Tuesday, September 25, 2012

Nursing Manglement

Nursing: a career in which the more education one receives, the less likely one is to actually know how to do the job.

I thought when I got my degree I would "get" why nurses in management were such dicks to non-management nurses, the nurses who are on the front lines and caring for patients, the nurses who get dumped on with ever-increasing paper work and bullish*t.

Guess what.  My expensive high quality education has ill-prepared me for insightful revelations into the though processes of management: I don't get it.

There seems to be several types of nursing management that I have had the dubious pleasure to work with:

1.  Did the job for a long time.  Can't do it now, but respects nurses who do; does whatever possible to make  the job run more smoothly.

My most-favorite boss/leadership mentor of all time was my manager in a big ER where I was a clinical leader.  She gave me the best advice ever: listen.  Sometimes it's the only thing you can do.  The second best piece of advice was one she often used, offer "What can I do to help?" She did actual nursing for some portion of almost every day, even if it was only holding a kid long enough for someone to stick an IV in.  This is a nurse who not only had all my respect, but someone whose respect I wanted in return.

2.  Has limited clinical experience. Has lots of education.  Couldn't do the job terribly well and now can't do the job at all.  Ineffective.
At one hospital, some upper management brainiac decided to promote the horrible ICU nurse manager and make her ER nurse manager as well.  Great idea.   All the ICU nurses hated her.  She didn't know a balloon pump from a water balloon.  She never worked a single shift in the ER and had no understanding of how ER nurses work.  Or how our department was run.  In fact that small hospital was the only place she had ever worked from the time she passed her boards.  Miserable human being, she was eventually canned because 10 people quit, including me.

3. RN with an MBA.
If you are going to run with the big dogs, and all that.  Yes, she dealt effectively with upper management so probably didn't spend much time with bullsh*t nursing theory classes, of which I swear I will never take another the rest of my life.  What good is nursing theory when it ill prepares a manager to deal with other managers?  This boss said every day she could not do our job clinically, although she was lavish with praise for jobs well done, as well as a bang-up customer service rep.  However, the only time I ever actually saw her was if there was a problem.  She was great for committees.  Have a suggestion or an idea?  "Great!  Get a committee together and let me know what you come up with!"  Shared governance really just means "let's have a meeting or 10 about that.  Then, management will do whatever they wanted to do anyway".

4.  The hands-on clinical leader vs. the hands-off clinical leader.
This type of boss may or may not have the education.  They are really good at either doing the job OR sitting on his/her ass and delegating.  Being a clinical leader is definitely the type of job that can be characterized as "Lead, Follow, or Get the Hell Out of My Way".  Clinical nurses can tell in about 5 minutes which ones are lazy and which ones support the nurses they work with by actually helping; some examples are supporting their staff by yelling at the floors to take patients, or bullying the nursing supervisors to get off their asses and have THEM yell at the floors to take patients.  They have little tolerance for lazy nurses and just don't put up with nurses who insist on riding the LNA's like My Little Ponies while they put their feet up and update their Facebook status.  My favorites love to put out fires; my least favorites run through the ward screaming "FIRE!" while it just gets hotter and the flames spread.


2 comments:

Tonja Treece said...

Yeah, my manager is definitely NOT a helping hand kinda gal....

rob. fraser said...

Good management seems to be a well kept secret in healthcare. The best advice I've ever heard of and like comes from Manager-Tools.com (I pay for their material and in no way get paid for saying thier name). In their practical down to earth approach, for which they are paid very well by all sorts of companies, it is all about relationships and priorities.

First relationships. You can't do anything without your staff. This means getting to know them. Like you said, managers need to know when staff are being lazy or being over worked. They need to have a pulse on who loves there work, who is thinking about leaving, and who mentally checked out years ago. The way this happens is spending time with your nurses. In some cases this happens on the floor when ensuring you are present, and is even better when they actually help (tidy up, bring a coffee, hold down a patient while a line is secured, etc.). This is that time you mentioned when a manager can listen, ask how they can help, and figure out if they need to push their staff to accept new patients or make calls to help their patients keep moving.

The second part is priorities. There is no question there is to much to do. I don't think there are many nursing jobs (clinical to VP) where this isn't the reality. The key is deciding what you are and are not going to do. I think meetings and emails are taking up to much space and can often prevent the most important work from being done first. I think this is another tell tale sign of a great manager. Is there schedule done well in advance, do we have the equipment we need, are new staff being hired, are staff getting feedback, do we know how we are performing as a unit? When nurses are spending their time (there is no managing time, you can only spend it) on the right proirities it makes a huge different.

On a final note. Mangers are incredible people, whether we think them good or bad, they live between the rock and a hard place. We should all be nice to our managers, it is a job that is hard to do well and there are hundreds of people watching.