- Email: [email protected]
Confessions of a former nurse manager
Professional Notebook Confessions of a former nurse manager Author: Laurie Sena Gehrke, RN, BSN, CEN, Clive, Iowa
S
ooner or later everyone has an epiphany. You know what I am talking about—one of those moments when everything becomes clear and all the fog in our head that we normally walk around with lifts. I had always thought this instant would be momentous, like a loud ringing bell or the old commercial in which the man slaps himself on the head and says, “I could have had a V8!” Instead, in my case, a gradual progression of events occurred that led me to comprehend several basic management facts in a way I had never seen them before. You see, this is the confession of a former nurse manager. Many of us learn about management from mentors, high-paid consultants, or the multitude of management courses we are required to attend. I found my clarity in a different way. I became a staff nurse. Now, most of us are staff nurses before we become managers. Maybe we have a lot of ideas and ideals before we assume the position, but once we are hired as a nurse manager, an evolution of sorts begins. We are taken into the political environment and taught that to effect change, we must jump through a million hoops and “understand all the potential ramifications of such change.” We are told we cannot be friends with anyone, that we must trust no one. New managers learn “hospitalspeak,” that is, the ability to talk without saying anything and without anyone really knowing what we are saying. We speak of paradigm shifts and circadian rhythms as if they are of utmost importance. We go to meetings. We go to meetings about meetings. We are on committees. We have committees to get ready for meetings. We speak of “team building” but have been taught that no one on our team really understands us. By the time we are fully oriented to duties, expectations, and meetings, our
Laurie Sena Gehrke, Iowa ENA, is a former ED Nurse Manager now living in Clive, Iowa. For reprints, write: Laurie Sena Gehrke, RN, BSN, CEN, 1837 NW 152nd Court, Clive, IA 50325. J Emerg Nurs 1999;25:556-8. Copyright © 1999 by the Emergency Nurses Association. 0099-1767/99 $8.00 + 0 18/9/102448
556 Volume 25, Number 6
great ideas have taken a back burner. The evolution is complete about a year later when all our valuable time is spent at meetings, preparing for meetings, and writing up minutes of meetings. We begin to think of our staff of wonderful, talented nurses and paramedics as “them.” They just do not understand or appreciate all that is done for them. Or so we think. Actually, probably just the opposite occurs—staff begin to doubt that their manager understands or appreciates them. They are probably right. By this point the manager has just gotten too far away. As a protective mechanism, we surround ourselves with a layer of insulation. Assistant managers take the heat—they are the go between. Many managers never leave this familiar cocoon to see themselves from the other side. In my situation, a very ordinary event changed the course of my life. My husband took a new job in another state, and we moved away. I took a part-time staff nurse position and found myself looking at management from a whole other dimension. The situation certainly made me examine my tenure as a manager. Frequently it was like looking in the mirror, and I did not always like what I saw. Sometimes epiphanies can be painful. Do you want to know what I learned?
We go to meetings. We go to meetings about meetings. We are on committees. We have committees to get ready for meetings.
First, a little history. I was the manager of emergency services at a large university hospital. I had responsibility for a multi-million dollar budget, a level I trauma/emergency center, a ground-based ambulance service, a rotor wing air ambulance service, and
Gehrke/JOURNAL OF EMERGENCY NURSING
the trauma program. As I said, I did not resign because I no longer wanted the job. I was not fired, and my position was not merged with another position. I simply quit because my family relocated. I had been a manager for 5 years; before that I had been an assistant manager and an emergency staff nurse in both adult and pediatric facilities over an 8-year period. Upon our relocation in the new city, I took a PRN position. This position was very similar to those I had held in the past and like those of the staff I had more recently supervised. I thought I had found a manager who was a lot like me; we were of similar age and background, yet I quickly found my new manager to be unapproachable. Although not unkind, she had built a thick layer of insulation around herself. Staff did not come to her with praise—they only brought complaints that had simmered under the surface until they were unbearable. Understandably, because of this behavior, she was tense when approached and often reacted to criticism or questions with anger. Who could blame her? Everyone, it seemed. Had I been like that? I am sure I was; no one likes to receive only negative feedback. It is said that if you kick your dog often enough, it will begin to cringe at the sight of you. Lesson for staff: Give praise when it is due, offer constructive criticism early, and provide solutions; do not simply present the problem. Lesson for management: Ditto, plus the additional encouragement to listen and reflect, not react.
Staff did not come to her with praise—they only brought complaints that had simmered under the surface until they were unbearable.
As a staff nurse, I believed that my manager wanted to be part of a system that was constantly evolving and changing. I wanted to help facilitate that change. What I found instead is that maintaining the status quo is easier for management. Change requires work, policy development, budget alterations, and so forth. Whether that change can improve patient care is unproved, so why go to the trouble? Because staff feel ownership in change they facilitate, that’s why. They can get behind the use of new equipment if they decide they need it, not because the manager or medical director saw it at some conference. Animosity re-
garding the decision-making process coupled with the headaches of new systems purchased without input leads to failure and unhappiness. Failure and unhappiness cannot produce high-level patient care. A couple of manager lessons here: One: Involve staff every way you can, not just to do your busy work, but to actually decide what needs to be done to improve the work environment. Your staff members are highly educated professional people whom you trust to administer emergency patient care. Surely they are up to the task of taking control of their work and work environment. If they are not up to this task, you have an entirely different problem much too difficult to address here. Two: Welcome change. It makes life more fun! No one likes the same old thing day after day. Monotony cannot be enjoyable for the type of intelligent persons you want to have as staff. Another lesson I learned: If at all possible, do not go to clinical educational conferences unless you are a clinical manager. What I mean is, if you do not staff the unit on a regular basis, stay home and let others who do regularly staff the unit get the benefit of the conference. Did I stay home and send others to conferences as a manager? No. Should I have? Oh, yes. Did I see how much animosity this decision caused? Not until I was the staff nurse left behind while my nonclinical manager traveled off to a conference. When you are a manager, staff often come to you with problems, both professional and personal. You are sort of a mother/father figure, and they sometimes need your counsel. I can recall several occasions when staff needed my ear regarding issues that were not directly applicable to our unit. These issues involved life decisions about marriage or divorce, or confessions of traffic violations that could prove embarrassing to emergency care staff. When staff members have an internal dispute, frequently the manager must act as mediator to resolve the dispute. The staff must know, in all these situations, that they can trust you. They must be able to think of you as they would a priest, someone who can help them without betraying their confidence. When I became a staff nurse again, I had occasion to visit with my manager about a staff issue that peripherally involved me. I wanted to be sure she understood my involvement and my motivations. Our visit was cordial, and I left feeling as if I had done the “right thing.” Later that week, I was contacted by another staff member who had a very distorted view of my interaction with our manager. My conversation, which I had assumed was confidential, had somehow left her office. I never felt the same about my manager again. I never believed I could trust her, and therefore felt as if I did not have an ally in management. The lesson: What is said in
December 1999 557
JOURNAL OF EMERGENCY NURSING/Gehrke
your office should remain in your office, unless you are obligated by the situation to take it forward. If you must take a situation out of your office, tell the staff member then and there.
Staff do not understand how you can clear your calendar to go to an all-day meeting outside the hospital but cannot do the same, on a regular basis, to staff the very unit you represent.
Lastly, I want to address the issue of clinical versus nonclinical managers. Nurse managers are hired for their expertise as nurses and leaders. If the nursing portion of the position was not important, emergency managers would be graduates of business schools, not nursing schools. Finding time to staff the unit, although difficult, is a must. When I was a manager I did not staff the unit often enough, which I now deeply regret. When you staff your unit you wear scrubs, and just by the virtue of looking like staff, you are approachable. You see and experience firsthand the frustrations your staff feel every day. How else would you know that the blood pressure cuff in the pelvic room leaks, making accurate vital signs all but impossible? This minor problem becomes magnified in a staff member’s eyes. Staff do not see it as an “I did not know” situation but as more of an “I do not care” situation. Talking with you is much easier for staff if you are in the unit sharing cookies or coffee than if
you are in your office, requiring them to make a trip to see if you are busy. Going to your office is too formal for most little things they need to tell you. Staff do not understand how you can clear your calendar to go to an all-day meeting outside the hospital but cannot do the same, on a regular basis, to staff the very unit you represent. They do not respect your expertise if they cannot see it. I also advocate taking some time to staff off shifts. I am not saying you should become a night nurse, but occasionally working at night is beneficial because that is when the newest staff members usually work. They do not know you, have no history with you, and only saw you at the interview. Therefore, their entire impression of you as a person and as a manager is what they see at staff meetings and what they hear from other night staff. Think about it—do you really want other people, good or bad, taking responsibility for your reputation? Do you wonder why there is so much adversity there? You should not, and would not, if you spent some time in their shoes. I learned these lessons as a night PRN staff nurse. I certainly wish I had known it earlier. All the management courses and all the books cannot say it simply enough. Experience what those whom you manage are feeling, and you will be much more successful at representing them. Distance yourself, and you will find that the chasm you create will only grow bigger. Be trustworthy, honest, and kind. Listen to your staff. This type of behavior works in everyday life, and it will work in management, too. I wish all of you the best of luck!
Editor’s note The Journal would welcome “Confessions of a former staff nurse” from a staff nurse who has become a nurse manager. If you would like to submit such an article, E-mail me at [email protected], or call (800) 900-9659, ext. 4044.
Information for Authors Know of a great case? Have a good idea for an article that you want to write? See pages 13A-15A for information for authors and query information.
558 Volume 25, Number 6
S
ooner or later everyone has an epiphany. You know what I am talking about—one of those moments when everything becomes clear and all the fog in our head that we normally walk around with lifts. I had always thought this instant would be momentous, like a loud ringing bell or the old commercial in which the man slaps himself on the head and says, “I could have had a V8!” Instead, in my case, a gradual progression of events occurred that led me to comprehend several basic management facts in a way I had never seen them before. You see, this is the confession of a former nurse manager. Many of us learn about management from mentors, high-paid consultants, or the multitude of management courses we are required to attend. I found my clarity in a different way. I became a staff nurse. Now, most of us are staff nurses before we become managers. Maybe we have a lot of ideas and ideals before we assume the position, but once we are hired as a nurse manager, an evolution of sorts begins. We are taken into the political environment and taught that to effect change, we must jump through a million hoops and “understand all the potential ramifications of such change.” We are told we cannot be friends with anyone, that we must trust no one. New managers learn “hospitalspeak,” that is, the ability to talk without saying anything and without anyone really knowing what we are saying. We speak of paradigm shifts and circadian rhythms as if they are of utmost importance. We go to meetings. We go to meetings about meetings. We are on committees. We have committees to get ready for meetings. We speak of “team building” but have been taught that no one on our team really understands us. By the time we are fully oriented to duties, expectations, and meetings, our
Laurie Sena Gehrke, Iowa ENA, is a former ED Nurse Manager now living in Clive, Iowa. For reprints, write: Laurie Sena Gehrke, RN, BSN, CEN, 1837 NW 152nd Court, Clive, IA 50325. J Emerg Nurs 1999;25:556-8. Copyright © 1999 by the Emergency Nurses Association. 0099-1767/99 $8.00 + 0 18/9/102448
556 Volume 25, Number 6
great ideas have taken a back burner. The evolution is complete about a year later when all our valuable time is spent at meetings, preparing for meetings, and writing up minutes of meetings. We begin to think of our staff of wonderful, talented nurses and paramedics as “them.” They just do not understand or appreciate all that is done for them. Or so we think. Actually, probably just the opposite occurs—staff begin to doubt that their manager understands or appreciates them. They are probably right. By this point the manager has just gotten too far away. As a protective mechanism, we surround ourselves with a layer of insulation. Assistant managers take the heat—they are the go between. Many managers never leave this familiar cocoon to see themselves from the other side. In my situation, a very ordinary event changed the course of my life. My husband took a new job in another state, and we moved away. I took a part-time staff nurse position and found myself looking at management from a whole other dimension. The situation certainly made me examine my tenure as a manager. Frequently it was like looking in the mirror, and I did not always like what I saw. Sometimes epiphanies can be painful. Do you want to know what I learned?
We go to meetings. We go to meetings about meetings. We are on committees. We have committees to get ready for meetings.
First, a little history. I was the manager of emergency services at a large university hospital. I had responsibility for a multi-million dollar budget, a level I trauma/emergency center, a ground-based ambulance service, a rotor wing air ambulance service, and
Gehrke/JOURNAL OF EMERGENCY NURSING
the trauma program. As I said, I did not resign because I no longer wanted the job. I was not fired, and my position was not merged with another position. I simply quit because my family relocated. I had been a manager for 5 years; before that I had been an assistant manager and an emergency staff nurse in both adult and pediatric facilities over an 8-year period. Upon our relocation in the new city, I took a PRN position. This position was very similar to those I had held in the past and like those of the staff I had more recently supervised. I thought I had found a manager who was a lot like me; we were of similar age and background, yet I quickly found my new manager to be unapproachable. Although not unkind, she had built a thick layer of insulation around herself. Staff did not come to her with praise—they only brought complaints that had simmered under the surface until they were unbearable. Understandably, because of this behavior, she was tense when approached and often reacted to criticism or questions with anger. Who could blame her? Everyone, it seemed. Had I been like that? I am sure I was; no one likes to receive only negative feedback. It is said that if you kick your dog often enough, it will begin to cringe at the sight of you. Lesson for staff: Give praise when it is due, offer constructive criticism early, and provide solutions; do not simply present the problem. Lesson for management: Ditto, plus the additional encouragement to listen and reflect, not react.
Staff did not come to her with praise—they only brought complaints that had simmered under the surface until they were unbearable.
As a staff nurse, I believed that my manager wanted to be part of a system that was constantly evolving and changing. I wanted to help facilitate that change. What I found instead is that maintaining the status quo is easier for management. Change requires work, policy development, budget alterations, and so forth. Whether that change can improve patient care is unproved, so why go to the trouble? Because staff feel ownership in change they facilitate, that’s why. They can get behind the use of new equipment if they decide they need it, not because the manager or medical director saw it at some conference. Animosity re-
garding the decision-making process coupled with the headaches of new systems purchased without input leads to failure and unhappiness. Failure and unhappiness cannot produce high-level patient care. A couple of manager lessons here: One: Involve staff every way you can, not just to do your busy work, but to actually decide what needs to be done to improve the work environment. Your staff members are highly educated professional people whom you trust to administer emergency patient care. Surely they are up to the task of taking control of their work and work environment. If they are not up to this task, you have an entirely different problem much too difficult to address here. Two: Welcome change. It makes life more fun! No one likes the same old thing day after day. Monotony cannot be enjoyable for the type of intelligent persons you want to have as staff. Another lesson I learned: If at all possible, do not go to clinical educational conferences unless you are a clinical manager. What I mean is, if you do not staff the unit on a regular basis, stay home and let others who do regularly staff the unit get the benefit of the conference. Did I stay home and send others to conferences as a manager? No. Should I have? Oh, yes. Did I see how much animosity this decision caused? Not until I was the staff nurse left behind while my nonclinical manager traveled off to a conference. When you are a manager, staff often come to you with problems, both professional and personal. You are sort of a mother/father figure, and they sometimes need your counsel. I can recall several occasions when staff needed my ear regarding issues that were not directly applicable to our unit. These issues involved life decisions about marriage or divorce, or confessions of traffic violations that could prove embarrassing to emergency care staff. When staff members have an internal dispute, frequently the manager must act as mediator to resolve the dispute. The staff must know, in all these situations, that they can trust you. They must be able to think of you as they would a priest, someone who can help them without betraying their confidence. When I became a staff nurse again, I had occasion to visit with my manager about a staff issue that peripherally involved me. I wanted to be sure she understood my involvement and my motivations. Our visit was cordial, and I left feeling as if I had done the “right thing.” Later that week, I was contacted by another staff member who had a very distorted view of my interaction with our manager. My conversation, which I had assumed was confidential, had somehow left her office. I never felt the same about my manager again. I never believed I could trust her, and therefore felt as if I did not have an ally in management. The lesson: What is said in
December 1999 557
JOURNAL OF EMERGENCY NURSING/Gehrke
your office should remain in your office, unless you are obligated by the situation to take it forward. If you must take a situation out of your office, tell the staff member then and there.
Staff do not understand how you can clear your calendar to go to an all-day meeting outside the hospital but cannot do the same, on a regular basis, to staff the very unit you represent.
Lastly, I want to address the issue of clinical versus nonclinical managers. Nurse managers are hired for their expertise as nurses and leaders. If the nursing portion of the position was not important, emergency managers would be graduates of business schools, not nursing schools. Finding time to staff the unit, although difficult, is a must. When I was a manager I did not staff the unit often enough, which I now deeply regret. When you staff your unit you wear scrubs, and just by the virtue of looking like staff, you are approachable. You see and experience firsthand the frustrations your staff feel every day. How else would you know that the blood pressure cuff in the pelvic room leaks, making accurate vital signs all but impossible? This minor problem becomes magnified in a staff member’s eyes. Staff do not see it as an “I did not know” situation but as more of an “I do not care” situation. Talking with you is much easier for staff if you are in the unit sharing cookies or coffee than if
you are in your office, requiring them to make a trip to see if you are busy. Going to your office is too formal for most little things they need to tell you. Staff do not understand how you can clear your calendar to go to an all-day meeting outside the hospital but cannot do the same, on a regular basis, to staff the very unit you represent. They do not respect your expertise if they cannot see it. I also advocate taking some time to staff off shifts. I am not saying you should become a night nurse, but occasionally working at night is beneficial because that is when the newest staff members usually work. They do not know you, have no history with you, and only saw you at the interview. Therefore, their entire impression of you as a person and as a manager is what they see at staff meetings and what they hear from other night staff. Think about it—do you really want other people, good or bad, taking responsibility for your reputation? Do you wonder why there is so much adversity there? You should not, and would not, if you spent some time in their shoes. I learned these lessons as a night PRN staff nurse. I certainly wish I had known it earlier. All the management courses and all the books cannot say it simply enough. Experience what those whom you manage are feeling, and you will be much more successful at representing them. Distance yourself, and you will find that the chasm you create will only grow bigger. Be trustworthy, honest, and kind. Listen to your staff. This type of behavior works in everyday life, and it will work in management, too. I wish all of you the best of luck!
Editor’s note The Journal would welcome “Confessions of a former staff nurse” from a staff nurse who has become a nurse manager. If you would like to submit such an article, E-mail me at [email protected], or call (800) 900-9659, ext. 4044.
Information for Authors Know of a great case? Have a good idea for an article that you want to write? See pages 13A-15A for information for authors and query information.
558 Volume 25, Number 6