ improved for them." Instead of saying you are doing the payroll, say that you are making sure their work hours are correct so that they can be correctly and on time this pay period. etc.

2. Don't ever let them say something like, "Oh, I see you working today" when you help them on the unit clinically -- which implies that you are NOT working when you are doing office stuff. Respond with something like, "Oh I work every day -- I just don't do the same job tasks that you do." Of course, say things like that with a smile.

3. Give them updates on your work and progress with projects that are meaningful to them. I have been in mostly educational positions -- but I have had some jobs that were a combination of education and management at the unit level. I found that posting a monthly report of my activities (written in politically wise ways, of course) was very helpful. When people knew what I was working on and how it could help them ... they were much more supportive.

4. I am also a big fan of being as honest as possible. Sometimes, you have to say something like ...."Listen, I have my doubts about the value of this change, too. But we need to give it an honest try. We'll collect data and if it doesn't work, then we'll have the evidence we need to change it to something that will work better." Or ... "Listen, I know this isn't the most convenient thing for us to do ... but it will really help our colleagues in the XYZ department. Let's given it a try to help them and maybe we can figure out a way to make it work for us by adjusting it a bit. But we won't be in a position to help either XYZ or us until we start giving it a try."

Those are just a few thoughts off the top of my head.

[HouTx, BSN, MSN, EdD]

OP - THANK YOU for the plain talk - I love the truthiness of it. This is exactly why it's so darned difficult to recruit experienced nurse managers.... most of them have opted out of this awful role. They've moved into something less challenging and less soul-destroying.

Just a suggestion. Have you explored ways to lighten your load by turning some tasks over to your staff? It takes time and patience to get there, but implementing self-scheduling or even developing a scheduling "committee" is well worth the effort. Staff begin to realize how difficult it is, and they also have some very creative ideas to fill holes, like 4 hour 'mini shifts' to cover holidays (actual example from a department I managed for a while).

Cut back on meetings. Just say "no" to busywork. Honestly, based on my own experience, there are probably quite a few tasks and reports you could skip and no one would even notice. See if you can talk you boss into declaring a 'meeting free' day or portion of a day... then you can use that time period to take care of your own department priorities.

Schedule time to round on your own staff. Try to meet with each one at least quarterly to talk about: 1) their performance, 2) their needs. Schedule some 'early' or 'late' days to ensure that you are present for your night shifters. Make sure to touch base with any weekend-only folks on a regular basis. CELEBRATE - recognize accomplishments of individuals or the department as a whole.

Take time to grieve... sounds weird, I know. By moving into a management role, you have 'lost' access to the warm fuzzies that gave meaning to your nursing practice (patient and family contact). This is a profound change. Your rewards are now few and far between. The stress of maintaining your 'game face' all the time can be overwhelming. If possible, find an expert, seasoned manager to serve as your mentor and sounding board. It can make all the difference.

[AliNajaCat]

2. Don't ever let them say something like, "Oh, I see you working today" when you help them on the unit clinically -- which implies that you are NOT working when you are doing office stuff. Respond with something like, "Oh I work every day -- I just don't do the same job tasks that you do." Of course, say things like that with a smile.

Wonderful. When I was a clin spec and classed as middle management, I wore street clothes and a well-fitting lab coat with my scissors, clamp, steth, and suchlike in the pockets. They got pretty regular use, but I still put on scrubs and worked a shift in the ICU about once a month to keep my hand in. Once somebody said to me, "Oh, Ali, you look like a nurse today," and fortunately I had the presence of mind to say, with a smile, "I look like a nurse every day."

On a related note, in my present role I get asked when the last time was I worked as a nurse. Same answer. "I'm working a a nurse today, counselor." Opportunities for education are boundless.

[MrNurse(x2), ADN]

Nurse managers are the wall between the nursing staff and those who really make policy and impact the staff's life. The huge difference for those that remember head nurses is involvement. I loved my head nurses, they fought for us AND worked alongside of us. Then, academia stepped in and decided nurses were not professional enough and the nurse manager was born, committees were the only way to change things (after months and months of discussion). Managers were pulled away from their units and their staff became names only. Managers were burdened with the oversight of the increasing regulations in charting, so the police role was adopted further and built a greater divide. I understood my manager fought for the floor, but I don't think she fought for the individual, I think she always saw it as it was her against the individual, lest she be targeted by administration and attacked for defending that person. You couldn't pay me enough.