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Being a Nurse Manager: The Good, the Bad and the Ugly

New Kid on the Team
February 3, 2017 10:27 AM by Samantha Therrien

Starting a new job in a new place can be nerve wracking even for seasoned nurses like me. I'm working at a major hospital in the city that I grew up in, and I almost forgot what it was to go back to work in a hospital setting coming from a small, free-standing ambulatory day surgery center. I'm working in the same area as I used to work prior to ambulatory care-in preop and stage II. I was feeling like a new grad again; all those emotions that I felt as a brand-new nurse came back to me. I was nervous, excited and anxious.

Starting any new job can be filled with promise and expectations, but it can also be marked with uncertainty. I found some approaches that has helped me transition into my new environment:

  • Attend the hospital orientation to gain insight into what to expect on the unit and from your managers.
  • Working closely with your preceptorby listening to theirwisdom. Ask questions and for help when you need it. It's better to ask for clarification before completing a task the wrong way. I keep a small notepad on hand and chart any pertinent info that Imight need for later.
  • Take initiative by doing something like helping a coworker or a team leader. By bonding with theteam, coworkers will view you as a team player.
  • Act confident. At times, we all feel unsure, even though we know what we are doing. Don't underestimate yourself.
  • Keep a positive attitude and don't give up on yourself or the institution when you get frustrate. Any change is frightening, and it takes time to adapt to anew role. Stay away from negative attitudes and gossip.Judge every nurse for yourself; nurses all have different personalities
  • Set priorities and goals, learn to evaluate which needs are most critical and look for ways to delegate tasks. Set your goals and achieve them.
  • First impressions are important, so dress professional, establish good attendance, befriend and support staff and management and show your appreciation to everyone who helps you learn the ropes during your first days on the job.
  • Help your fellow coworkers during your downtime, and they will help you in the future.
  • Learn to be efficient and organized. Grouping tasks that need to be done for each patient will save you time inthe end. Remember, doing it right the first time is the right thing to do.
  • Take a break, sit down and eat. A five-minute break to go to the bathroom is needed. You will learn after time that if you don't take care of yourself, you will not able to care for others. And remember to de-stress and take time for yourself.

At times, I feel frustrated and discouraged, and I find myself thinking, "Did I make the right decision in changing to a new job?" Change is frightening at first. I realize that I will need at least six months time to adapt to my new job so I feel comfortable and I won't feel stressed.

Remember: Rome was not built in one day.

'Don't Burn Your Bridges'
January 10, 2017 4:09 PM by Samantha Therrien

We all have heard the saying, "Don't burn your bridges." This saying is used often when resigning from your current job. But what does it really mean? It means not to do something in life that will potentially affect you in the future, such as wrong the same people or company that might one day decide or influence your future.

Today I gave my formal resignation to my work, after working as a nurse manager for several years in an ambulatory day surgery. It was a hard decision to make after many months of contemplating. I finally came to an answer that it had to be done due to personal changes in my life. There's never a right time, the timing will never be perfect, and if I choose to wait, I would miss out on many opportunities that were presenting themselves. I made the decision to make a jump at a new opportunity, and in my gut it feels like the right decision.

Parting is bitter sweet... and then some. Whether I was moving toward something better or from an insupportable situation, deciding to leave my job was difficult and stressful. There are so many emotions that I experienced, ranging from sadness, excitement, guilt, hesitation, and everything in between. Finally, walking away can be a wonderful relief, but I still grieve for what I had and what I lost. Sometimes this is hard, especially for us nurses. We spend so much time taking care of others, often we neglect our own needs.

Then it spills over into our home life as well. These losses include collegial friendships with my coworkers. As nurses, we often develop strong friendships in the work place, though some of them may be based on timing, convenience, or shared suffering. I need to recognize that some friendships will end when I leave the building, but true friendships I developed won't.

Biting the bullet, giving proper notice, and leaving on good terms will help me in the future. Because I will never know when I will encounter someone from my facility who I will need a reference or a recommendation from as I move forward. My advice: resist the temptation to talk negative about your facility. Walking out without sufficient notice causes a problem in future prospective employment, and it leaves a bad impression of you. Bury any animosity you may have, no matter how justified, by wiping the slate clean. You will feel better about yourself in the long run.

Easing my way out of the door was challenging. I kept it civil and professional. No matter how good or bad (especially when it was rough), the most respectful thing that I did was to leave with honor and dignity. I'm looking forward, not backward, with my head up. I will leave with respect instilled in me. Leaving a positive impression showed my colleagues that I care about them and showed my supervisors that I remained committed and loyal to the institution and wrapped up any of my responsibilities. Deciding to quit any job is stressful, whether you're leaving a job you love or a job you loathe. By thinking it through you can leave any job gracefully. And by me doing so, I experienced far less stress, left a positive impression and felt energized and lighter.

And yes, burned bridges, like karma, do come back and haunt you-in ways you least expect.

Mean Nurses, Where are Your Manners?
December 5, 2016 10:34 AM by Samantha Therrien
Every day in our nursing career we meet a lot of diverse types of people. But handling different types of nurses at work can be a dismaying task. It can be very challenging working with lazy, difficult coworkers who don't pull their weight. If you have been in this profession for any length of time (22 years for me), you know who I am talking about. Gone are the days that we say please and thank you. When I started my nursing career everyone was family; now it seems we're just colleagues.

I noticed the other day while working on the unit with my staff, when the schedule was crazy, doctors were running behind, and the patients were getting angry, that some of my coworkers who are nurses forgot their manners when talking to other nurses and their managers. I feel I need to vent about this subject.

On this day in question, I stopped for a minute and finally took a sip of water when I heard this nurse being rude to another nurse. And the worst part of it? A patient witnessed the incident. My mind was screaming "Noooo!!! I can't believe they just did this if front of a patient!" I could not even speak. At that moment, I realized that nurses are the meanest people that I ever met. Why do they feel the need to sabotage other nurses or managers and make them feel miserable?

I decided in that moment to set boundaries for myself: some nurses will see you as a manager. Some might think you are too conservative or too traditional or too smart or too stupid. I will not satisfy them one way or the other no matter how much I might want to. So I won't try.

Maybe it's because nursing is predominantly women, and we can be catty, mean-spirited, and plain nasty when it comes to each other. Is it because we're such an oppressed group? As the saying goes, "Girls will be girls."

I think it really boils down to taking whatever is dished out by so many different peopleadministration, doctors, families. We venture not to stand up to these people, because complaining could jeopardize our jobs. So we develop a lot of anxiety and hostility that is likely to pit us nurses against each other. We end up being so hateful to each other. It's hard to be pleasant and considerate of other nurses when you are overworked, emotionally and physically depleted, and you have so little time for yourself, let alone your colleagues.

And if there's a toxic environment, you won't be able to give your full attention to patient care.

As a nurse manager, I set the standards for the staff. Nurse managers sometimes forget to monitor our own behavior even if it's unintentionally. We get caught up in the demands of the schedule, patient satisfaction, etc. For example, sighing heavily after someone speaks could be interpreted as negative. Other behaviors to watch out for are favoritism, certain body language, gossiping, and speaking in a raised voice.

For too long nurse managers have taken the responsibility for the individual nurse's behavior. Let's stop taking all the blame for what is wrong; we need to teach nurses how to cope with difficult situations and to have the skills to diffuse a situation. This is critical to ending rude behavior. We need to begin to place the accountability where the accountability belongs per the ANA Code of Ethics. Nursing, as a profession, needs to support an environment of knowledge, education, and collegiality. We all gain by supporting each other, and equally, we and our patient lose when we knock each other down.

Be yourselfa nurse. Mean and nice nurses are all over; do not let them chose who you are.

The Flu is Coming
November 1, 2016 8:29 AM by Samantha Therrien
It's that time of year again when the flu season will be among us. As nurses working in a healthcare facility—whether it be in hospitals, clinics, physician's offices, schools, or ambulatory day surgeries—we need to be more diligent in preventing the spread of germs.

The flu season varies quite a bit from year to year. Some years, relatively few people die. In 1986-87, there were 3,349 flu-related deaths. In 2014, the US and Canada saw the deadliest flu season ever within the past 5 years. That year's flu killed healthy young people with healthy immune systems—not the weak or the elderly.

The 2016-17 flu vaccine quadrivalent recommendation (meaning you will only be vaccinated against the 4 most common strains of flu) includes an additional B virus. This slightly differs from the 2015-16 vaccine. Last year's vaccine recommendation was based on several factors, including global influenza virologic and epidemiologic surveillance, genetic and antigenic characterization, antiviral susceptibility, and the availability of candidate vaccine viruses for production.

Germs are everywhere. We all know that we need to prevent the spread of germs by educating your staff and patients on the importance of infection prevention measures. Work closely with your infection control preventionist and with your facility's policy and procedures for routine cleaning and disinfection of the facility's environment. It's up to us as nurses to be the "Germ Busters."

Hand Hygiene

This is the best and most efficient method of preventing the spread of germs—and the cheapest. Good hand washing consists of rubbing your hands together with soap on the back of your hands, in between fingers, and under your finger nails for 20 seconds while humming the happy birthday song from beginning to end twice. Good hand washing is the first line of defense against the spread of many illnesses, from the common cold to more serious infections such as meningitis, bronchiolitis, the flu, hepatitis A, and most types of infectious diarrhea.

So, when do we wash our hands?

  • Before and after touching a patient—even if gloves are worn.
  • After touching the patient's immediate environment.
  • After contact with blood, body fluids or excretions, or wound dressings.
  • Prior to performing an aseptic task, such as placing an IV or preparing an injection.
  • During patient care after glove removal.

Environmental Cleaning/Medical Equipment

Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated pathogens and frequently touched, including bed rails, bed side tables, TV remote controls, and call lights.

After each patient leaves their room, each surface, from their stretchers, chairs, bed side tables, blood pressure equipment, to even the remote controls, should be cleansed with selected EPA-registered/manufacturer's recommendation disinfectants. In my facility, each patient's bay has TVs with remote controls. We place the remote control in a zip lock bag with a red sticker when a patient leaves the room so that the remote is cleansed and a new bag is placed with a green sticker, indicating it's been cleaned (this is a good system at home, too, when someone is sick).

All medical equipment must be cleaned and maintained per the manufacturer's instructions to prevent patient-to-patient transmissions of infectious agents. Medical equipment is labeled by the manufacturer as either reusable or single use. Have medical staff wear and have accesses to appropriate PPE when handling and reprocessing contaminated patient equipment.

Respiratory Hygiene /Cough Etiquette

Respiratory hygiene is a component of standard precautions, emphasizing the need for prompt implementation of infection prevention at the first point of encounter with the facility. First point of encounter can refer to a number of places within the facility: reception, lobby waiting areas, admission, and triage areas. This approach is targeted primarily at patients and accompanying family members or friends with undiagnosed and transmissible respiratory infections—any person with signs of illness from point of entry to the facility and continuing throughout the duration of the visit.

I suggest you:

  • Post signs at all entrances with instructions to patients with signs of respiratory infection to cover their mouth and nose when coughing and sneezing.
  • Use and dispose of tissues, and wash hands after contact with respiratory secretions.
  • Provide no-touch hand sanitizer receptacles in waiting areas.
  • Offer masks to coughing patients when entering the building.
  • Educate patients and families on the importance of infection prevention to prevent respiratory pathogens.

These are just some key points for infection prevention expectations for safe care. Part of my job also involves being the employee health nurse, and when September and October come around, I often hear coworkers asking "Why do I need a flu shot?" or "When do I get my flu shot?"

Why do you need a flu shot? You can't get the flu from the flu shot. This is a common misconception, because vaccines used to be made with whole viruses that had been weakened; they were still strong enough to make us feel sick. Today's vaccine is made with the smallest piece of virus possible and not the virus itself, therefore it is impossible to get sick from them.

When should you get the flu shot? The CDC recommends that people get vaccinated against flu soon after the vaccine becomes available—if possible, by October. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against the flu.

Again, though, there is nothing more than good old fashioned hand washing with soap and water to bust any germs.

The Infamous Colonoscopy: Tips for Prepping
October 4, 2016 8:47 AM by Samantha Therrien
A colonoscopy: At some point in our lives, we all will have one, either because we have reached the screening age of 50 or because we are having issues with our GI tract.

Having undergone my colonoscopy and being under the age of 50, with having a strong family history of colon cancer, I too was dreading the evil prep. Going through the colonoscopy was not a barrier for me; it was knowing that I would have to drink the vile-tasting liquid and be running to the bathroom for most parts of the day and night. And who knewI might just be sleeping there.

Working in an ambulatory surgical and endoscopy center has made me aware that colon cancer is the second deadliest cancer in the US that affects both men and woman of all ages. It's also is the most preventable major cancer, and if caught early, it can be highly treatable. An estimated 60% of deaths can be prevented with early screening.

If nurses could write "tips on prepping for your colonoscopy," it would help patients prep for this procedure by lessening their fear. Having a procedure that involves looking into your colon and your rectum sounds unpleasant and even scary, but it's the prepping that's the worst!

By far the most important thing is that we, as nurses, instruct out patients to hydrate, hydrate, and hydrate. This is the most common complaint I hear from patients when they are coming inthey are thirsty, weak, hungry, tired, and dehydrated.

My first tip is to drink lots of clear fluids, water, Gatorade, clear juices, and/or coconut water, which is the best fluid for maintaining hydration and fluid balance. Stock up on these fluids. You are going to need them. Drink the prep cold and slow through a straw, which will help prevent becoming nauseated.

Limit eating meat a few days before your prep to ensure the prep works efficiently and quickly. Increase eating veggies and high fiber. Rest as much as you can days prior to your procedure, because you will be having a sleepless night.

Get zinc oxide cream for your bottom. Due to the prep being an acid base and with the amount of times that you will be running to the bathroom, your bottom can get excoriated. The zinc oxide can protect it. Also, baby wipes with aloe vera and extra super soft toilet paper will help. Get hemorrhoid cream if you suffer from hemorrhoids. During the prepping phase, these will come out and scream at you.

If you get light headed, lay down for a bit. Don't shower or take a bath until it passes.

Wear comfy clothes and bring extra garments of clothing. If you suffer from incontinence, use depends for underwear just in case you have an accident.

The day of your procedure bring a book, an electronic device, a family member, or a friend to help pass the time and keep you relaxed, just in case there is a delay in your procedure or your doctor is running behind.

Most important, ask questions about your procedure, sedation, test results, and managing discomfortthis will lessen anxiety and fear.

In the future of colonoscopies, researchers are working new ways to make the process easier and more palatable. This could increase colonoscopy screening rates and potentially save lives. Being a patient for a day and having these few tips helped me survive my colonoscopy.

Working with the Harried Doctor
September 6, 2016 8:51 AM by Samantha Therrien
Most nurses have heard stories or experienced how unpleasant some patients or their families can be. How about the doctors they work with? Almost everyone in the medical industry has a story to tell about how doctors harass the nurses, insulting them and having screaming matches in the operating room.

As nurses, we experience different types of stress in the work place, including staffing shortages, issues with staff members and the physical and emotional exertion involved in patient care. A stressor that nurses encounter is that of the intimidating or hostile doctor. For the most part, doctors are great colleagues, and when doctors and nurses work well as a team, the best care can be achieved. In all my years of being a nurse, I have experienced dealing with harried doctors and witnessed doctors degrading and insulting nursesoften in front of their patients and other staff members. The everyday lack of respect and communication can affect staff morale, stress and patient care. The feelings of fear and lack of confidence in nurses who find themselves exposed to this type of situation can have significant impact on patient care.     

Nurses appreciate the incredible restraint and patience required when dealing with rude behavior. While this is an inevitable part of the job, there is always a way to deal with challenging doctors without it getting to you. I tell my staff to exhibit professional behavior, be prepared when reporting patient information or assisting with a procedure, advocate for the patient and family, and treat staff members and doctors with respect and consideration.

When approaching harried doctors with such behavior, consider taking these steps in managing difficult behaviors:

Don't take it personallyAs nurses, we can get too emotional and sensitive. As professionals, we need to be resilient. Most doctors get frustrated by the situation but that does not mean they hate you personally. As nurses, we are known to be very resilient and tough; we go through so many events in a day and still get back to work the next day, energized and strong.

Always remain calmDon't reciprocate anger with another negative emotion. Always approach the situation factually and without opinion.

If it your fault, apologizeApologize when appropriate. It will not make you les of a person if you learn to recognize and accept your mistakes. We all make mistakes, but make sure that you learn from yours.

Refuse to accept bad treatmentState calmly that you wish to be spoken to in a respectful tone. Alternatively, you can:

  • Walk away without saying a word.
  • Walk away while staying calm and ask the person to speak to you respectfully.
  • Stand tall and don't say a word.

DocumentDocument the behavior objectively to produce a record in a case of future situations or confrontations.

Report the behaviorReport to a manager or administrator if necessary to ensure official acknowledgement of the doctor's behavior.

When the lines of communication are kept open and a feeling of mutual respect and recognition exists, the work environment will likely improve. The bottom line is that you have to maintain your professionalism even in the middle of an argument with a doctor. You have to remember that you are a nurse, and nurses are there to give quality care to patients with confidence, and doctors are to be assured that their patients are receiving the highest level of care.
The Bitter Team
August 2, 2016 8:34 AM by Samantha Therrien
Every place I ever worked as a nurse/manager, there is always someone on staff that erodes morale, the employees who repeatedly slack off, talk back, or fail to complete tasks on time. Let's face it: we have all encountered this at some point in our career; the issue is how to handle this. When an employee starts to lose respect, your authority and control can be undermined. This effect can be toxic. Accountability diminishes, productivity level drops, and the problem behavior can spread to others.

When you're a manager, you are responsible for a lot. It can be overwhelming to run a team and a department and demands coming from all sides. We're so busy trying to do everything expected as a team manager that dealing with difficult employees is the last thing we want to do.

Everyone has a bad day, and everyone makes mistakes, so you don't need to address every single time that something happens, but you need take note and be aware if the problem continues. If you notice that things are getting worse, if the staff member is continuing to repeat the same behavior, you need to step in specially in front of other staff members or patients.

Who are these staff members?  They're the employees who:

  • continually find things to complain about
  • spread gossip and start rumors to pit employees against each other
  • talk behind managers' and co-workers' backs
  • undermine manager's authority with a never-ending flow of disapproval

As a manager, you need a strategy to deal with employee's attitudes. Acknowledge the problem. The employee's behavior was unprofessional and inappropriate. More often, bad behavior stems from lack of security and lack of trust-like when a new boss comes in or when there is another change in the organization. Understanding an employee's behavior will help you to do something about it. Things are not likely to improve if you don't address the underlying problem. 

Establishing policy is a solid step in creating a good outline and make it clear that negative actions will no longer be tolerated.

Accentuate the positive. Keep it non-confrontational and positive when meeting with the employee, giving them an opportunity to tell you what the problem is. Try to have the conversation with the employee when everyone is calm. In the heat of the moment, a lot of unpleasant things can get said. Except, it's absolutely necessary for you to speak up right there, at that moment about the problem. Highlight the employee's good work, explain to them that you are there to help them and make their work life easier. This will help build work trust and respect.

Unfortunately, as managers, we're not equipped with psychic or superpowers that allow us to read our employees' minds. My job as a manager is to make sure every single staff member on the team is successful by helping them do their best work and strengthen their career. To be an effective manager, you have to face difficult employees head on, not only for their sake, but also for the sake of the rest of your team. A difficult employee can send bad vibes through an otherwise awesome team and make other staff members' workplace more difficult.

As my grandmother used to say: "If you have nothing good to say, don't say it."

Summer Madness, Vacation Challenge
July 21, 2016 8:28 AM by Samantha Therrien
Summer is here! Living in New England, our summers tend to be short, but so is staffing.  For most of us, summer is a time of fun, relaxation and beach days. Many employees already have summer and vacation on their minds; after all, it's been a long winter and the staff is ready to get away from it all and get some much needed R&R. Research has shown that taking time off is critically important to avoid long-term burnout, builds resilience and increases staff's morale.

Vacation time is the most challenging and hardest time for managers to staff the unit. As managers, we are still responsible for keeping the unit running smoothly while allowing the employees downtime they need. The first challenge is vacation requests: who gets what week? And how to be fair?

In the past, it was always first come, first serve-and don't forget seniority. This strategy can work, but it can end up not being fair. Creating a strategy ahead of time and outlining how approval is determined will ensure that your staff's productivity does not take a vacation.  Have a plan in place so your staff knows what to expect and so you aren't seen as playing favorites.

Here are some of the tips that managers use for staffing summer vacation and holidays:

  1. Announcing that any summer vacation time requests should be submitted in a timely manner, preferably 3 to 5 months before summer starts. This will help to determine if you will be able to grant incoming vacation requests and still have enough coverage, or whether you will need to change some of them.
  2. You can ask staff to submit their first and second choice of weeks off for time away. And, if you can, try to make sure that everyone gets at least one of those weeks off that they requested either as their first or second choice. Keeping a copy of previous years of vacation taken off by staff can help with having a rotation were the same staff is not taking the same weeks every year.
  3. A great way to minimize stress of absent staff is cross training throughout the year with other departments. On my unit, preoperative and PACU nurses are crossed trained in these two units. The benefit? A maintained, steady productivity while they are gone.
  4. Explain to your staff the circumstances. If you are not able to get enough coverage, you might need to deny some requests, but you will do your best to avoid that from happening. Keeping staff informed is crucial; saying nothing means the risk of upsetting your staff who never heard "no" before. This will also help in preventing resentment from staff, and they can plan accordingly and ask for their recommendations.
  5. Be apologetic about it and openly appreciate that people are willing to pitch in to make it work. That does not mean that your staff will be thrilled about it but seeming insensitive and unconcerned will make it go over worse. Do what you can to make being at work during vacation season more pleasant for staff. I bring in food (my nurses love chocolate). Find other ways to show appreciation. And always say "Thank You" at the end of a shift.

Remember, as a manager, there are no small gestures.  Make sure you schedule your own summer vacation, along with everyone else. I'm looking forward for the dog days of summer when the temperature rises, and I can actually kick back and relax.

Nurse First, Manager Second
June 22, 2016 2:47 PM by Samantha Therrien

Being a nursing manager these days, people automatically assume means being dressed in a suit with a lab coat, rarely venturing out to patient care areas and a having a nice big office. The biggest complaint that I hear is that managers forget about being nurses and are not clinically involved and lack clinical credibility.

Reality check. I manage an extremely busy pre-operative day surgery facility. We do as many as 74 cases a day, which includes surgical and endoscopy patients.  My job is to manage staff, patients and the daily schedule.  Being a nurse for 21 years and having a diverse background in nursing has helped me become a manager and still be a nurse first.

 Yes, you will see me behind a patient's curtain wearing scrubs, clogs and carrying a stethoscope around my neck and having daily patient clinical case load along with my staff.  Some days it becomes very challenging, especially those days when there is a full schedule.  As a nurse manager I feel left out at times, staff can see you as the enemy and do not appreciate your work.  Being a leader, I must remind myself I'm always under the microscope. I personally struggle with this and I'm afraid it will ruin me. One certain rule that I have learned throughout the years is that it can be lonely at the top. 

 Years of working alongside with other nurses and sharing their lives, successes and failures create a strong bond with your staff. I encourage my nurses to communicate their concerns, frustrations and empower them to participate in decision making, giving a sense of ownership and autonomy. This allows my nurses to become united, working as a team instead of creating a competitive atmosphere.

 Managing means being able to manage people. Being a nurse manager requires nursing skills and managing skills and being good at both things. A highly experienced and trained nurse does not suddenly become a competent manger, likewise an experienced manager from another area would need time to develop nursing skills.  

Being a competent manager is being able to utilize the skills that are learned and using the resources at hand to deliver a service that is required. Great managers have to be creative and able to see tiny details as well as the broader perspective, easily approachable, accessible and empathetic to their staff.

I believe that being a nurse manager is a unique skill. It has been one of the most interesting and rewarding experiences in my career. I have challenged myself and developed knowledge. Having insight in what I need to do in a day to day basis in a wide range of areas and circumstances has made me become a successful nurse manager.