Where to begin, what to do

[ExploringNurse]

I posted in this forum because I wanted the opinions of the ones who live it day to day.

I have been debating on my MSN specialty for some time now. I really enjoy leadership and management, because I feel like I am a leader and great at resolving issues. I really also love patient bedside care and dealing with all different kinds of patients, which leads me to nurse practitioner.

Money is not the biggest factor, but it helps. I want to live comfortably, and go on vacations with my family and pay down student loan debt. Most nurse practitioners that I've seen or talked to make between 80 and 100k a year, and directors I have talked to make over 120k a year.

I'm torn between the two. Can a nurse practitioner fall into a management role? As well as can a management position that is a serious one that makes good money fall into a bedside patient role? The directors I have and talk to are so disconnected from bedside care because of meetings, responsibilities, other administrative duties, etc.

I really don't want to be bedside as an RN forever, as it wears me then and puts a lot of unneeded stress on me and family. I am looking into clinical roles that are not bedside, and I think an MSN would help with that too.

Let's get some opinions! Administration, do you guys get sick of pushing outcomes and reimbursement to an already overworked and tired, short staffed crew? Does the job involve more? I mean , I know it does entail the day to day but I don't want to be an email and paper pusher all day with no connection to patients, so what administration job mixes the two?

[Rose_Queen, BSN, MSN, RN]

I'll be honest and say that any administration job should be a mix. A nurse manager should be competent in being able to take the unit's standard nurse to patient load should the need arise. In fact, I almost wish the manager of the ICU in my facility could be cloned and sent to manage every unit- she jumps right in when help is needed, has taken patients, and perfectly blends competent bedside care with admin duties. Same with upper management- they should be responsible for patient care at some point, even if it's only a brief time so that they remain in touch with the reality of current bedside nursing, not what they experienced years ago back when they were bedside nurses.

However, as much as I wish it were so, I'd say an actual position like that is going to be rare, if it even exists. You may find that you need to work a management job and pick up a PRN position to get the bedside aspect.

[ExploringNurse]

I agree with that but I want a job where I work what I work and don't get called by the hospital every 3 hours to pick up cause they're short staffed. I don't want to remain prn. I want a single job and fulfill my time and spend the rest with family. It may sound selfish but the way of America is to work to death and I don't wanna be a part of that.

[Orca, ADN, ASN, RN]

Managers get called all the time because units are short staffed. Sometimes you wind up going in. You are better paid for it, but don't believe that you are walking away from dealing with staffing shortages because you become a manager. Far from it.

[ExploringNurse]

I'm not that naive to think that. I see it every day at work. I'm referring to a higher up job such as unit director, director of quality care, etc. Those kinds of jobs.

[SummerGarden, BSN, MSN, RN]

I'm not that naive to think that. I see it every day at work. I'm referring to a higher up job such as unit director, director of quality care, etc. Those kinds of jobs.

Yes, under normal circumstances you should not be providing direct bedside care or in the case of Director of Quality or the Director of Case Management, you should not be providing direct front line care because your unit/department is short staffed. On the other hand, it always depends if there is an manager, assistant manager, or a supervisor in between you and front line staff because when you are short there needs to be someone else who can cover when short staffed. If you have no buffer (a person who can cover others when short), than it is you who must step up to the plate no matter your title or position within the company. For example, a friend of mine who works in a rather large facility in case management worked a shift where the Assistant Nurse Manager, the Manager, and the Director of the Case Management Department worked as front line case management staff because they were short Nurse Case Managers.

By the way, buffers get sick and take vacations too. So you may want to look at positions that are way up the food chain before you imagine a time that you will not be obligated at least once or twice to work as front line staff... Executive level management is a safer bet compared to that of Director...

[llg, PhD, RN]

Have you considered staff development roles? The pay is usually not quite as good as NP's or Administrators, but it can be close. And those of us in Staff Development often have a blend of responsibilities that include some clinical things, some management things, and some educational things. It's often a flexible, in-between role that includes many elements -- a good choice for people who like variety in their work.

Or maybe a CNS role ...

Are you limiting your options to NP or Administration for a reason?

[ExploringNurse]

Definitely not and I like the open ended questions. What you listed as in clinical things, mngmt things, and educational things sounds perfect, and what I would be aiming for. The problem I see with CNS roles is the fact they are steadily phasing out. Money is not a huge priority but I'd like enough to pay down student loans and go on some family vacations. What MSN path points down that road?

[jrt4]

As a nurse manager I do not feel as though I have "lost" my clinical skills. However, I am rusty. Prior to stepping out and doing patient care I always tell my staff that it may take me a little longer and I may have questions but I still know what I am doing. I also want to point out that I think it is inappropriate for the nurse manager to be stepping in when there are call ins or short staffed on a consistent basis. I got stuck in this patter early on and it really has a negative downstream effect on your leadership productivity. There are things that need to be done and monitored that the staff nurse just doesn't understand. If these things are left unattended there are negative consequences for the department. The manager needs to be allowed to do their job so the front line staff have what they need to do theirs. I wish I could implement a "walk in my shoes" day for staff. I always here that manager do not understand what the staff are doing...just keep in mind that the same argument could be made. Just because managers are not out on the unit regularly doesn't mean they are not positively impacting patient care. I think there needs to be a good mix. I see the managers who the staff love but they often are not good managers in terms of getting their work done. One of two things happen...they get burnt out or they leave stuff unattended and it creates more work for them in the future.

[jrt4]

I also want to point out that it is possible to work 40 hours per week as a manager. It has to be a conscious choice and proactive. If I am here 10 hours today, I will leave early the next...if I have 40 hours by Friday...I am taking Friday off. If I can't make that happen then I take a day off the following week...I believe in a strong work life balance. We are paid at a salary rate for 40/week and my time is valuable.