What happens to your integrity when you go into management?

melsch · Jul 22, 2004

The problems I have noticed with managers is that they don't communicate with their staff. Our managers would seem to make decisions which would effect the staff and residents without speaking to staff or residents about the changes. This led to feelings of distrust between management and care staff so that even when managers made decisions which could have made things better in the long run staff would fight the changes.

If you are in management please let the staff under you know when you are going to bat with upper management for them and what the outcome was. Even if nothing changes the staff know you were willing to try to fix the problem and that it is out of your control. If you don't let them know this then they will assume that the problem is you and will feel that you won't support your staff.

RNPATL, DNP, RN · Jul 28, 2004

I am actually on the verge of making a decision to move back into management as we speak .... I am finishing up my interviews tomorrow. As a nurse that has been in management, but has also worked the floor as a staff nurse, I can really see both sides. I think most nurse managers really want to do the right thing for the right reasons, but due to pressure from the senior management, end up not speaking their minds and become somewhat powerless to really direct and manage their unit as well as impact quality of care.

My experience as a manager has been tough. I am viewed many times as the voice of the nurse .... always asking how this policy or that policy will impact the nurse providing care or the patient receiving care. Voices like mine are needed in management. Sometimes however, that can be a frustrating role to play and at times does not win friends or influence people. The toughest part of being a manager is not dealing with senior management .... it is indeed dealing with the nurses. Many nurses have a pre-conceived idea of what a manager is and no matter how hard you try or what you do, it is not enough. Certainly, this does not reflect every nurse, but it does many.

I know for me, as a manager, I must know in my heart that the decisions and the actions I take each and every day are actions that I believe in. I do believe in my personal and professional integrity, I am honest and fair and try, oh so hard, each day to make the lives of the nurses a little better. Somedays it works and some days it does not. But I will end this long ramble by saying that I have a great deal of respect for the nurse managers that face this challenge everyday. Likewise, I have a great deal of respect for the nurses that have to deal with ineffective nurse managers each day. And, I can understand why so many nurses do not believe in or trust their manager.

shellasee · Sep 3, 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.

Wow, I'm a nurse manager who is salaried and works 50 hours a week. Can you tell me what hospital you work at that gives bonuses for that? I lost money the last 2 years as a manager, and I can't get a second job because all my time is taken up by my manager job. I don't want to even calculate how much money I really do make because I don't want to cry. I also struggle everyday with decisions I don't like and with defending my staff. Then I get to go home and continue to get calls throughout the night, just so I can screw my staff every chance I can. I even lay awake at night dreaming of ways to do that. Maybe I should move to your hospital where it sounds like I can be guilt free and get extra money.

Please!! Not every hospital or manager works like this. If anything our staff run the show. We have implemented a shared governance. We got a director that got us 21 new nursing positions her first 6 months on the unit because the staff came to us with a problem and a way they thought it should be solved. Implemented 12 hours and 8 hour shifts. MOved senior staff off of weekends if they preferred. Weeded the garden of the negative staff that were bringing the moral down for years (as told by their peers). Arranged for an LPN to be taken away from the bedside to spearhead organizing the supplies and equipment that always had to be hunted for, AND took the heat for the overage of FTE's by having her do charge recapture and showing how much money she was finding that wasn't being charged for. She more than paid for her salary and probably more. If you work for a manager who has "crossed over to the dark side" then maybe it's not the manager, but the organization. Why would you choose to stay in that kind of environment.

nursemaa · Sep 3, 2004

Wow, I'm a nurse manager who is salaried and works 50 hours a week. Can you tell me what hospital you work at that gives bonuses for that? I lost money the last 2 years as a manager, and I can't get a second job because all my time is taken up by my manager job. I don't want to even calculate how much money I really do make because I don't want to cry. I also struggle everyday with decisions I don't like and with defending my staff. Then I get to go home and continue to get calls throughout the night, just so I can screw my staff every chance I can. I even lay awake at night dreaming of ways to do that. Maybe I should move to your hospital where it sounds like I can be guilt free and get extra money.
Please!! Not every hospital or manager works like this. If anything our staff run the show. We have implemented a shared governance. We got a director that got us 21 new nursing positions her first 6 months on the unit because the staff came to us with a problem and a way they thought it should be solved. Implemented 12 hours and 8 hour shifts. MOved senior staff off of weekends if they preferred. Weeded the garden of the negative staff that were bringing the moral down for years (as told by their peers). Arranged for an LPN to be taken away from the bedside to spearhead organizing the supplies and equipment that always had to be hunted for, AND took the heat for the overage of FTE's by having her do charge recapture and showing how much money she was finding that wasn't being charged for. She more than paid for her salary and probably more. If you work for a manager who has "crossed over to the dark side" then maybe it's not the manager, but the organization. Why would you choose to stay in that kind of environment.

Thank you!! I'm a nurse manager, too- 50 hrs/week, paid for 40, plus all the phone calls from the off shift supervisor when they are having problems. I take work home, have come in (in addition to the 50 hours) to work as staff at times, sometimes after a 10 hour day and no sleep! At least the staff nurse has the option to say "no" when called to work extra. No bonuses, not even a whole lot of appreciation from some staff members- but a significant amount of complaining and backstabbing. But no matter what I do, it never seems to be enough for some staff. I will grant you that I chose this job, but if I had known then how unappreciated I would be and how many times I would have to remove a knife from my back.... anyway, not all managers are bad. You have to remember that you may not be aware of all the "behind the scenes" work that a manager does that helps you. And many of us do fight for and defend our staff, but we aren't usually the final word...everyone reports to someone, and those above us may say "no" regardless of how hard we fight. And yes, sometimes we do have to make decisions that aren't popular. Just like sometimes you may have to do things that are unpleasant or uncomfortable for your patient in order to produce the optimal outcome.

RNPATL, DNP, RN · Sep 3, 2004

Wow, I'm a nurse manager who is salaried and works 50 hours a week. Can you tell me what hospital you work at that gives bonuses for that? I lost money the last 2 years as a manager, and I can't get a second job because all my time is taken up by my manager job. I don't want to even calculate how much money I really do make because I don't want to cry. I also struggle everyday with decisions I don't like and with defending my staff. Then I get to go home and continue to get calls throughout the night, just so I can screw my staff every chance I can. I even lay awake at night dreaming of ways to do that. Maybe I should move to your hospital where it sounds like I can be guilt free and get extra money.
Please!! Not every hospital or manager works like this. If anything our staff run the show. We have implemented a shared governance. We got a director that got us 21 new nursing positions her first 6 months on the unit because the staff came to us with a problem and a way they thought it should be solved. Implemented 12 hours and 8 hour shifts. MOved senior staff off of weekends if they preferred. Weeded the garden of the negative staff that were bringing the moral down for years (as told by their peers). Arranged for an LPN to be taken away from the bedside to spearhead organizing the supplies and equipment that always had to be hunted for, AND took the heat for the overage of FTE's by having her do charge recapture and showing how much money she was finding that wasn't being charged for. She more than paid for her salary and probably more. If you work for a manager who has "crossed over to the dark side" then maybe it's not the manager, but the organization. Why would you choose to stay in that kind of environment.

This was a great reply! I feel your pain and totally undersand what you are saying. Not sure how many nurse managers actually get bonues, but I don't! And, even if the hospital changes that policy and I am eligible for bonus, why would anyone want to "screw" the staff out of pay? Seems like the poster of this message needs to look for a new job if that is how their managers are working.

Tia*Rae · Sep 4, 2004

I work in an exceptional VHA hospital in the midwest....have for 24 years and I can tell you our nursing management will put up with very little BS from Docs, whether it be questionable patient care or bad behavior towards the nursing staff. I have seen and known of countless times when a situation was reported and direct action taken immediately by our DON with the Medical Director standing right beside her. About 8 months ago our Director actually got an ortho surgeon suspened for 1 month for horrible behavior towards one of the surgery nurses. Our Surgery Director feels we have a unique hospital in that if he goes out on the limb for us the higher ups won't cut the limb off while he's out there. Sometimes you can find Management who keep their integrity just fine but they won't stay with an organization that lacks a backbone. We also have very little turnover and virtually no nursing shortage. Our patients feel this positive energy. I think, if I ever work in another healthcare environment, I'd not last 1 month in place that didn't take good care of our concerns. But they are out there. I feel bad for anyone, patients, physicians and staff going to the kind of place you decribe. Do not for one minute let this affect your own sense of what is right or wrong. And what you describe is just wrong......period. And doesn't always happen.

bobbiesal · Sep 4, 2004

I've been a manager for going on 8 years now. I hate it. I'm really good at...but I HATE IT!!!!!!!!!

I'm good at it from the staff's perspective, I STILL get asked to come back, people I did disciplinary action on still want to work for me, people threaten to quit if I leave. I'm good at it from the doctors' perspective, I earned their repect, changed the behavior that was detrimental to patient care (like telling staff to clear their scedule a day ahead of time), managed the budget from a deficit of 11% to a profit of 25% (where are those bonuses being given?)

Administration likes me, except for when I point out things just a LITTLE too loudly to certain departments (like PR).

I took my current job because it wasn't a management position, well, guess what? Two months after starting, they got rid of the supervisor, giving me two full time positions...do I get paid for both, he**, n o!

I don't like being responsible for the way others spend their time, I don't like budgets, I don't like meetings, I don't like not being able to hands on care.

Despite the "virtual nursing shortage," despite the fact I'm a PNP who has seen patients throughout the past 7 years...NO ONE WILL LET ME WORK AS A STAFF NURSE! I could care if I'm over-qualified...why can't I make that decision...

Middle management is a very difficult place. You have to answer to staff & upper administration. One thing should guide every decision you make - Is this right? If the answer is no - and you can back it up - then you're always able to say no to senior administration with a clear conscience. I've done it several times, without repercussion, & have later been praised for my integrity!

barefootlady, ADN, RN · Sep 12, 2004

Friday, I was returning from my patient visit, and I saw all of the NM/CM were out of the office. I went to the temp desk I have been assigned, only to learn all of these managers were in a room accross the hall with the door closed yelling at each other. Seems that no manager wanted to take call for this weekend. I just did my job and attempted to ignore the noise. After the meeting, as the managers were filing back to their offices another nurse came up to my manager and told her she had just gotten a call from home and had a personal emergency, she had to leave and go to the hospital. This manager went balastic on this nurse and told her she had too many emergencies and this one would have to wait. Well, to make this story short, the nurse said "NO, I am leaving, my son was hit by a car." She got her purse and was out of the door. As a new employee, less than a year here, I am wondering, what is so important to each of these managers lives they cannot and will not take call this weekend, but when another nurse gets a call like this one, they tell her the job comes first. I will be looking for another position soon. Just have a few more bills to pay and I am back to med/surg even if I have to move.

RNPATL, DNP, RN · Sep 12, 2004

Well, let's see, after putting in almost 60 plus hours this week, I have received greater than 15 calls this weekend concerning everything from staffing to problem patients. There is simply no time off for a nurse manager. This is unacceptable. Barefoot .... I would certainly never restrict a nurse from leaving work due to a personal emergency. However, if this is a regular occurrence, then as a manager, I would certainly question it.

As far as taking call .... I am on call 24/7. End of discussion. Even if I have someone handle staffing for me over the weekend, the buck stops with me. It can be a very difficult situation overall, but you learn to manage. I know for me, if I have had a really tough week and have not been able to spend enough quality time with my kids, I get very protective over my time off (which is not a lot). That time off is reserved for my family. I can understand why there were questions about who would take call for the weekend, but that is certainly no excuse for yelling and screaming at each other.

I get along very well with the other nurse managers and rely on them as friends and peer associates. I can not imagine ever yelling and screaming at them.

Good luck with your transition back to MS. Please let us know how that goes! :)

nursemaa · Sep 12, 2004

Well, let's see, after putting in almost 60 plus hours this week, I have received greater than 15 calls this weekend concerning everything from staffing to problem patients. There is simply no time off for a nurse manager. QUOTE]
Sounds like my week! I worked my usual time as manager, then worked some off shift hours to fill in as staff. Came home Friday evening (very late) exhausted! I too receive numerous calls over the weekends regarding staffing. I'm seriously considering returning to the bedside after 10 years in management. It's draining and you can't have a life at all....yet staff continue to make comments like "you don't know how hard we work", "you don't know what it's like", "must be nice to have an easy mon thru fri job" etc, etc...

RNPATL, DNP, RN · Sep 12, 2004

Well, let's see, after putting in almost 60 plus hours this week, I have received greater than 15 calls this weekend concerning everything from staffing to problem patients. There is simply no time off for a nurse manager. QUOTE]
Sounds like my week! I worked my usual time as manager, then worked some off shift hours to fill in as staff. Came home Friday evening (very late) exhausted! I too receive numerous calls over the weekends regarding staffing. I'm seriously considering returning to the bedside after 10 years in management. It's draining and you can't have a life at all....yet staff continue to make comments like "you don't know how hard we work", "you don't know what it's like", "must be nice to have an easy mon thru fri job" etc, etc...
Over the years, I have often thought about why nurses berate their nurse manager. We do work hard and we do work a lot of hours. I am not sure why it is that nurses feel like managers do nothing. Granted, there are managers that do not participate and do not help on the units, but like you, I am not one of those managers. It is my philosophy that if you have a good manager, one that you can respect and work for and espcially if your manager is fair and works hard for you, then why would you want to abuse this person, for fear that your next manager may be a real jerk!
I guess it all comes with the job and that is how it is. Sorry to hear that you are considering leaving your management position, but I certainly understand your need to have some time for self. That is hard to come by as a nurse manager. Good luck!

HarryPotter · Nov 8, 2004

Well, this is a very interesting discussion.

I recommend to you all a book called "The Essential Drucker."

Management is not a bleak reality, but it takes guts and a willingness to step out of comfort zones and make a difference in your workplace reality.

I did in mine, and I found my manager very grateful for the steps I took that impacted my workplace in a very positive way.

I really relate to the manager who wrote, telling about how much she cares. Being a manager is a very tough job. Good managers create team-work, respect, growth and development, a positive culture within the workplace.

Unfortunately, the norm is what I have read from most of you, but, really you have the power to transform your workplace. Being silent, or complaining without taking positive action is deadly.

This is a very important topic, as the role of a Business is to Society. Business has a responsibility to its employees, and to their community.

Hope I don't come off as being harsh. My intent is to help create positive work environments. Looking forward to this discussion. Lynne