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???

[hluscan]

It is the worst job. I know because I spent 3 years in administration, 1.5 years as DON and 1.5 years as ED nurse manager. I was on call 24/7 gave 100%, got so many things changed to make it better for the nurses, worked many shifts, sacrificed time with my kids with very little appreciation, and still dealt with nurses complaining. I got burned out, left for a staff nurse position and am in nurse practitioner school. My nurses respected me, but that isn't always enough. If you are miserable and giving more than you want to give-get out. Life is more important than money!!

[beemrdon]

Quit! You are perpetuating a broken system. You are a co-conspirator. Walk away.

[MikeyT-c-IV]

Wow, there have been some thought provoking and great input on this thread. I was a NM previously and on a tough day I could easily have been the Nurse pointing out the difficulties of the job. I'm going to go out on a limb and say that most NM's aren't extensively taught how to be a manager. In my case I learned the role like several other jobs, OJT. I have numerous tips but those are too extensive to place on this forum. I'll mention a few:

If you haven't already, form a relationship with your experienced peers. They have or are experiencing the same situations. Seek dialogue with them 1:1 (or small peer groups) and keep the venting out of official meetings. I've seen venting take place in meetings and it just takes away important time from other managers.

Now to address some of your comments: No, not everyone views you as the enemy and not everyone hates you. That is extreme thinking. While it is an undeniable fact that you can't please everyone, some will be very satisfied with you and your efforts. We are working in less-than-perfect conditions (to say the least) and no human is perfect with perfect solutions for every problem.

It's okay to close your office door from time-to-time. There were times I needed to complete a complex audit and the general noise on the unit was too distracting. It's tough when you're on a deadline and can't concentrate. I would put a note on my door stating that I was available. I never turned anyone away when I was needed.

Keep sending your emails. This is the best form of communication to reach your audience. Again, it's extreme to say that nobody reads them. True, there will be some that check their email once or twice a year but you did your job. We asked our staff to check their email at least once a week. If they don't, they aren't holding their end of the responsibility. That needs to be addressed.

Scheduling sucks. I spent several frustrating months ironing out this issue and those surrounding it when I first started the job. Unfortunately I had to "clean a little house" and bring in some new talent. The biggest complaint from the staff was the constant floating to other units. It was a frustration that I shared with them. Again, those are decisions that were out of my hands. I never denied PTO. There were tough days but I was never afraid to get out there and do the best I could with the rest of them.

Dealing with conflict, terminations, and poor evaluations is part of the job. It takes time to develop those skills. But it must be done. Again, seeking advice from your colleagues can be very helpful. Have one of them present and participate when dealing with these difficult situations. It's good practice to have a witness present. Hopefully it's in your hospital policy to be in HR during terminations. Things can get ugly. Be honest on all of your evaluations.

Hiring staff is one of the most important and impactful duties of the nurse manager. I can't stress enough the importance of hiring the right person. I can't explain or tell someone how to do this. I'm not that articulate or interested in cracking open that book on this forum.

Otherwise, let your nurses be nurses. Leave them alone as best you can. There will be those that can't handle the autonomy (take advantage of the situation,) deal with that too. Let them find balance in their work day just as you need in yours. And be sure to round on them daily. Check in and have quick daily huddles.

Again, the job is so broad in responsibility it's impossible to talk about everything here. With all of the variables, initiatives, personalities, patients, staff, and boss's, it's a never ending soul sucking job.

[JinnSchlajfertig]

You couldn't pay me enough!

BTW, I've had fantastic nurse managers. It isn't easy to hear corrective feedback. But I appreciate it because I know I'm not perfect and always want to do better. So hopefully you are not hated!

[TonyaMarie, MSN]

I recently got promoted to a nurse manager within my department and I'm going to tell you what my mom told me, "Make new friends at the level you're on." Shortly after starting I realized that my teammates (now my employees) will never understand my role because they have never been there. It's sort of like telling a person that's never been married what marriage is all about.

I remind myself daily what it's like to walk in their shoes and what can I do to make it better. I know that you're doing all you can but diligence is key. Sooner or later things will turn around. You've made a great career move and your heart is in the right place so don't let the negativity get you down.

I'm rooting for you! 

[klone, MSN, RN]

I am of the opinion that a government which governs least, governs best, and thats how I like my bosses. Leave me alone. Don't bother me. Don't have to really praise me or do things FOR me, either. You hired me because I'm competent and good at what I do, and am very self-directed and effective. SO let me DO.

The problem with that is that you're a rare bird. I'm the same as you. But I've come to realize, as a manager, that most people are NOT like that. Most people WANT that connection, want their manager to be involved, want them to be present.

It's incredibly hard to juggle the vastly differing needs of various employees, and KNOWING what each person needs and prefers.

[klone, MSN, RN]

learn lessons from your manager whether it is something you want to adopt as yours or something you want to stay away from. wahh wahh waaahhh

Are you an angry elf?

[AnnieOK76]

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'.

You are right, it cannot be left to chance and should not rely on "word of mouth." As I said in my original comment, our DON left typed memos and notes in our break/report room on a bulletin board which was strictly for that reason. Some required a signature showing you had read it and could be held accountable for that info. These notes/memos were limited to patient care related issues, and not the constant "reminders" of proper dress code, proper behavior, proper whatever else. Those issues were dealt with one-on-one with the person needing the reminder.

-------------------

"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."

I appreciate that you also don't like the 'mommy' mentality. As for being a nag, and it sometimes being necessary, yes, sometimes it is, but my opinion is that it's best to be a nag only to the person needing the nagging, and not the entire team. Is demoralizing when it doesn't apply to you. Thanks for the conversation. :)

[tokmom, BSN, RN]

I think I would like you as a manager, because you came from the trenches.

I wish my manager would come in at night shift to see how things are.

I wish my manager gave us praise, instead of saying "The EXPECTATION is"

There is no asking...there is only telling..

Busy day the other day. NO staff took a lunch. The only ones eating the pizza the manager bought was one CNA and the manager.

[minnie.tbl]

The nurse manager has a difficult job trying to balance the often opposing needs and demands of superiors and those working for him/her. Often, superiors win out for they hold the purse strings and if you, as a manager, did not take that into consideration, your tenure as nurse manager would be short. That doesn't mean that you do not advocate for your staff, but the 'dance' you must do to advocate for them while not damaging your relationship with superiors is a fine one. I don't believe that staff nurses do not know that; however, I am not sure they appreciate to what extent you go to bat for them. As a staff nurse for over a decade, I have not encountered a manager who has given a glimpse into that to her staff. I am not suggesting that you tell your staff everything you do, but in your weekly emails, it might be helpful to highlight in broad terms some of the issues that your staff have that you have lobbied for on their behalf to your superiors. Let them know that you have raised the issue and then let them know what the response was. This demonstrates to staff that you have both listened and taken them seriously.

Recall to when you were a staff nurse. What kinds of concerns did you have and what type of solutions did you envision your then manager should have been employing? Create a culture of respect on your unit where every voice is heard and every suggestion and idea is given consideration. Make time for these at staff meetings. Ensure that staff know that they are free to speak their mind respectfully and that there are no repercussions to their thoughts. Give all concerns, ideas and suggestions serious thought and respond to them respectfully with explanations. You may have some of your own that you want to bring to a staff meeting. For example, you might want to bring up the issue of gossip and how damaging it is for morale on the unit. You might ask of staff how they might want to solve this and how they might be part of the solution.

On the subject of being the boss when you used to be a staff nurse, you need to recognize that you are now the boss and that relationships with former colleagues will need to change while at work. You can't be their friend and their boss without risking perceptions of favoritism.

Finding time to work on your own tasks while maintaining an open door policy is quite difficult. It requires a great deal of organization and focus of you. It is equally difficult for nurses to find time in their busy day to talk with you on issues. Encourage them to book a meeting with you at a time that suits both. For urgent issues that come up, you will need to be flexible. Delegate where you can. If possible, book yourself a block of time where the door is closed so you can do your work. If necessary, book one office day every month where you are not to be disturbed and have a staff nurse take on the role of team leader to deal with issues.

[englishgarden]

I just don't think managers are able to be present on the floors these days. Administrators are in meetings all day long trying to figure out how to improve the delivery of care. My last two managers were nurses I had worked with and I really respected and appreciated them. I knew these managers were hard working and understood the job I did at the bedside; I trusted they were working to improve or protect both the nurses and the patients. I also appreciated that they knew who I was and the quality of work I do; I never felt like I had to defend myself...they always had my back if there was a family complaint. It's unfortunate that managers don't have more time to spend working along side their employees, improving processes that are specific to their unit. Everyone is squeezed in Corporate America.

[klone, MSN, RN]

I just don't think managers are able to be present on the floors these days. Administrators are in meetings all day long trying to figure out how to improve the delivery of care. .

To me, being on the floor helping out, answering call lights, pitching in when there's an emergent situation, is a very important part of being an effective manager. Once in a while there are days when I have 6 hours of meetings in my day, but most days I can still spend a good chunk of time out on the unit. I have blocked my schedule from meetings at 0700 and 1500, so I can be present for shift report. If I have to spend an hour doing tasks on the computer (like working working on timecards) I will go out to one of the computers at the nurses' station so that I'm not holed up in my office.

And sometimes I just have to say no to meetings. Not every meeting that shows up on my schedule is one I absolutely HAVE to attend. I try to be very protective of my time on the unit. I don't feel a unit manager is very effective if they don't spend at least a small amount of time ON THE UNIT they manage.