How Do They Manage to Manage?

This is a great shot from an old Wyeth ad. Looks like an early rendition of a triage nurse. She is talking to the woman who rode off with Toto in the Wizard of Oz. She could use a whopping dose of Advil because you just know she is going to have a migraine at the end of the day. I love doing triage. Some people hate it. Some of my most exhausting shifts have been in that triage chair; I would sometimes have 45-50 people cross my desk in 8 hours. Some were easy, clinical issues. The babies always took the most time as they needed weights, rectal temps and, for some crazy administrative reason, measurements of their head circumference. And that's after you have taken all seven layers off them. Then their socks. Under their booties. In the summer. With a fever. I could write an entire dissertation on the phobia of fever. But I would deal with 100 babies with fever before I would consider doing what I consider the most thankless job in nursing: being the manager of a nursing unit.

Nurse manager. Clinical Coordinator. Head Nurse. Whatever the title, it's a rough job. They must balance the needs of the nurses and the unit with the orders that come down from Administration. They take the brunt of patient complaints and angry doctors. They are expected to encourage, counsel, dicipline, teach, assess and evaluate their nurses who are taking care of the patients for whom they have the ultimate responsibility. They are expected at meetings, they are expected to hold meetings. They pass along the edicts from Administration and deal with the objections of staff, even if they agree that the change/rule/requirement is needless. They need to be open to staff and allow them to ventilate. They try to balance the personal needs of their staff to the staffing needs of the department, often having to say "no" and then absorb the fallout.

And they are often paid less than the nurses they manage.

I've had many managers over the years. Some new, some experienced. Some calm, some hotheads. Some were born to be leaders and some just went through the motions. I actually took a job because I met a manager (and a Critical Care Educator) more enthusiastic about nursing than anyone I had ever met. I had a manager who was as close to super-woman as you could get with three departments at two facilities under her control and they ran like clockwork. There have been managers in small units that would bend over backwards to accomdate every request and managers at teaching hospitals who had so many nurses you were just one of the bunch and whose attitude was "sorry, no-can-do". I had managers who I could call if the night shift got nuts and managers I only saw every other month.

To most managers I was trouble-free staff and to a few I was their worst nightmare. (Let's just say God help the manager who has to deal with a nurse going through severe, depressive burnout.) Looking back at my relationships with various managers and now from the vantage point of maturity (I think), I realize what a staff nurse needs to do to help their manager be a good manager:

• Do your work to the best of your ability. That's a given. If you are assigned a special project to help with department flow, do it without being reminded. Keep your certifications up-to-date and make sure all appropriate copies are in your file. Keep your timecard correct. Make yours one less thing she has to deal with.
  

• Keep in contact with your manager. Sometimes it's not easy if you work the off-shifts, but check in now and then to say hi. Ask how you're doing. (This is not the same as your evaluation. Your evaluation should not be the time you find out there is a problem, but often that is the only time you actually sit down with your manager). Have they noticed any areas you could improve? Don't just assume that because nothing has been said that everything is okay. Oh, and don't try to do this on the run unless your manager has an open-door policy and is always available. Make an appointment.
  

• Managers deal with problems and complaints. Constantly. From all quarters. Don't have every encounter with your manager be a complaint-a-thon. The one thing you don't want your manager thinking when they see you is "oh no.....".
  

• Of course there are appropriate times for voicing a dissenting opinion or making a complaint or asking for help with a problem. When meeting with your manager,
• Have a couple of possible solutions in mind before you go in. You will come across as a problem solver (which you are) and will not come across as, heaven forbid, whining.
• If you are reporting a problems with a doctor or staff member
• Try to handle the issue with the person involved before involving your manager. This is not always an easy thing to do, especially if you feel intimidated.
• Document the problem as best you can. It's hard for managers to get a handle on issues when they have no data.

• Finally, let your manager know that they are appreciated from time-to-time. Just a note to thank them for handling your time-card issue or for taking up Dr. Smartmouth's temper-tantrum with the appropriate department. You get the idea. Yes, it's their job, but everyone likes positive reminders that their everyday tasks are appreciated.
  

Boy, there is no way on God's Green Earth that I would take on a Head Nurse position (I like the term "Head Nurse". I'm just old fashioned, I guess). I learned early on I don't have the temperment or the ability to handle that load. But this Indian appreciates a good Chief.

So here's a tip of my nurse's cap to the women and men of nursing management who run interference so that my job is easier. Thanks.