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.