What do you do when the thing that makes you a great nurse manager is also your primary source of burnout?

Jedrnurse, BSN, RN · Dec 1, 2019

Three things come to mind -

1. What is the common element(s) of the scenarios in which the units were drowning? Is there a longer-term "fix" you can work on other than showing up in person to the rescue?

2. Do you have a practice of developing staff, particularly your strong ones, so that the burden of unit problems don't always land directly on you? (One caveat- you have to make it worth their while somehow, so you're not essentially punishing good workers by giving them more work without some sort of reward.)

3. Are you sure you want to stay in management?

allnurses Guide · Dec 1, 2019

10 hours ago, klone said:
So, I've been a nurse manager and director of inpatient units for 3+ years now. I'm really good at my job. I am clinically very competent, have an innate ability to foster strong relationships with people above and below me in the hospital hierarchy, and am an effective leader.
One of the things that I believe makes me an effective leader who garners the respect of the nurses whom I lead is that I am good at bedside nursing, I enjoy bedside nursing, and I'm willing to help out when they need someone on the floor.
However, this very trait has caused extreme burnout. I take the whole "24/7 responsibility" thing very seriously. What that means is if they're drowning, they call me, and they know I will be there to help them out. But that often means that I'm working 60-hour work weeks and coming in on weekends.
I'm leaving my current job, but want to figure out how to balance things in my next job, so that I can be an effective leader who doesn't burn out.
Is it possible to be a good leader, while still being able to separate work and home life, and not being available between 6pm and 6am or on weekends to bail them out when they're drowning?

It's tough isn't it, I've been a nurse manager for around 15 years now and will always pitch in the the clinical areas are short staffed. I got to the point where I was working 12 hour days every day and becoming exhausted.

I've had to be more disciplined, I now dedicate only 1 day a week where I work clinically and whilst that 24/7 responsibility is still there you don't share it alone. I try to empower and encourage my team to problem solve and give me other solutions to staffing gaps themselves and often they come through. When they aren't able, then I will pitch in.

beekee · Dec 1, 2019

So the obvious question is why staffing short so often? Hiring? Retention? Budget? Acuity? Inadequate training/skill set?

Maybe focus on the root of the issue.

2BS Nurse, BSN · Dec 1, 2019

Kudos to you. Where I work the manager NEVER works clinically and doesn't really understand what's going on. I would take one day/month from my supervisor!

Staffing is a national problem and it's unfortunate that our managers get paid so poorly.

adventure_rn, MSN, NP · Dec 1, 2019

I do agree with other posters that at the core, you need to solve the staffing issue via hiring and retention. I also think you need to set boundaries: If you're short enough that you're regularly being pulled into bedside care, you need to be using travelers; however, nobody is going to think that travelers are justified if you're willing to come in any time, any day. You need to set the precedent that you getting pulled into staffing is the exception, not the norm. Once people start to expect that you're available all of the time (like you did in your last job), it's really hard to rein it back in; I think it will be easier if you to set those boundaries from the beginning at your new job. I get that you want your staff to feel supported; however, it will be worse for them in the long-term if their management turnover is really high.

I'm not sure if this is feasible (because it's quite expensive), but something that has worked in my last two units is to create the position of Clinical Leads who function kind of like assistant managers. They assume certain management tasks (like staffing/scheduling, managing certain committees, etc.), but they also have clinical time (i.e. at least one shift per pay period where they have to be in charge). That way, if we're critically short-staffed, they get pulled out of administrative time instead of pulling away the actual manager.

I almost think of it like they're delegating the 'jumping in at the bedside' task to somebody who is still on the 'leadership team,' but has more time to do it. I feel like it works well because it does seem as though management has our back, and it still makes it feel as though our management team is still accessible (since we work with those Clinical Leads quite often). For reference, my last unit with 80 core staff had two Clinical Leads (one day and one night), and my current unit with 250 core staff has six (four day and two night).

peacepilgrim66, ADN, RN · Dec 2, 2019

Hello,

Similar situation here at a LTC facility. I love what I do as a manager, but my availability to cover the floor is burning me out. Staffing is short everywhere and we are a NO agency facility. I am so busy doing floor coverage, that i am not really present to work on the systems of management. Good input from posters above. Things to consider to keep the trainwreck from happening over and over again.

Sour Lemon · Dec 2, 2019

Boundaries. I can't imagine that any reasonable person would expect you to be available 24/7 to work the floor.

If you're able to help out once in a while, maybe a couple of times a year when circumstances are extreme, that would be a a good nurse manager in my mind. The "Plan A" at your current place of employment needs improvement, though. They shouldn't be drowning so often.

**RosesrReder, BSN, MSN, RN** · Dec 2, 2019

You are following a servant leadership style. It only works if the environment is supportive and properly staffed which sounds to be the problem.

K+MgSO4, BSN · Dec 2, 2019

I hear you. I was initially in the same position where the staff were calling me on the weekend to trouble shoot or I was hanging back until 7PM helping.

What I learned was that I needed to give my assistant managers the skills and authority to deal with situations. This needed some investment in training them to think through issues but also for me to flip my response from wading into fix things.

Unless you are in a tiny facility there are after hours hospital management or house supervisor or whoever you title that person to assist with the issues, and honestly I have been that person and it irked me when the ward said they had called the NM on a Sunday afternoon to trouble shoot something I could assist them with. It also gives the impression of micro management.

I am out on the floor in the morning until about 11 assisting with flow - I will do 1 round so the NIC can do the other because both teams turn up at the same time. I will relieve the NIC for a tea break. If staffing is terrible e.g. grads, casuals and no seniors I will stay out and assist- do double check meds, answer buzzers or drop a pt down to theatre or pick one up from PACU. I will relieve a sitter if the junior nurse has forgot to get them a break. But by 11 / 11.30 I will go to my office and do "boss stuff" as my team refer to it.

I am available if not at a meeting to help and any emergency I am out to assist. Sometimes I may sit a confused patient in my office for an hour to give the nurse a break.

Today I was the admin person as she called in sick and could not be replaced. So I answered phones, updated diets, did admin sideof discharges and admissions. But I also left that at 11.30 when all was OK.

If I have a day of meetings or I have a presentation to write I let the staff know I am about but that non urgent stuff needs to wait e.g. roster swaps for next month, asking about annual leave for July 2020.

I have also learned a great trick from a colleague. Put an appointment in your diary for half an hour before you leave. Use this time to finish what you are doing and tidy up for the day. Write a todo list so you don't forget the thing in your head.

I also stuck to a New Year resolution this year! I block out 30 min for lunch and eat with the staff. It is good to chat abd it means I actually get to refuel.

Another thing was I started doing clinical Pilates twice a week and I have to be there one weekday after work by 5.30PM. This means I have to leave by 4 that day as traffic is either nothing ir brutal. The place has not fallen apart without me.

The last time I was in on a weekend was when we lost a regular patient in a horrific code blue (oesphageal bleed).

Some days are a complete failure and I leave at 7PM but those are getting fewer and further between. Upskill your leadership team, manage your diary, make time for your well-being both at work and outside. Learn to say no to people when they ask you onto the 100th committee.

klone, MSN, RN · Dec 2, 2019

Thank you to all who have responded. I am reading and thinking. Will post later to individual responses.

Closed Account 12345 · Dec 3, 2019

First, it sounds like you are a wonderful manager!

Second, I agree with the previous posts saying this is ultimately a staffing issue.

I know it's easier said than done because of budgeting, but err on the side of excessive staffing and lower nurse to patient ratios. That gives you built in wiggle room.

Always schedule a nurse to be on call. Absences are going to occur, so having back up staff in place is essential. Allow your nurses to self-schedule their call days on a sign up sheet/document. Perhaps you could sign up for 2-3 call shifts a month yourself; then you're still a clinical team player, but you aren't working 24/7.

If your call nurse has to come in, write a thank you note and offer some small token of appreciation, even if it's just a $5 gift card. It sucks when an off day is not truly off because of call, and the $2 an hour call pay doesn't come close to making up for that. Feeling appreciated goes a long way to eliminating the resentment of being on call.

If possible, have nurses voluntarily sign up to be "second call" or back up staffing if they don't mind being called on their off days. The on-call nurse would still get called first, but this provides coverage if there are multiple call ins. If a nurse voluntarily comes in when they aren't scheduled/on call, reward them kindly - thank you note and extra PTO or a shift bonus.

Once a month, see if you can find a local restaurant, theater, grocery store, or business to donate a good gift card or gift for a raffle. For each call shift or unscheduled shift a nurse works that month, her name goes in the drawing for that month's good prize. Again, this is just another way to eliminate the resentment of being on call and to increase the willingness of staff, other than you, to provide extra coverage as needed.

Work on developing strong charge nurses who can handle things as they arise. Ensure your charge nurses are trustworthy, fair, and good resources to the staff - not cliquey, not playing favorites, etc. Around 9 pm, call your night charge and say "Just wanted to check in really quick before I settle in for the night. I'll call when I wake up tomorrow morning to see how everything went." Unspoken message: Don't call me before then.

But after all of that, all you can really do is set firm boundaries. Ultimately, nurses are used to feeling like they're drowning during shifts. It is not ideal, but it's reality. Other than your own call shifts, do not make yourself available for staffing unless unit coverage is truly unsafe, not just uncomfortable/difficult. I think if you make yourself readily available 24/7, people will take advantage. (<I thoroughly dislike my own advice here, but I think it is necessary.)