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

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by klone klone, MSN, RN (Member) Member Nurse

klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

1,389 Posts; 13,005 Profile Views

1 hour ago, FacultyRN said:

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.)

 

You essentially want staff to give up one of their hard earned days off for $2/hr and the high chance of having to work?

Ah, no. People who have put in their time aren't responsible to staff the hospital on their days off. That's what per diem, float pools and agencies are for...

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FacultyRN has 12 years experience.

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55 minutes ago, Jedrnurse said:

You essentially want staff to give up one of their hard earned days off for $2/hr and the high chance of having to work?

Ah, no. People who have put in their time aren't responsible to staff the hospital on their days off. That's what per diem, float pools and agencies are for...

Since you read my post, you know I said "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." 

I think being on call sucks.  I think paying nurses $2 an hour to be within 30 minutes of the hospital all day sucks.  

But more than those things, I think patients deserve nurses.  In every hospital RN position I held, except one, I worked call - even in an administrative role.  I did not like working call; no one does. That's why I said showing extra appreciation goes a long way.

I agree; "People who have put in their time aren't responsible to staff the hospital on their day off."  I do not believe in mandatory overtime; working 72 scheduled hours + 8 call hours = full time, no overtime. Being on call is part of "their time."  Call shifts should be thought of as scheduled shifts with a chance of staying home.

Per diem nurses work shifts that are scheduled in advance.

Many hospitals and units do not use agency nurses.  Agency nurses aren't budget friendly, nor do they just appear 2 hours after a staff nurse calls in. 

Float nurses aren't available to all units; they are often in short supply, too.  A nurse with a med-surg background can't float to L&D, ICU, ER,  OR, procedure areas, etc. Float nurses are often scheduled to specific units in advance. Because they are in short supply and hot demand, this does not solve the problem of covering call ins.

The original post was by a manager who is being asked to fill in frequent gaps, and it isn't working. She's exhausted. She needs a budget friendly, realistic solution that allows her to focus her attention on management, not bedside care. Utilizing call nurses is an effective solution. It is part of working as a hospital-based nurse.  I offered several ideas for making this undesirable solution as nurse-friendly as can be: self-scheduling and incentives.

 

 

Edited by FacultyRN

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

1,389 Posts; 13,005 Profile Views

45 minutes ago, FacultyRN said:

Since you read my post, you know I said "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." 

I think being on call sucks.  I think paying nurses $2 an hour to be within 30 minutes of the hospital all day sucks.  

But more than those things, I think patients deserve nurses.  In every hospital RN position I held, except one, I worked call - even in an administrative role.  I did not like working call; no one does. That's why I said showing extra appreciation goes a long way.

I agree; "People who have put in their time aren't responsible to staff the hospital on their day off."  I do not believe in mandatory overtime; working 72 scheduled hours + 8 call hours = full time, no overtime. Being on call is part of "their time."  Call shifts should be thought of as scheduled shifts with a chance of staying home.

Per diem nurses work shifts that are scheduled in advance.

Many hospitals and units do not use agency nurses.  Agency nurses aren't budget friendly, nor do they just appear 2 hours after a staff nurse calls in. 

Float nurses aren't available to all units; they are often in short supply, too.  A nurse with a med-surg background can't float to L&D, ICU, ER,  OR, procedure areas, etc. Float nurses are often scheduled to specific units in advance. Because they are in short supply and hot demand, this does not solve the problem of covering call ins.

The original post was by a manager who is being asked to fill in frequent gaps, and it isn't working. She's exhausted. She needs a budget friendly, realistic solution that allows her to focus her attention on management, not bedside care. Utilizing call nurses is an effective solution. It is part of working as a hospital-based nurse.  I offered several ideas for making this undesirable solution as nurse-friendly as can be: self-scheduling and incentives.

 

 

I don't believe that 72 hrs + one day at $2 hr (if you don't end up coming in) is full time. And yes, while per diem staff are scheduled ahead of time, they are also be asked to pick up last minutes shifts. Of course it's not a guarantee that they can, but at least having a pool increases the chance of being able to cover the staffing shortage.

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SmilingBluEyes has 20 years experience.

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Ah--- that's the problem. The poster who mentioned "servant management" hit it on the head. I too have followed that model, only to never have backing from administration above me. It's a fast ticket to burnout. If you don't have sound leadership up the food chain, you won't ever emerge a winner.

Being salaried oftentimes, is to be used until you burn out completely ( to suffer moral distress, really) and then being tossed away like yesterday's coffee.

I also echo the other poster who asked you if you truly desire to remain in management. If so, boundaries are needed like mentioned and you need to take care of yourself better.

If not, you may find being a staff nurse is so much better for your personal situation. Clock in, do your best, clock out. Turn off the phone. It can be wonderful going back to staff nursing.

I have no fast answers. I wish you the best.

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SmilingBluEyes has 20 years experience.

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I have heard it said: Middle management is the most difficult position to hold. Having experienced this, I know for a fact, it is true. There is no (or very little) gratitude or thanks for your efforts, most often. Often the pressure is tremendous from both the leadership about you and the nurses you supervise...... Moral distress ensues and you are done.

There is no amount of pay that makes all that "worth it" IMO.

Try going back to staff nursing and see if that is what you really want. To do that is to be able to shut off the phone, concentrate on caring for patients, which is likely why you entered nursing, and taking a deep breath.  You did a great job and the experience is never to be taken away from you. Be a staff nurse again, as I think it's what will make you feel better. I've no regrets doing so, and am actually making more money now than as a manager.

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by CVVH New

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To me, it sounds like the main issue is continuing to work at the bedside when they're short.  Hopefully in your new position there isn't that expectation.  At my hospital, neither assistant managers nor managers are expected to take patient assignments when the unit is short (and none do whether or not it's expected).  We have float pools, per diems, and can call staff in for OT.  If all else fails, then the unit is just short (and fortunately it isn't a regular thing at my hospital), and there's just the understanding that we do the best we can.   Sure, the ANMs and NMs will help out here and there during their day with ADLs, codes/rapids (and none of that is again expected), any conflicts, etc., but taking an assignment is unheard of.  

I also like the idea of calling the night staff at 9pm to see what's going on, etc.  This is something that our attendings do with the fellows before they go to sleep, I think it would be great for the night charges to have the same interaction with the nurse manager so that potential issues are already discussed.   

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I'm floored when I see the salaries posted so low for RN supervisors. It's no wonder they can't fill the positions!! Any other industry would pay $125,00/year for a management position of that level!

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