When I came home I had received a letter from someone who had gotten my name from another blogger, knowing I was a manager in the healthcare field. This person had recently taken a position as a manager and feeling all the aches, pains and self doubts that come with the job. Looking for a bit of advice, maybe a little direction. In answering the letter, I paused alot. It really made me take a deeper look at myself and what I do, and why I do it. By the time I finished the letter, I knew I wanted to post it here. That way I can go back and remember the whys of it all....when I'm in that place of fear, anxiety and self doubt.

The letter:

Hi,

Wow, quite a letter, and I know your frustration. First, let me tell you just a little about me. I'm currently a DON in a 160 bed skilled nursing facility in Detroit burbs. I've worked as a DON since 1986 in LTC, with a short two year stint as a consultant but hated the traveling and ended up being an interim DON anyway. I can say without any qualms this is the toughest job I've ever had. I really really would love to quit, but I hate to admit it, part of me likes the challenge.
The best piece of advice I can give you is: Yes you are a manager, you manage people....but, as a nurse, you are a caregiver first and foremost. It's not your job or my job to make employees happy. Our job is to deliver the highest quality of care in the most efficient way possible. Our patients are the ones that need to be happy. I'm very verbal about my expectations. There are no surprises, no second guessing, quality care is expected or there will be consequences. Do what you say you are going to do.

Any changes I make in systems or protocols for the employees - perceived as being positive or negative the first thing to consider is patient outcome. All changes must have a positive impact on my patients short term and long term or it's not beneficial. Staff feelings are secondary. Remember any change will promote negative responses from some. They get over it...and the ones that don't move on.

Being a manager is a very lonely job. Not only do I feel I can not trust my employees, but I really never trust my superiors either. Yes everyone is very kind, caring, considerate and respectful to your face, behind your back it's always different. Do not take it personal, it's not personal. It's human nature to point the finger at the bosses when there is anything about the job a person does not like. I am respectful and courteous to my employees, but I do not befriend them. It's impossible to be friends and be a good supervisor. Many in non-management positions will tell you that's not true of course. Don't listen. It's important that you are able to keep your objectivity and that's impossible with friends.

Always go out of your way to examine yourself for being fair and objective. Remember there are two sides to every story and never make a snap decision about disciplinary action without hearing all sides. Take a breather, go back and ask more questions.

People will bring you more issues then you can possibly imagine and expect you to be the solver of all. Again that objectivity needs to come into play and decide if it is an issue. Is it impacting patient care or have the potential to do so? If it is, it's your baby to deal with.

You mention one nurse having an attitude and having a come to Jesus talk. I usually ask upfront quickly if there is a problem so we can move on, I literally have no time for bullshit, so if there is an issue we need to deal with it quickly. If they say no, then meetings over. I don't baby or coddle. That person is an adult, they need to lay it on the table or move on. Sometimes it might come down to just a personality clash. It happens. Keep it respectful, courteous and professional. I don't have to personally like everyone and I really could care less who doesn't like me. I have a job to do.

You asked how to survive in an atmosphere of basically being alone so to speak. Only way I can answer that is....what I do, my job, it's not about me. It's not about what I want, if that makes any sense. I'm there to take care of 160 people to the best of my ability and to improve their quality of life. The day I feel I can't do that I will have to move on.

Sometimes all the staff crap can get so in the way of that main goal. That's when I start losing it...losing perspective, feeling dysfunctional, feeling inadequate and useless. Just step back, breathe, remember what it's really all about. After all this isn't working the counter at Mickey D's, peoples lifes can be on the line with screw ups in our field. You can't afford to lose perspective for long.

Some people aren't cut out to be supervisors, if you end up being one of them....so what? Nothing wrong with that. Everyone's tolerance level for bullshit is definitely different and being a manager you definitely deal with a lot of bullshit. Hell I wouldn't blame anyone for walking away, life is tough enough without adding to it. But then again, it's a tough job and somebody has to do it right?

I don't know if any of this helps you...but it did make me re-examine myself. I needed that...thanks. I hope to hear from you again....and good luck.

Dawn

So now you know.

The meeting yesterday absolutely sucked. The "big boss" flew in from the land of big bosses so we didn't get out of the meeting until 4. Since I sat for 7 hours yesterday my back is screaming like a 1964 Beatles fan. Still. Twelve hours later.

I developed this "war wound" back in 1983 hiking the sweet, 178# Ms. Nellie up in bed. Something I'd done every day by myself for ages. On that fateful day someone obviously snuck in the room and hit me in the lower back with a baseball bat. Homerun. One of those moments in time never to be forgotten.

Nurses are notoriously known for having bad backs and knees. Patients always complain why we walk so slow....now you know. Womens bodies are not meant to lift 200# repeatedly throughout the day, over and over, day after day. How often do you see a nurse over 45 giving direct patient care? We just fade away.

I've pretty much babied this back for years now. I know my weight limit is 50#, if I lift over that I'm playing with fire. In my job description for this job I currently have, it list one of the requirements is lifting 100#. I told them when they hired me I can't do that anymore. No problem they said. Now no where in those negotiations was sitting for 7+ hours mentioned.

In 2 weeks I have to go to Houston for 4 days of meetings. Already have the agenda: 8am - 5pm meetings. Now I'm mentally screaming. This can not be a good thing.

I've got to start formulating Plan B. Soon as this Motrin kicks in.

Tony always posts the most interesting things. Well this post...I'm not sure if it's the "neatest" thing, but "Flatus Odor Judge" reminds me alot of nursing.

I can't begin to explain how much smell plays a part in nursing. If you've been a doctor or a nurse long enough, somethings you can almost diagnose from smell alone.

Intestinal C. Diff. infection. The most horrific bowel movement odor imaginable that pervades throughout a unit, or a hospital floor. I was doing rounds about 3 weeks ago with one of my nurse managers. As I entered the hall - the smell about knocked me over. I asked her who had diarrhea on her unit. She told me nobody. My response was bullshit - no pun intended- someone has C. Diff. After questioning a couple of the nursing assistants, the patient was pinpointed, and 2 days later verified by lab tests.

A wound with a staph infection...very distinct. Gangrene, horrid, all you have to do is walk near a patient.

Uncontrolled diabetics urine smells just like maple syrup. Just yesterday when I went in early at breakfast time I asked the nurse on a unit I had just passed through if they were having pancakes for breakfast or if we have a new diabetic. Gross I know. Actually it was waffles for breakfast.

I could go on, but I won't. You get the idea.

Tony, I think you have the most informative, interesting blog on the net. No shit. Pun intended.

I really hate the thought of going back to work Monday. Beyond hate, it's really bumming me out. I'm a nurse, I believe I was meant to be a nurse, but the healthcare industry has changed so drastically you can't be a nurse anymore.

Acidman set me off this morning with one of his posts and according to him, and rightly so, he said I barked at him. I did. I apologized for that. Someone who is not in the medical industry can not possibly understand what is going on.

Nurses have left in droves. There is a nursing shortage. It's not about salaries and benefits or nursing would of died off back in the 60's. That has changed over the years...salaries and benefits have improved. The majority of nurses that do stay only because 1) they keep hoping someday they will be able to do their jobs, and 2) they are locked into that salary level.

Many are saying fuck it all, they are the smart ones that realize that #1 is not going to change in our lifetimes. If I hadn't divorced then the ex dying, which drastically altered my future financial outlook (no I didn't ever receive alimony)...I'd be long gone by now. I will be long gone soon. Everything I have focused on in the past year is to simplify my life so I can take a drastic cut in wages. Well, one more to put through college anyway. Six more years? ARGGHH! Life sucks.