What happens to your integrity when you go into management?

jnette, ASN, EMT-I · Nov 16, 2003

Thanx, Steph. Hard to fit everyone into one mold, right?

I must say at our dialysis clinic, our DON/Clinical Mgr. spends nearly more time on the floor with us than in her office. She carries those 30# bicarb and acid jugs along with the rest of us, takes her day doing "water" and all the stocking, carrying, etc. that goes along with it. She had foot surgery on Friday and was back to work on Monday... two pins in her foot. She's out there on the floor with us taking her share of patients, rolling along on a stool... and a crutch when she has to stand. She spends much of her weekends catching up on her office work she puts aside to help us out during the week.

So no.... not ALL nurses who go into mgt. are ....fill in the blanks.

I'm grateful for ALL GOOD nurses... be they the brand new grad or a nurse manager.... they are a joy and privelege to know and work with. :)

Audreyfay · Nov 16, 2003

Olympiad...very nice post. Sometimes I wonder if it isn't the "Peter Principle" in action. The middle manager is about the worst position to be in. Those who are great managers are expert jugglers and I tip my hat to them. I "attempted" nursing management at one time and ABSOLUTELY hated it! I have had some great managers, and some poor. The great ones, want to be great. The poor ones want their paychecks. Is it different in other areas? I suspect No.

kathyann · Mar 10, 2004

I've been a nurse a long long time and have worked in a variety of roles, now a CNS for the past 10 years. My question is for all those nurses who have chosen administration/management roles. I ask: What happened to your integrity? your sense of what is right? Where is your backbone? Have you all forgotten why you went into nursing in the first place? Are you so desperate for your job that you are willing to give up on your values or do you even know what they are any more? Time and time again I have heard nursing administrators "talk the talk" of "quality" "optimal patient outcomes" and "accountability" . And repeatedly I see these very nurses backing down , failing to support their nursing staff and avoiding a confrontation with physicians . We all talk about things like "shared accountability" but in reality it is all about keeping physicians happy. Lousy physicians are allowed to practice poor medicine without repercussion. All the while we as nurses are put in positions of having to work along side them, risking our own licenses and compromising our integrity. I'm sick of this. No wonder nurses leave the work force in droves. Why should they even pretend they can make a difference when those who have the authority to speak up back down.

You sound very frustrated with your nurse manager, and that is a shame...really. But, not all managers are like this and if you are truly as frustrated as you seem, then perhaps you should air your frustrations on a more useful venue...such as in your facility's DON office.

kathyann · Mar 10, 2004

From what I see there is one very specific cause for this change in behavior. Nurse managers are salaried. The only way they can be adequately compensated for the 50 plus hours they put in is through their bonus. How do they get that bonus? The bonus comes from a percent of what they come in under budget. How do they come in under budget? They screw their staff every chance they get out of pay. They leave positions open so they don't have to pay bennies and mandate overtime. They keep supplies so low that it causes shortages. The list goes on and on. I have said before the practice of paying bonuses should be banned.

Where are you that the nurse manager's are paid bonuses??

I want to apply!!:)

Sorry, but this practice is not happening in my corner of the world....and I have truly never heard of this. The only people getting large bonuses in healthcare that I have seen are CEO's, not nurse managers.

In my department, it is a struggle to get everything approved that I asked for in the budget-coming under it is impossible!!!

movealong · Mar 10, 2004

I've known good managers and bad. The good rolled up their sleeves when we are short on the floor and pitched in. The bad don't care.

I had a girlfriend who was a manager for 3 years or so. She said she had "golden handcuffs", meaning her salary was good enough to make her want to stay in that position, though she didn't like alot of aspects about it. After 3 years i think, she stepped down and went back to the floor. She and I worked in a hospital where we were unionized. As a manager, when a strike was looming, she would have had to cross a picket line, and she wasn't for doing that....

Quicksilver · Mar 10, 2004

Here we go again . . . making blanket statements. ALL nurses who go into management do not become unethical or lose their integrity or forget where they come from.
sheesh, what cruel stereotypes.
Our nurse managers work very hard to make sure we have adequate staff. They pitch right in and help if we need them. Our DON and the administrator of our hospital do not favor the docs at the expense of the nurses. Actually, our docs for the most part are pretty good.
Not everything is perfect but life is not perfect.
If you are being treated badly, you have no one but yourself to blame for putting up with it.
steph

Thank you steph for that.

Speaking as someone from the other side( I wasn't a manager but a supervisor) it's true that there are both good managers/supervisors and really bad ones. Making blanket statements about ALL administrators is not good. I beleive any manager/supervisor who favors docs or administration over the nurses on the floor has no business in that job. After all, administration should be there to SUPPORT the staff, without the nurse at the bedside, we'd be no where. Give the ones who DO try to help make things better for the nurses a little credit.

Commander Vimes · Mar 12, 2004

Very broad statements from a lot of people.

the reality tends to be that when we go into management, and there are many different levels, you tend to become involved in a wider context within the organisation, therefore your priorities change. As a rehab manager i am looking after the whole system. As a staff nurse my concentration and focus is purely on my immediate client. The managers position is such that other influences that are external to your control impact upon the care on the shop floor. A good manager will fight for what is ight but also be aware that others are also fighting for their own patch. The impression is then from the shop floor that they are not Shouting and Screaming for the rights of their own immediate staff and patients. A false impression. The higher you go the more aware you become of the external forces that influence the care you deliver. Its a cut throat world we live in. :imbar

Darchild77 · Mar 12, 2004

In my hospital, the L+D floor has no NM!! The hospital supervisors have stated on occasion that they think we are lazy on our unit, and get a kick out of sending us "difficult" or complicated cases if they can get away with it. And as for our DON, she says that no nurse is "indespensible" and that if we don't like it we can go somewhere else. Our hospital is a city owned facility that places way more importance on retaining doctors not nurses.

Commander Vimes · Mar 13, 2004

Sounds like you got a clear case of bullying and harrassment. see the union.

caroladybelle, BSN, RN · Mar 13, 2004

In my hospital, the L+D floor has no NM!! The hospital supervisors have stated on occasion that they think we are lazy on our unit, and get a kick out of sending us "difficult" or complicated cases if they can get away with it. And as for our DON, she says that no nurse is "indespensible" and that if we don't like it we can go somewhere else. Our hospital is a city owned facility that places way more importance on retaining doctors not nurses.

Been there.

Done that.

Heard that.

Quit that, and am so happy to be away from, that.

I became a traveler, and virtually every manager that I have worked since has been so amazingly wonderful and appreciative of my talents since I left that facility, it is unreal.

If enough "despensible" nurses leave, then administration will learn how indespensible we are.

renerian, BSN, RN · Mar 13, 2004

I see you all have had crappy managers. sad. We are not all like that.

renerian

nightmoves · May 4, 2004

Please don't make a value judgment until you have walked a mile in my moccasins.

I have been a nurse manager for the past eleven years, prior to that I had been pushed towards assuming a leadership role for five years, so I decided that perhaps somebody or something was trying to tell me something and perhaps I had better listen.

It is frustrating to have to balance needs of different groups, juggle budgets, listen to people who do not want to see you until they have a problem and then expect you to fix it, preferably five minutes ago. I have been in the position of working for some really bad nurse executives who are so busy sucking up to hospital administration, wealthy contributors, and the medical staff that I doubt they can even find the floor. I am not salaried (I am overtime eligible, but administration has a way of making your life miserable if you try to claim overtime,) and routinely put in forty-eight hour workweeks.

The only reason I stick with this job? I get to be a role model. I'm not above picking up a bedpan, starting an IV, or covering for breaks and holidays. I would miss patient contact if I didn't, and it provides me a chance to maintain my skills, assess patients, and assess nurses' performance. Once in a while I get a chance to impact the system by working with it and improving things in some small way for the nursing staff I am privileged to work with. I despise it when I hear nurse managers refer to "their nurses" (after all, they outlawed owning people in this country in 1864) and I do not ask staff to do anything I would not do myself. I have informed upstart physicians that I was doing surgery when they were fingerpainting, have formed some collegial relationships with other departments, and yes, I have some enemies. I almost enjoy the young nurses who present themselves stridently as "advocating for patient care" and sometimes make my life a little more difficult, they remind me of myself so many years ago when I thought the mean old supervisor never worked at the bedside herself and was clueless as to what it took to do so.

As a child of the 1960's I learned that the best way to change the system is to work within it. That is why I took this job. Sometimes I get real lucky and can do something really positive. The high I get from that carries me for a good six months, through the times when the overtime budget is off the chart, there are eight people out on sick leave, and a struggling orientee who doesn't seem to "get it" and leaves me no alternative but termination.

I decided a long time ago that I am the one who has to look at myself in the mirror, and that as long as the Creator and I approved of my actions, it didn't really matter who else did or didn't. I go to work and do my job, which sometimes means confronting a nurse who should not be supported. I don't like this but don't shirk from it. I guess I have set limits enough that the physicians we encounter do not throw temper tantrums, and I recall pushing one sexually preoccupied attending into the treatment room after he pawed me, getting into his face and telling him that if I ever caught him doing that to any nurse under my supervision never mind the human rights committee, I would get on the phone promptly and call his wife. (The look of terror on his face was priceless.) I do not play games like screaming on the phone to other people in front of the staff so that staff will think I am supporting them, but I try to resolve issues one on one with other managers and departments. I'm no saint. Sometimes I hate my job and want to just hop a jet to some tropical country and sip a Mai-Tai. Sometimes I get good ideas and can implement them. Sometimes I'm successful. Sometimes I'm not. Sometimes I make mistakes. I admit them, learn from them, and move on.

So I don't know where I'm going with all this, and I volunteered for this, so I don't pity myself. I just ask that those of you who do have aspirations toward nursing leadership to remember that the manager peering over his or her reading glasses at your documentation, your schedule, or your sick leave usage is a human being and an RN.