What's it like for you?

i have been a 3-11 ltc supervisor. i was responsible for making sure the staff was adequately distributed as equitably as possible to the various units. it there were call-offs for the night shift i was responsible for attempting to find replacements for those people. these staffing things were job one. after that, i assisted with problems that came up. for example, if a patient fell i would help out with the paperwork or calling the doctor since this does consume a lot of the charge nurses time. or, i might help the charge nurse get her medications passed while she followed up on what had to be done for the fall. if we were short a nurse, i often ended up having to be a charge nurse for a particular unit myself. this, unfortunately, happened a lot more than you would think. however, it did give me a very good knowledge of all the patients. i often helped the charge nurses with their regular duties (med passes and treatments). we had one unit that was really heavy with 5pm meds for some reason, so i often helped with their 5pm med pass. there were also a couple of patients who consumed a great deal of time with their dressing changes and i often helped out with those. when things were running smoothly i would do unannounced rounds of the patients to see that things were in order and aides were not doing things they weren't supposed to be doing and then when it was really slow i started cleaning and re-organizing shelves and cupboards. i was often the only one who defrosted and cleaned the refrigerators on the nursing units. one of the biggest headaches of the job (and if you get into supervision it will come your way eventually) is having to deal with the occasional difficult employee or some sort of discipline. the first times you have to deal with it are scary, but like any skill, you develop a mastery over it. this is more intellectual work and involves a degree of understanding psychology. another job duty i had was assisting in the writing of the yearly employee evaluations and sitting down and delivering these and discussing them with the individual employees. you learn very quickly, if you want to survive at supervision and become a good supervisor, to stop gossiping about other employees and what the word "confidentiality" really means when it comes to employees. like all other employees i worked a 40-hour week. when the staff was short or there were call-offs, of course, i got called on my days off when they were in search of a body to fill in as a charge nurse. they almost never replaced a supervisor who calls in sick. i made a good deal of extra money working doubles when a licensed nurse from the night shift would call-off and i couldn't find a replacement.

my philosophy of supervision has always been that in addition to the obvious role of overseeing workers, the supervisor should also be an extra pair of helping hands if it is possible to be able to do this. it garners respect and camaraderie with the people you are supervising and shows to them that you are not above getting down to their level to assist in getting the work done. there are often times when your input in helping to solve problems is needed. a supervisor should be an enabler and help to bring out the best in those they lead, not suppress them and bend them to their will and authority.

i was just thinking that there is something i probably should mention. most people probably wouldn't say this. i started my career in supervision as an acute hospital supervisor. i learned in short order that it would be very easy to be able to do the very minimum that was required of me which was to make rounds and check up on the units i was assigned to after staffing assignments were done and then go sit down and read or goof off until next rounds were due or i got paged for something. after all, there was no one checking up on the supervisors. and, as a supervisor, you can get away with this--pretty much doing nothing, except what is absolutely minimally required of you. i did work with a supervisor who did this. she used to brag that she spent about 5 hours of her 8 hour shift just sitting on her duff doing personal things. however, i was raised to have a work ethic and i can't just sit still while i know others are working away and dealing with problems. i also feel i owe my employer in work what they are paying me in wage. i made deliberate attempts to get to know nurses, especially new employees and new grads, to question and get reports from charge nurses about what was happening with their patients so i would have a good idea of what kind of stressful burden they were dealing with that shift in an attempt to see where i might be able to lighten that burden, and to sometimes make work for myself. believe me, employees see, or don't see, if you are off and invisible somewhere, what you are doing or not doing and form their opinions about you. i have always wanted to be known as someone who other nurses could count on as an extra pair of helping hands or someone they could come to for a helpful opinion or suggestion. people won't come to you if they don't think you are approachable. the more they see you and you interact with them, the more approachable they will see you to be. power and authority don't mean that you have to set yourself out to be superior to others. teamwork is still teamwork and it has to start and be demonstrated at every level of authority.

The only actual evaluations that I gave face-to-face were with the CNAs. I had input into everyone's evaluation, however. The DON would just hand me a blank evaluation form for each employee when theirs was due and ask me to fill in my comments. She actually did all the final evals. When I was a nurse manager later, I understood why. There are certain ways things need to be worded and there has to be documented backup when you are delivering poor ratings for certain things. I wouldn't know if the documentation existed on all things unless I had a pow-wow with the DON before discussing the evaluation with the employee. The nursing staff was pretty good about doing the monthly summaries, but I did have a card file where I kept track of which patient's was due and when, so I did check to make sure they were being kept up. My big thing was the monthly reconciliation of the MAR and TARs against the newly months printed orders that came back from the pharmacy service. This was a major project that consumed about a week to a week and a half of my time until the first day of the new month when these were placed into their notebooks for use. Because of my computer background I was very particular about making sure that the duplicate sheet that went back to the pharmacy had the changes on it that we wanted printed out on the next months set of MARs and TARs. I rewrote ambiguous orders, made sure the computers made administration time changes that the nurses wanted and made sure that we had those "special orders" on certain charts (DNR's, Tube feeding orders, special equipment for positioning or restraint, etc.) and faxed the doctors and wrote the telephone orders to go along with all them. At first it was a massive undertaking, but after a few months, the orders were in very good order and we had very limited problems with errors incurred due to carry-over orders. On the night of change-over I check every single chart to make sure we had picked up every single new doctor's order that might have been written in the past few days. I also gave special attention to the charts of new admissions coming back from the pharmacy service for the first time to look for any orders that might have gotten missed from the first few days of the patient's admission as this was a time when orders got messed up the most, particularly with Medicare Patients. Yes, I got my share of wearing the building manager hat. We had an exit door that was sensitive to the wind which set off it's alarm at all hours of the day and night. We also had two actual fires in our basement while I was on duty at two separate times from exposed wires that resulted in moving patients to other wings of the facility. We actually had smoke coming up into the hallways with one of the fires. I never saw such scared looks on the aides faces as we had that night. We had one Christmas Day where 7 of our 10 scheduled nursing assistants called off sick and we had to regroup and decide what care we were and weren't going to do that day because we were so short staffed.

LTC--gotta love it. If you can charge nurse there, you can be a manager anywhere.