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Old 01-21-2008, 07:40 AM
Posts: n/a

Wow! I have read this thread twice now and... all I can say is, "Wow!" The expressions of personal accountability and the insight related to the performance and social stressors associated with middle management were marvelous to read.

As a middle management-type I find the ease of weathering the storm of opposing demands directly related to my relationship with staff and senior management. If trust is present, then my job is pleasant indeed. Earning this trust can be difficult, but is worth every effort.

Since much of the turmoil in acute care surrounds staffing, please allow me to describe things from my perspective.

Many more times than I can count I have been critized for staffing above what is considered adequate by senior management. Most ordinarily my rationale for the staffing is all that has been required to difuse the situation. On occasion, however, the holes I've poked in the budget have threatened to sink my boat. I have yet to need to swim, but I have become mighty damp at times. And I can see the sharks circling!

The "Howdy Rounds" I do before assigning staffing for the next shift enable me to gather the information necessary to make an informed decision. This means asking very direct questions of and listening to RNs, CNAs, and Unit Secretaries. From psych to peds, from ortho to medical/surgical, from critical care to L&D, and all the way through the ED I get a feel for the house. And so I staff accordingly if at all possible.

The increasingly frequent days when the number of available staff does not meet the acuity/census need (as well as during those times when the ER is overrun) are challenging. This is when I fly around the place ensuring breaks, doing tasky things for harried nurses or CNAs, and trying in all ways to be all things to all people so that I might reduce the burnout level of staff. Is this what a house supervisor does? Well, it is what this house sup does!

And about the rest of the stuff that a house sup does... well, I do that, too. I do act as an arbiter of policy and procedure issues. I do ensure a safe work environment by active listening and establishing boundaries for staff, physicians, and the public. And while the decisions I make are not always accepted with applause, I do make every effort to be collaborative.

Finally, I do complain when the pain of being squeezed between a very hard rock and a very hard place becomes too much. In fact, if you all will allow it, I may even complain a bit here in this forum now and then... Anyone willing to bring the crackers and cheese to go along with my w(h)ine?


ps - so tell me, please... What can we house sup-types do differently, not at all, or better to ensure that staff have what they need in order to optimally provide the art and science of nursing care? What can staff do to help themselves?
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