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???

[DatMurse]

There is a saying, if you don't like the way things run, get into a position to make a change. Sick and tired of people complaining that wont give feedback to the NM and wont give suggestions. Not all NM are great, but the ones I had have tried. The upper management is the problem. Not lower management like NMs and ANMS.

People need to join committees, in services, practice, etc.

My current floor is new and people sit there and complain but do not offer solutions. They are complaining that they are short. Nurse Manager is offering double time for people to come in and the nurses are still attacking her saying she isn't doing anything.

You have 2 sides wailing on you and its hard to make people happy. I tip my hat to you

[BeenThereDoneThat74, MSN, RN]

The best nurse manager I've ever had was just a few years ago; I appreciated her because she LEFT US ALONE. By that I mean, she trusted us to manage our schedules after she put it out; if we needed to make a trade we did it and left her a note. She didn't have to "approve" it. If we got to work and the census was low and someone wanted to go back home, or leave in the middle of a shift, we let them; took turns. Didn't have to call to get approval. In fact, we tried to not take advantage of her generous staffing, and not ride the clock. We didn't have an endless stream of memos, emails, etc, about what we "couldn't" do, or "must" do, or need to "try harder" on. She seemed to stay in the background, and I learned later that much of her time was standing up for us in hospital board meetings, doctor meetings, and admin meetings. She always fought for good staffing. She had been a staff nurse. She staffed us well; and I don't ever remember having a request for time off denied. She didn't work on the floor very often, but if the ER went crazy she was there. We also didn't have "mandatory" meetings; I don't really remember many meetings at all. If there was some info that we needed to know she put a typed note in the break room so we would ALL eventually see it. Some would probably call her very "hands-off" or a "do-nothing" manager. I however, found it very refreshing, after 35 years of nursing and feeling like we staff were treated like junior high age people, that we were treated like professional adults. And I believe it caused us to rise to it, and we took care of many problems on our own.

This was in a very small rural hospital, and might not be possible in a large hospital.

As you said, it may not be possible in a large hospital. It also may not be possible in some smaller facilities either. It really depends on the culture of the unit. I could see many places where the staffing you mentioned wouldn't work. I am not a manager, but am in a lateral position, so I observe and hear a lot (from both sides). I see units where everyone wants the same days off, and everyone puts themselves on the same days, and refuse to budge. They plot in their own schedule, and the NM or ANM has no choice but to deny.

As far as memos (what can and can't be done), curious to know, how was this information disseminated then? New policies, situations that staff NEED to be made aware of (as a result of sentinel events, etc) can't be left to chance, hope that the staff gets the info. It can seriously backfire, because the first thing the nurse/CNA/other staff member will say is 'nobody ever told me about that'.

I consider myself to be more 'hands off' in my approach of things, this is why I ask. I am not a nag; I can't stand that 'mommy' mentality. But in my experiences, sometimes it is necessary. I hate for it to have to get to that point.

[BeenThereDoneThat74, MSN, RN]

Night nurses might need to get home to get their kids off to school. Or their spouses need the car to get to work and the Night nurse is going to do child care all day while needing to sleep. Just sayin'.

Day nurses have the same issue. The bottom line is, there is no good time for a staff meeting. Day nurses are running out the door, night nurses can't keep their eyes open in the morning (and are also running out the door). Meeting need to be held more than once. I see this in my current workplace; the NM stay late to have the meeting on the night shift. They come in late on those days.

For the record, I am 'shift neutral', in the ongoing wars. I have worked days, nights, have never been a manager (but a house supervisor) and am now a staff educator, who works primarily nights. I hear the night nurses complain (directly to me, but almost always in a professional, respectful manner), and I overhear the day nurse complain (on my way out) about the NMs. I work closely with the NMs now, so I literally see every side.

[JWG223]

I guess my real question is this: Where in the hell were you when someone ELSE was the NM? Are you that clueless that you didn't pick up on how things went while you were working the unit you say you came from, which is the same one you are NM over, now? Did you not overhear and even form your own opinions on what was BS, and what was good stuff from management? I completely glossed over that. You lived it...and now you need help from someone on the internet to understand it. I don't think we can help you. "You forget your father's face!" is very appropriate here.

[VerbalGrl715]

I agree you have a thankless job. You seem like a nice person and you try to be a fair and respected nurse manager. However, at least 90% of the nurse managers I have worked for are the embodiment of pure evil. I'm sure they weren't the nicest people to begin with but they have let their job destroy them. I seriously don't know how they sleep at night with the terrible things they have said and done to their staff. Don't let that happen to you. I don't really care what people think about me but I never want to be hated like that 90%. I believe in karma too much.

[albachiara]

Nurse manager is a very stressful job, not easy. Unfortunately very few nurses are able to manage and become very good at this job. They accept the role because they want to make a difference, and are motivated. First they need to find a leadership style that fit their believes and the one that is right for the unit and facility. They also need to learn how to gain the trust from the nurses and have their support. With this said:

I lately do not have any respect for nurse managers unless they prove themselves that they are worthy of their position. I do not have the time to educate nurse managers while my work is overloaded and can not waste my time explaining why a patient found on the floor is an occurrence, do not have the time to explain step by step in certain situations the policy and protocol, and the why, and then re-explain all over again because the nurse manager still does not understand; why readjust a medication time because it interacts with other meds given on the same time, why a doctor ordered IVF to lower the sodium and why the doctor prefers one solution versus another, and I like this one what is a QT?” When her questions are answered: her answer is a big and prolongs OH”.

It is difficult to have the nurse manager understand that she cannot interrupt with asinine questions during a med pass, not once, but multiple times, and most of the time is not important and she can wait or look it up for the information. I am doing her work and mine. I am also correcting her when she mixes patients. My facility likes to add extra work to the day shift because the following shift have admissions and the night shift cannot call doctors during the night and cannot wake patients. Nurse managers have more excuses and understanding for other shifts instead of the shift that they work. Day shift has admissions too, doctors ordering/calling doctors, family members asking questions, pharmacy calling, consults, PT/OT for 2 hours, everything that the night shift passes on the day shift, and so on. Day shift is buried with work. Instead of making nurses accountable when work is not completed nurse managers' solution is to add more paper work. My facility is e-chart but they add paper work example nurses signing accountability to ensure that CNA completed their work at the end of shift, and writing vss for each patient and so on. In the eight-hour shift I write vss in the paper, in the e-mar, and with each BP meds.

Nurse managers during the day shift are hiding in their office. They just get out from the office for meetings, break: breakfast and lunch, and go home on time. After a year being hired as a nurse manager she is not able to make a schedule, which is already done since primary nurses self-schedule. She approves schedule with days being overstaffed and others understaffed. When schedule is finalized I point out the days and tell her to switch my days to have a balanced staff. Nurse managers hate to approve vacation because they do not want to look for replacement. I requested a vacation that then I did not need, I did not make her aware of it. However, after the schedule was finalized this nurse manager gleefully asks, if I forgot of my vacation”. I like this one too from the nurse manager at the end of shift asking are you ok?” answer is no, I am not ok”, she just walks out. I am still waiting for her to make a difference. I can go on forever, I am just mentioning a few faults.

I asked a DON why are they hiring nurse managers that are not well experienced and knowledgeable her response was that this is the type of nurse managers that are in the market and expected to be hiring and, qualification is no longer important and, in the future it might get worse. WOW! If this is the future…...(DON was fired because of lack of leadership). But I believed that for once she was honest because the facility is hiring incompetent nurse managers. I want to say that I work for a very big company (hospital).

Years ago I worked with nurse managers that their knowledge was unbelievable with great nursing skills. They were amazing and I was grateful that I had the privilege of working with some of them. I am able to see the difference and able to work independently. These nurse managers had to deny vacations and they needed to do what it was required for the unit. Some nurses were happy others not so happy.

The difference is that they were confident of their role, and would fight for the nurses if they believed it was necessary for the unit to improve quality of care. They were honest and communicated to the staff new direction. They were also visible in the unit, and hands on. They gained the trust and respect from their nurses. More importantly they gained the support of the nurses.

Today nurse managers are afraid of being stripped of their role and are sheep. They have two years of unit experience and go back to school for their masters. They expect automatically that primary nurse respects them because of their position without gaining the trust. It is also annoying that these nurse managers are being appreciated for their hard work while the primary nurse that was all day long on her feet, without a break, and left the unit three hours later is not being recognized of the hard work. This my current experience with nurse managers at my facility.

I am hopeful that one day I will be working again with great nurse managers that can bring innovation, make a difference, transparency of leadership and honesty.

[avon123]

Who is "they" and that is the reason people cannot stand some nurse managers. Condescending behavior

[I.Am.A.Nurse.]

I am so over joyed by all of the positive responses I have received. I am now reading them as I am riding back to the metroplex. I was not expecting this level of support; I honestly feel refreshed! I am also taking the not so positive comments into consideration... as many of them are also valuable.

Many of you have offered great suggestions. I am doing many of them now, and will try the new ones!

Wow, thank you everyone! I will keep you udated as time goes by.

To answer a burning question: Yes, I was a nurse before being the manager. I was PRN, a staff nurse, a clinical supervisor, and then manager. All within that same unit. It's been an exciting journey!

[I.Am.A.Nurse.]

Yes, skill and talent. That is what I keep hearing and reading! I'm working on it!

[I.Am.A.Nurse.]

I like to influence change. It was easier at the bedside. I only had to pitch my ideas. It's easy to come up with the ideas, but I have learned it's very hard to implement the ideas. I work for the unit, I hope to create a unique culture - something we need a boost on.

[avon123]

Jwg223, exactly. Where was she? What exactly is the op looking for? Sympathy?!

[avon123]

Exactly, Sunny time. Op is looking for sympathy. If you can't stand the heat, get out of the kitchen