Your Most Difficult Management Challenge

[RNPATL, DNP, RN]

I am really interested in hearing from other nurse managers about what their most unique or interesting management challenge has been over the years.

For me, in my last position, I was the nurse manager for a very large med-surg unit. This unit often presented challenges unlike anything I had seen in the past. Anyhow, this particular situation involved the opening of a surgical step down unit because one of our physicians did not want his patient's going to ICU because they did not need that level of care, but his patient's were to acute for a general med-surg unit. Now, that was not the challenge .... the challenge came when my CNO wanted me to open the unit in less than a week.

Fortunately, I had a great group of experienced core nurses that really rose to the challenge and wanted to be the seedlings for this new and innovative unit. We worked together to get the newer nurses trained on chest tubes, epidurals and some other "more" complex care requirements. Within the week, we had a fully functioning 9 bed unit open and running, with a full occupancy I might add.

The next challenge this unit presented was in relationship to productivity ..... whew, that was really a tough one. The unit was budgeted a 7.45 productive hours per day. I generally had to rob from Peter to pay Paul on this one, by transferring hours from step down to my larger med-surg unit .... but that really created a problem on the MS unit, especially when they were busy and needed the extra staff. Again, my step down nurses really came to the resuce and proposed a staffing plan that was innovative, creative and cutting edge. In the end, the nurses pulled together to make this whole unit run and run within an established budget.