Oh to be a Nurse Manager...

MMMmmmm.....

2008-10-19T09:05:00.008-04:00

I've been watching "the practice" Sunday mornings on FX. I really liked this show back in the day. I, also, really liked Bobbie.

*rawr*

He is one fine looking gentleman.

But, it has gotten me thinking. I still find him quite attractive, but I have also find other types of men quite attractive.

Like...

Anthony Edwards is hot.

I cried when Dr Green died. I haven't watched ER since.

What is the point to all of this? None. I was just thinking.

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I haven't posted in a long time. In fact, the whole month of September is not here. The reason is it was bad. I was overwhelmed, down and all adjectives of like. I was done with it all. I was ready to place my pager on my desk and leave. Just walk away.

To get me through this, I planned a trip for me and my boys. They had fall break coming up and I needed to get out of town. Having that trip waiting for me out there improved things immensely. It helped me to just let things go because Oct. 4th I was going away!

We went down to Orlando and Walt Disney World. We had the most wonderful time. I bought 5 day park hopper tickets for us. We didn't have to rush. We could do everything we wanted. The money spent was well worth it.

Also, there was a Food and Wine festival at Epcot. Score!

Of course, the Monday I went back to work, I sat down at my desk and eyed my piles all over my desk. Ugh. But, it was okay. I just put it out of my mind and got to the immediate needs. The schedule.

It's going to be okay. I will do my best and go from there.

I've, also, joined Weight Watchers and started a blog at Blog to Lose. I found this site by following a link from Beth at PixelRN

Why reluctant.

2008-08-23T13:12:00.003-04:00

I never set out to become a nurse manager. I loved coming in working my shifts and leaving it all there. It was perfect.

Then my husband decided he would be happier not married anymore. It didn't matter what I thought or about our boys. It was about him. And, really, now, I can't blame him. It has taken me four years to say that though.

So, I found myself a single mom of four boys with a week-end nights position. Would have been fine if I had any support around. Alas, my parents live across the nation. My in-laws helped me out after the ex decided he didn't want to keep the boys every weekend like he first said he would. Besides, he was living somewhere where I would not let the boys go stay and every time he left the house again it felt like he was leaving all over again. Wouldn't want him to have any guilt.

Instead, my in-laws would drive an hour twenty minutes on Saturday to pick the boys up after their soccer games, then take them home with them. Sunday, the boys would go to church with them (they taught Sunday School) and then drive back here. They would spend the night Sunday and I would rush home Monday mornings to take the boys to school.

This went on for four or five weeks. This was much less than ideal and I had to figure out a way for me to take care of my children on my own. Logically, that would be to work a day shift job. I started looking for a position that I could go in at eight so I could take the boys to school. The boys go to private school and I didn't want to take them out. So much of their lives was changing and I didn't want that to change.

I couldn't find one. There was an opening on day shift in ICU (I was in CCU at the time). It was 7 to 3 Monday - Friday. I found a daycare that I could drop the boys at in morning (6:15) that would take them to school and pick them up. We did this for over a year. It wasn't ideal either but was better than my in-laws making so many trips back and forth. I can't even imagine them doing it now with the cost of gasoline.

This was not a permanent solution. When my oldest turned 13 he would be too old to go there any more. I always had my eye out for something different. I did interview for a job in radiation oncology. It would have been cush. More like an office job than bedside nursing. Unfortunately, they went with some RN with oncology experience instead of me with critical care experience x8 years. I heard she was not very motivated. Their loss.

About a year and half after going to day shift, our charge nurse died. It was very sad and heartbreaking. I decided to apply for her position. Our nurse manager came out in the unit (something she didn't do very often) and told me I got it. I remember thinking, "What have I done."

That was in June. In August, there were rumors that our nurse manager had applied to education. I asked her if it was true. She used some of that manager double speak and said that if she ever was going to leave, I would be the first one she told. Later that week, I got a phone call at home. She was accepting a position in education. For the next couple of months I did charge and made out the schedules and what ever else that came up that needed to done that director asked me to do. I toyed with the idea of applying, but who would want to do that job!

I was working the weekends I didn't have my boys (The ex had gotten his own place and now took the boys every other weekend, but was not helping me to pay for their private school. I have since gotten that taken care of when our divorce became final). I would work five 8's, two 12's and then five more 8's. I would two days off and start all over again. I was wearing myself out. It was one Sunday after 3 pm and I was in the med room doing something. A nurse had floated down from COU to help us out. He was talking about the program he was in for NP and telling me how I could do it too. I stopped right there, listening to him, and decided I couldn't go on like this. I needed to do something else. I would be a broken down nurse by the time my youngest graduated (he was in kindergarten at the time). I really couldn't go back to school. I was already "in" four different grades. I saw the nurse manager position as my out so to say. I could take the boys to school. No more getting up at 5:30 for them. I could leave in the middle of the day for dentist appointments or class parties. There were some perks to the job. And, I squeeze those perks hard.

I applied. That must have been in mid September or early October. By Thanksgiving, I had the job nearly two years after I started looking for something that would allow me to take my boys to school. I was still in critical care.( When I was looking for something else, the thought of leaving critical care was very sad to me. I love it.) I try to be a nurse advocate and not forget where I came. ( I worked a 12 hour night shift back in June because we were horribly short. I hadn't forgotten anything, but I was slow.) I like to think of myself as passionate. Where as others think I am difficult to work with. We just have different end points we are trying to achieve

Long post. Sorry. But, that is how I became a relctant nurse manager. I never wanted to be one, but here I am.

Take my word for it.... Never, EVER MERGE!

2008-08-19T19:45:00.002-04:00

Last year around this time... or maybe it was June... anyway, our CEO announced plans to merge our system with another local system. At the time, we really didn't know what it would all entail.

A yearish later, we've closed the other "downtown" location, combining services or moving them to other facilities. I have weathered the RiF's (reduction in force). I now have an additional 14 beds to be covered with an addition of 30 staff members. We have tripled our open heart cases and now have patients flying in from outlying community hospitals like we are some kind of tertiary center. I think our total bed count is 400-something.

Plans are to build a brand, spankin' new hospital within the next three to five years if financial goals are made.... And, financial goals will be made.

I have been on cost reduction teams where we have evaluated everything from the type of pillow we use to how we order batteries.

Let me tell you, it's the pits.

But, the thing that I think is getting me down is the extra work from the added staff members. It's more phone calls. "Can I be off this day if I work that day?" "I can't see incentives in BidShift, but I know I have picked up all of my hours." "I think my paycheck is wrong... again." "Can I not meet my requirements of my FTE?"

It goes on and on. And, on. It's not that I don't care or want to help staff, but it does not stop.

On top of that is all of the "manager" crap.

Quality, Case Management, Medication Safety, RFI's, Capitol Budget, Learning Center, Payroll, HR... on and on. And, on.

I need help.

or I need a different job.

I dunno.

I do know... I liked my job before the merger. I liked the size of my units and number of staff members. The workload was big, but somewhat manageable. Now... I just want to hide under my desk and not think about how I am supposed to come up with four heart beds when all of my units are full.

They came. They saw. They accredited!

2008-08-09T08:45:00.004-04:00

I had the distinct pleasure (note sarcasm) of having the Joint Commission come to our facility.

For months now our quality person in charge of compliance would check their website to see if we were on their hit list. Every day I would get the email around 7:30 "No survey today". To my utter surprise this past Tuesday the email was different. "Alert! Survey Today!"

I stared at it in disbelief. I was at home, half dressed, with my boys in different states of dressedness. I called the unit. All the lines were busy. We have four lines. Bad omen. I next called the staffing office.

"Is it true?"

"Yes. Some woman I have never seen before came in here, threw some papers at me and said JACHO is coming. I am sending the pages now."

Needless to say, I uttered an explicative.

I hurriedly finished getting ready while nagging the boys to do the same. Pages and emails start coming through my blackberry. In my stressed out state, I don't answer any of them.

As I am driving my boys to their summer camp, I get a call from my boss.

"Hey."

"I know. I have to drop off the boys and then I'll be right in."

"Okay."

Literally that was the whole conversation. He said only two words.

When I finally got there, it was barely passed 8 o'clock. My charge nurse had everything under control and is truly worth her weight in gold (She is not a small girl either).

We were only visited twice by the administer surveyor. I am shocked we did not get the nurse or the physician surveyors. The two RN's and respiratory therapist he talked to did a fantabulous job. They answered every question expertly. I couldn't be more proud.

They were here for four days visiting the main hospital, our satellite campus, home health, hospice and DME. We passed with full accreditation. We took some hits as we knew we would (unapproved abbreviations, med rec, pain management). None of them found in my units!

I survived my first survey as a nurse manager. I wonder if I will still be here in three years to survive another. Monday I was ready to quit. Tuesday, Joint Commission showed and I haven't thought about it since. Now I am just elated it is over.

Rumors, Lies, Betrayal and Death

2008-07-26T09:45:00.005-04:00

A couple of weeks ago, one of my nurses came to me to tell me about some rumors going around about her and another nurse. She denied them. I believed her. I recommended whatever behavior that was causing the rumors needs to be pulled back.

This week, one of the 3-11 team leaders (house supervisor) came to me about the rumors. I told her of my previous conversation and of my believing the nurse.

This morning I received an email from the nurse's husband saying she had admitted everything to him. He named the other nurse. He said it happened while they were at work. He, also, sent the same email to the CEO of our region.

I talked with my immediate supervisor. He made appropriate emails to give the Chief Nursing Officer and Regional Clinical Officer a heads up.

I went into work around noon. I had some stuff I wanted to get done. I then find out they had been trying to reach me. The nurse's husband had killed himself sometime after he sent me the email.

I am devastated. For her, her young children, for all my staff. And, for me. Should I have done something different? Should I have not been so gullible and not believed her? Made (not that I could have) her go to EAP? Should I have called this morning when I received the email? Should I have responded to the email?

I know it is not my fault. I know I could not have changed things. But, I feel so bad.

Now, I need to be there for her and my other nurse. Offer them support. They were adults. They made a choice. Now we all will live with the consequences especially the children.

I know how he felt. When my husband left, I wanted to die. I don't know how I lived through it. Every time (all the time) I thought that way, I didn't do anything because of my boys. I couldn't do that to them. How could he do it to his?

Holiday?

2008-05-26T19:59:00.004-04:00

Why would a manager go in on a holiday if she wasn't on call? ...Because the boys are gone. My ex keeps the boys on Monday Holidays if the preceding weekend was his weekend. I had already been alone all weekend, I wanted to go in and get some stuff done. It is always easier to get stuff done either after 3pm or when other managers are not there.

So, what did I do?

Updated our patient satisfaction boards on both units (Dern CMS publishing our scores.)

Updated the Rapid Response board. It had not been done since our previous manager. (Yes, I suck.)

Titled our new Critical Care Collaborative Practice board. Maybe the CM will get some info on it now.

You know... it really seemed like more.

I did have somewhat of a productive weekend. I went and saw the new Indy movie. I enjoyed it for what it was. Bought new sheets for my bed. You can not beat Egyptian cotton sheets. And, I scrubbed my tub and sink this morning. So much better.

I have lots to get done this week as I leave on Sunday for the Beach! (I know you are jealous.)

Get the new core schedule done for July and set up available shifts in BidShift.
Finish the updated manager weekend call schedule. I think I will just get it done until late September, then I can add the newbies.
Have staff meetings and buy everyone lunch.

I know there must be more...

Happy Memorial Day.

I was an eyeborw waxing virgin.

2008-05-18T22:00:00.004-04:00

I somehow let the lady who gave me a pedicure and was doing my nails talk me into waxing my eyebrows.

I wasn't so sure at first. I'm not really good with pain and such... I have to sit down when I get my flu shot. I was not much better at my last TB skin test. I am basically a wuss.

She put on the hot wax, applied the paper (or whatever it was. I had my eyes closed.), and pulled. It hurt. It burned. It wasn't so bad.

I now have lovely shaped eyebrows (not quite as nice as the picture. Imagine a lighter brown eyebrow with green eyes). I think they are kind of light on the ends. I may need an eyebrow pencil.