Sunday, July 20, 2014

The Revolving Door Of Nursing Managers

Our procedure center is a pretty stable unit. We have employees who have worked there for ten to twenty years. We all know each other like family. We've seen each other's children being born, grow up, and graduate from school. It is a very comforting place to work.

But one position that seems to have constant turnover is our nursing manager. The nursing manager, as the title implies, manages the nurses' activities. She (they have almost always been she) makes the call schedule. She determines what time nurse comes in and when they leave. She makes sure the payroll is made out properly. She plots the yearly vacation schedules. She intervenes in interpersonal conflicts at work. In essence, the nursing manager is in charge of almost all aspects of the nurses' work.

Unfortunately this important position has seen a continual flux in our center. The problem, I feel, is that whoever accepts the job is not really in it for the long haul. Our nursing managers tend to view the job as resume padding, not the final role for a career well done. They always seem to be looking for the next rung up the ladder of their nursing career.

Because so many of them view this assignment as a temporary stop, we don't get the best people to help manage our busy unit. We basically get two types of personalities that accept this appointment. One is the politician. She is always on the go, attending every possible meeting she can to shake hands and have face time with her superiors so that she can get promoted as quickly as possible. Her office door is always locked because she is somewhere else cavorting with people who might give her the promotion she so desperately craves. The job of the nursing manager then falls upon the most senior nurse on the unit, who usually does a pretty good job as she's had to do this many times before.

On the other end of the spectrum is the micromanager. And this one is actually worse. The micromanager will do everything possible to demonstrate to everybody, especially her bosses, that she is fully in charge of the unit. Even if her decisions make absolutely no medical or common sense. For instance, one of our recent nursing manager's first executive decision on the unit was to reverse the order of the bed numbers in the unit. What used to be bed numbers one through ten became numbers ten through one. There was absolutely no reason to do it. It did not improve patient safety or increase the efficiency of patient care. On the contrary, for weeks afterwards people went to the wrong bed because everybody was so used to the old numbering system. But the manager showed that she was the boss and could make people do whatever she wanted.

Another time the nursing manager suddenly decided that every patient who went to the recovery room after a procedure needed to be hooked up to a transport monitor for vital signs during the short traveling distance, which is literally just down the hall. A defibrillator also had to accompany the patient each time. It didn't matter if the anesthesiologist was going with the patient or that the patient was stable, awake, and breathing room air after a short MAC case. The manager insisted that this was the new safety standard being adopted nationwide and we had to follow it. When the anesthesiologists objected, she simply ordered her nurses to put the monitors on the patients themselves. Needless to say, the nurses weren't terribly happy about this either since they were the ones who had to bring all those heavy monitors back to the unit after dropping the patient off in recovery. Many monitors were lost because of her new rules.

But like the weather in the Midwest, if you don't like what you currently have, just wait around a little bit and a new one will show up shortly. The average length of employment of our nursing managers is usually about eighteen months to two years. They have all gotten promoted to a higher position or have been fired unceremoniously after stepping on too many toes. We're still waiting for the one manager who can find satisfaction in her work without constantly longing for a higher position. I'm not holding my breath.

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