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Old 01-20-2008, 10:19 PM
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Smile Middle Management

Okay, so we al know all the bad stuff about middle management. What is it that we want to see happen? What qualities and efforts do we want to see them have and do? Let's help them out with some constructive ideas.
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Old 01-21-2008, 06:40 AM
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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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Old 03-03-2009, 08:55 PM
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Default Middle Managment (need help/advice)

Oh my gosh Babyboomer, thank you for posting that!!

I am one of those Clinical Coordinators in the O.R. for the Eyes and ENT Service lines. I am not scheduled in a room, so I can go from room to room. I can have 3-4 O.R.s running at a time (we are a 12 O.R. Level 2 Trauma hospital). I Read through the thread, and I soooooooo do hear what you all are saying. I am a 12 year Associates RN, that decided (OY!)to return to school last Sept for my BSN and then now understand that i want to go further to my MSN because i KNOW i am supposed to teach somebody, somewhere, somehow, someday. We have 9 coordinators and 1 SCA coordinator. Each of us also has Direct Report responsibility (yearly evaluations, discipline competencies), and about 4 of us are BSN and I am the only one currently working on my BSN. Total O.R. staff (including pre-op and PACU) = 150. PACU and Pre-op have their own management teams. So I would say we have about 115 in the O.R that covers 3 different shifts. We just recently got rid of the overnight call. and we are busy, busy, busy.

So, my job is to educate folks to my service lines, supervise its daily flow, manage the supplies and equipment related to it, coordinator surgeries with the doctors, and a mirade of other tasks. I coordinate the educational offerings for our in service that relate to my service lines. I attend continue education opportunities at our hospital (we offer of 2000 hours of nursing education classes!!)I am also one of the Laser Safety Officers for the O.R. I am in my rooms supporting the staff there (we don't have "teams" but there are staff that routinely get put in the other service line rooms, so Cysto and I are kind of the hand me down services so we get who we get, and because of those inconsistencies with staffing, sometimes I work with staff for cases, and then they aren't in there again for 6 weeks, so it's like helping them out new all over again.

I am free to scrub in if i want, which i am doing more often as we have people that will put up with helping me learn different procedures. I have been a coordinator in various service lines (Eyes, ENT, CV, GYN, Plastics, and Heart team) at various institutions for 8 1/2 years. Our hospital has a pretty good core of people, and because most don't "live" in the Eyes and ENT services, seem grateful i am there and available to help them be successful during their day. I do enjoy my people.

Of course we are going to be affected by the economy...haven't yet, and have been lucky. Our roles are pretty developed, but we have a new CNO who DOES value what we do, but of course with new people come new guidelines, so she encouraged us to look at our practice, and in the months coming up to think about what we would look like if more "bedside" was emphasized in our role. She already sees areas that she can shift some of our work burden, with regards to supply management, and maybe shifting the Direct Reporting back to managment (which none of us would be sad

We are in a unique position to peel back the layers that have created some hardships for us in the "tasks" we have to do, and maybe recreate what a new O.R. coordinator should look like. We have all discussed with our manager and director and with the CNO present, that it is almost virtually impossible to be able to do the job we are counted on to do AND be counted as room staff. We all HAVE filled in, but not as a regular schedule. Handling other rooms crises, fielding rep calls, doctors needing something, and try to be a circulator focused on a patient??

I worked in another hospital where they did that, and it was very dysfunctional. Not only for the service lines, but for the doctors and staff needing the help as well. And at this place it became common place for people to call in sick because there was a coordinator that could take care of the hole. There was alot of overtime being paid out because the coordinator would have to wait until the "shift" was done and then go do the coordinator stuff. While for a little while the pay was worth it, the stress was not. Docs were unhappy, staff were unhappy because docs were unhappy because we couldn't do our job during the day. So we are trying to avoid going to that model if we can help it, and it sounds like the CNO is giving us a chance to define the role ourselves before someone defines it for us.

So....with support from what Babyboomer said, can you all spare some constructive ideas, thoughts, concepts, models. I am middle management and i work my butt off for the staff (I think they appreciate me?) I also work for the manager & director who are so supportive of us and the work we do, so i think we have a good balance....but I am open to creative ways you might know of to help our staff, create the ideal Clinical Coordinator role (I can ferret out how to apply ideas from other areas (the floor, ICU, ER, etc)....Tell me what you as staff nurses NEED. Especially if you are in the O.R. (let me know how they do it where you work...)

Tell me what you love about your favorite Coordinator type person, what is it he or she does that makes your day better, that motivates you?? What would you change about your current persons role?

I know there are the "kick them back to staff comments" and i truly can appreciate where you are coming from, and respect your right to say it, and i won't fault you for being open, but at the same time, even if it won't help your current situation, put it here (only asking you to be positive in presentation) maybe it can help me be better for my staff.

Can we just go to the assumption that I don't sit in the lounge all day. I am moving, moving, and most often i eat breakfast for lunch at about 1330. So I am not a slouch in my job. So, if i am busy, and helping, what would your suggestions be from that standpoint, for me to bring my job to "bedside"? I do like my job, want to continue it...someday i am going to be able to go on to do something more and different, but for now, this is me.

For those that have the slouches or ones that are sucking up to management, I am sorry, and I apologize for bad management of the middle managers.

But i am here, in the best place to FIND help, amongst my peers.... nurses....

Ok... be gentle

and thanks for your help.

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