Nursing Voices Forum  Meet other nurses, share your nursing knowledge and experiences

Nursing Voices Forum Meet other nurses, share your nursing knowledge and experiences (
-   Politics/Debates (
-   -   Middle Management aka "The Bad Guys" (

MyOwnWoman 12-10-2007 07:48 PM

Middle Management aka "The Bad Guys"
Before everyone wants me thrown from a car into the path of a locomotive listen to what I have to say. Today I spent some time re-reading some of the threads here at Nursing Voices and noticed something that I had not noticed before. There seems to be a underlying tone that Middle Management (Nurse Managers/Supervisors) don't care about the day to day frustrations that the floor nurse goes through. The tone of some of the posts indicate that Middle Management's major concern is the budget, making them more Upper Management than the floor nurse thinks they should be.

First, I need to say that I am not Middle or Upper Management. I am straight-up a floor nurse. I am a floor nurse because that is what I choose to be. I don't think, for the most part, that I am Middle Management material because there are too many times that my mouth engages before it should. If you want an opinion on a specific problem, I have no problem giving it to you. You may not like what I have to say, but if you ask, I'm more than willing to tell you. This makes me "not so good" at being in the middle, which, in fact is where Middle Management is.

Middle Management are those nurses who are in between a rock and a hard place. They are suppose to be the staff nurse's advocate while being under the sometimes crushing thumb of Upper Management. Often times, it is Middle Management that takes the brunt of everyone's anger; from both the staff nurse and "the powers that be." While I think that Middle Management's heart is closer to the bedside than Upper Management, it is often hidden from the staff nurses view because of the controversial decisions that they, out of necessity, have to make.

If the truth be told, I would imagine that every Nurse Manager or Nursing Supervisor would like their departments to be staffed better than they are right now; but they walk a fine line between what they want and what reality has to offer. I have to admit, there are times when I don't make their job easier to do. Often times I don't see the big picture, but only the small patient that lays before me. I am not the one that is held accountable for a budget or a nurse to patient ratio, but I may be the first one to voice my upset when I don't have the things I need to take care of my patients immediately at my disposal or I feel short staffed eventhough our "staffing pattern" is what it should be.

It seems that I have forgotten that Middle Management are nurses first and management second. They have the same compassion that I feel only from a different viewpoint. Upper Management is often times composed of administrators who have never spent time with a patient. They are not nurses but businessmen and women who are concerned with the "bottom line" of the business. For the nurse, the bottom line is the patient, for the businessman, the bottom line is the dollar.

I, for the most part, am very fortunate to have Middle Management who, if I stopped and looked at things from outside of my own little box, really care about our patients. It must frustrate them when their hands become tied and they are no longer able to give the staff nurse what she wants and needs to take care of the patients in a way the patient deserves.

So, to all of you Middle Management out there. I'd just like to say that I appreciate what you do and I'm sorry if I don't say it often enough. Forgive me when the only view I have is my own. I know you are right in the middle and by the mere fact that you are in the middle means that you are being squeezed by both sides.

DisappearingJohn 12-11-2007 12:16 AM

Well said....
Well said, My Own Woman...

That being said, at least in the organization I work for, there is a fairly "flat" organizational structure, so there ain't a whole lot of "middle management". We have a charge nurse, who reports to a director, who reports to the CNO.

I get to play relief charge fairly often, so I do feel the pain involved there. And I have to admit to being guilty as charged about forgetting that our director is a nurse.

Thanks for bringing it back to my attention...

Icare4u 12-22-2007 07:02 AM

Those nurses who have chosen to be "middle management", have put themselves in a very difficult position. They recognize the problems/issues in the unit, but have to answer to upper management who are clueless to the reality of nursing. It seems that upper management want the "numbers" to look good, so that the almighty Press-Ganey scores are high, and the middle managers have the responsibility for elevating those numbers. In the ER the big push is to reduce: triage room patient waiting times, ER evaluation time and transport and bed assignments. If you work in the ER you know how unrealistic that is. Yes, you can bring the patient in from the ER triage room, reducing their wait time, but they just wait in the ER to be examined anyway..but the "numbers" look good, not the quality of the care. Middle managers scurry around and literally hound you to "move the patients". I try not to take it personally, because I understand what motivates them, but for those who take middle manager jobs, where to they go from there? I am quite content to be a staff nurse.

Mr Ian 12-23-2007 05:24 AM

I wholeheartedly agree and always retain a sense of 'reality' about a given work problem that my line manager has to resolve.

Having said that, as a supervisory nurse, I do very little to show it and often fire a convincing argument to them that leaves them with little options other than to meet my needs (based on junior staff/patient needs) or, less frequently, to tell me to shut up and get back in my box because there's nothing they can do about it. I accept that. I hate it but I know that if that is their answer then they don't have an alternative. Sometimes it is because they have other genuine agendas that compromise my arguments, rarely it is because they're crap managers. As long as they're straight with me, we did our thing and get over it and back to work.

I only get fired up when a manager tells me it can't be done, based on someone else's decision and when I think that decision is flawed. I'm not talking about state or national policy or hospital budget as I know there's little my middle manager can do about that. I'm talking about "we decided to do it this way because it seemed easier" (usually easier for them) and I don't subscribe to taking the easy route just for the sake of it.

I also dislike when decisions are put upon staff because it came down to upper management decision against shop floor nurses wants and the middle manager simply supports the hand that feeds it. However, I admire those who lose the battles to win the war; subtle but effective middle management.

I have respect for managers where deserved and sometimes simply by position/status (as my knowledge of their dilemmas are limited) but I do not let that stop me lobbying for my junior staff or patient needs. They opted into the job.

What I like is that I frequently roast my 2 line managers, their line manager and even the line manager above him regularly with my opinions (the top line manager is the one who tells me to shut up and get in my box mostly - but always with a sympathetic nod and mutual understanding - it's her job). Then at the weekends I sometimes go round theirs for beers, mine for beers or go play poker with them at the pub.
Even some of the crappiest managers are actually nice people... (and vice versa).

Julie 12-23-2007 09:20 AM

Speaking as a middle manager kind of person all I can do is to do my best to make a difference, to help others see the difficulties faced by those both below and above me and to promote effective and efficient management. There are good managers out there and there are nice managers out there even if I do say so myself!


Mother Jones, RN 12-26-2007 05:29 PM

There are three types of middle managers: The good, the bad, and the ugly. The good middle managers work really hard, and they don't get the credit that they deserve. The bad middle managers are the ones who may be trying, but they don't have the talent, or the support, to do a good job. Then there are the ugly middle managers. These people go into management to escape bedside nursing, and they will stab anyone in the back in order to get ahead. I'm sure that people on the board don't think that all managers are bad, we just like to gripe about the ones who are evil.

MJ :pepsi::pepsi::pepsi:

KimRN 12-27-2007 10:59 AM

I would never, ever go into middle management.

You get it from the staff and you get it from the top management and you are darned if you do and darned if you don't.

The best hospitals I worked in had the unit charge nurses in total control and they communicated with the other charge nurses on the other units for bed control and help when needed. There was no "middle" manager.

All our middle managers (nursing supervisors for the house) do is take sick calls and find staffing for the next shift, act as the go-between when the ER needs to admit a patient, find medications that are not in the Pyxis on any particular unit (by running to other units), call in the OR team when necessary and answer complaints from patients.

That does not sound like any type of job I would want to have.

More power to those who do it, though. It takes a special personality and I don't have it.

storknurse05 12-27-2007 02:02 PM

I have found that on our unit the "clinical coordinators" (aka former staff nurses who have no additional education or training but are thrown under the bus so that the manager can keep her job) take the brunt of the conflict on our unit. We have gone through 4 managers in as many years, with the current one being on staff for over a year now. It's nearly impossible to move up in our organization because there is too much socializing (that sounds terrible, I know...but it's like being too friendly with your kids...they still need a parent). People go from staff RN to "clinical coordinator" to being asked to step down and leaving out of embarrassment. They take the fall for everything that goes wrong even when they have the best intentions. I think that if you want to be a middle manager (at least in our system) you need to come from outside the system, pay your dues, and then move on to upper level management somewhere else...

DisappearingJohn 12-28-2007 10:37 PM

Why would anyone want the job...
That is the problem facing us right now. A charge nurse has stepped down, the position is open, and no one has applied. Like the age old question, "what if they threw a war, and no one came?" the same problem is being had. Several of us have repeatedly been asked to accept the position, and have expressed no desire to outright contempt for the job; until they realize the spot that position is regularly placed in, no one would willing want it.

Julie 12-29-2007 04:15 AM

Quite often in the UK people get 'seconded' into a post like that for a fixed period of time, say 6 months. That way the person gets to try out for real whether they really do or don't like it, they get to advise the powers that be why no one would touch it and if they really do hate it they go back to their original job. I did that very thing when I moved from district nursing into a specialist role in rheumatology, luckily I loved it and made it permanent, but if not I would have gone back to my original job.

All times are GMT -4. The time now is 02:25 AM.

Copyright © 2006-2012 MH Sub I, LLC dba Internet Brands