1. Describe why this clinical area was selected and what you initially expected to learn.
- I picked this clinical area because I worked there and knew that it would create a good clinical experience. I initially expected to learn what a manager does; the simple stuff like budgeting, hiring, staffing, etc.
- I learned that there is nothing simple about managing; it is much more than just budgeting, hiring, and staffing. It could be said that managers spend most of their time in meetings and answering emails; however, after this experience I would say that a lot of their time is spent thinking and planning (how to resolve this issue, how to improve the unit, how to make this physician happy, etc).There is so much for a manager to remember; there are little things like approving pay roll that many people would be angry if you forgot. Nurse managers are the advocates for the staff and for the patients. They are responsible for keeping the physicians, staff, and patients all happy. Nurse managers can make or break a unit. They set the tone of the unit. It is up to them to create a successful working environment that promotes motivation.
- My nursing career will be forever (I hope) affected by this experience. I now view management differently. I understand their role much better than before. I respect how hard my manager works for me (the staff). I know that I will be less prone to fighting changes as they come down from corporate; the manager does not make the protocols but is expected to enforce them. I know that I will definitely cut back on my complaining when we are instructed on new protocols; it doesn’t change anything, and it wastes time. Now if there is a legitimate reason why it would not work, I now feel more comfortable in bringing up the issues with my manager. For they do value constructive feedback.
- I also have sat in on interviews; this will hopefully make me a more successful interviewee for future positions.
- I am wearier to go into management than I was before this experience. I struggle with understanding why some people are perfectly fine with doing things mediocre all the time. Why are some more committed than others to service excellence? I try to do the best job that I can every day, while others just do the bare minimum. I know that this would be hard for me to deal with in management. I set a high standard for myself, and I expect others to follow the same standard. Perhaps, that would make people hate working for me? However, I do not believe in micromanaging. My manager sets the standard for service excellence and finds a good balance between accountability and micromanaging. The staff all loves her! Of course, there are still those who do the mediocre job, but the difference can be seen in the raises at the end of the year.
1. Examine the various roles and responsibilities of a nurse leader and manager.
- See previous entries and above descriptions. A good manager is not only a manager but also a leader. They are respected by their staff not because of the “authority position” that they hold, but are respected by their ability to lead. Recently all floor staff lost the privilege of having internet access; she does have internet but would not do anything that her staff should not be doing. This greatly impressed me, to set the same standards for her as the staff. Another nurse leadership role is to create a motivating environment for teamwork. A manager is responsible for keeping a balanced budget, competent staff, and clear unit expectations. The manager has to have a plan and vision for the floor. The manager is the liaison between administration and floor staff. The various roles and responsibilities of the nurse leader and manager are much more diverse than I would have ever thought.
- Check! I finished all my hours by March 9, 2011.
- I was able to speak up in meetings as appropriate. I was able to provide valued feedback as a nurse working on the floor. Nonverbal cues helped guide when these comments were appropriate. I also was able to help plan the charge nurse conference.
- I was able to assist in writing up letters to be sent out to physicians and assist in writing emails. I designed and posted staff meeting flyers. I was able to design a template to be used for submitting nurses of excellence nominees.
- I was able to help my preceptor in a variety of ways enabling me to become a true asset to her during my clinical hours.
5. Delegate appropriate tasks or activities to other and self-evaluate delegation style.
- As responsibilities were delegated to me I was able to fulfill the responsibilities. Only a few times was I able to delegate while working on this clinical. Often it was to relay a message to the clinical educator, the assistant manager, or staff. Once I assigned the task to give a staff member a book to read after a dispute between coworkers. The staff member took it really well. I delegate the most when I am a nurse working the floor. After self-evaluating my delegation style I would say it is more of a collaborative style due to the fact that I carefully assess the individual’s skills before I delegate the task. The good/bad thing about this is that I only delegate to those who I feel are truly competent, thus it may be the same people over and over again (excludes some and increases tasks of others).
- It is necessary for a good working environment to be in place for an optimal organizational climate and culture to thrive. Judgment must be suspended between all. Opportunities for employee recognize should be available. An environment conducive to creating a motivating atmosphere is key. Micromanaging should be little to none. Everyone should experience respect. Understanding that every floor has their own culture, helps one to better understand the flow of an organization. Staff should practice "being present" to help all feel validated and important. These are just a few of the ways that leadership and management skills contribute to optimal organizational climate and culture.
- Managers are responsible for follow up after incident reports and smoothing over upset patients. Calling and intervening for patients and staff as indicated are responsibilities of the manager. The manager sits in on the patient care coordination meeting as a practice of care monitoring. Policies and procedures are reviewed after incident reports to see if there needs to be a system wide change to prevent errors. Managers assure quality improvements by buying assets needed (more phones, better chairs, etc.) and by setting goals and plan to meet the goals. The GALLOP plan measures how satisfied staff is; she created an action plan to improve the scores. Unit goals correlate to National Patient Safety Goals. The staff is divided into charge nurse teams; each team has a different focus for each quarter. This helps the staff focus and improve one area, and then keep adding to it. Care monitoring, error prevention, incident reporting, and quality improvement are all roles of the nurse manager.
- The basics of leadership and management can be applied to any health care system. Principles are universally applicable. Health care systems may be capitalistic (for profit or nonprofit) or socialistic. However, the system does not change the leadership that should be in place, just rules of the business change. Good leadership and management skills are needed in every aspect of health care from the floor nurses in acute care to the home health nurses making follow up calls. Good care cannot be provided without the application of leadership and management principles by the staff. For example, the manager cannot be budget conscious if their staff are not with budget conscious with supplies. The patient cannot expect to receive affordable health care if the above are not doing their jobs. Health care is one big interconnected organization that can only run smoothly when all parties involved work together applying proper leadership and management principles.
1. Learn role of manager for the unit.
- As previously described, I was able to learn the role of the manager for the unit. I was able to listen, observe, and help in delegated tasks to learn the role of manager for the unit (See previous posts and above answers).
- Masters are the average number of nurses needed per shift per day. She reviews her masters to make sure she is staffing correctly. After reviewing her masters the last time, she found she was consistently needed more nurses on Wednesdays and Thursdays (heavier surgery days) and increased the number of nurses working that day. She staffs to the average of her masters. Other managers staff their masters to average plus one. She prefers to staff at average to enable her staff to consistently get their hours. The good side is that staff is rarely floated, but the down side is that nurses are often floated to the unit. I learned that she uses a computer program to do her scheduling. All the floor staff has rotating 6 week schedules that just repeat. Cluster staff sign up for days they want to work; their shifts come from needs. Staffing then helps fill in needs as requested the shift before. She always makes it a goal to work towards the staff ideal schedule as it becomes available. I was able to spend time with her trying to adjust staff's schedules to be how they requested them.
- I was able to experience interviewing and hiring with my preceptor (see old clinical updates). She conducts her interviews through assessment centers. All applicants give a three minute talk on whatever they want. This helps you to get to know the interviewee and brings out some of their personality. She then tries to get a good feel for how they work with others by doing group interviews and having them do a project together. While they work together, you can assess who are good leaders and team players. Next she asks behavioral based questions to further try to understand how they would react in real life. Then she follows up with 1:1 interviews and asks more behavioral based questions. Last she gives the interviewee time to ask questions. She looks for someone who has the potential of service excellence. Someone who is a team player and passionate about service excellence. She is always wary of someone who is overbearing though. It is difficult because you are always guessing if they are telling and portraying the qualities that you want to see, but then when actually working does not use those qualities daily. I loved participating in these interviews because now I know what it is like to be the interviewer, and it will help me in future interviews.
- Disciplinary action must be taken before firing a person, working with human resources (HR). The proper forms must be filled out. It starts with a verbal warning then leads to written warnings and contracts. Depending on the offense determines how fast the situation may be escalated. Before firing an employee it must go to HR for a committee, if the committee agrees, then the person is easily fired. If the committee does not agree, the manager has to take further action before firing a person. Luckily my manager has only had to do this a few times; when patients are at risk that is when it is escalated very quickly.
- (This was my goal until we couldn’t do projects any more for this class; luckily I had picked 6)
- She loves how her schedule is a lot more flexible; most of the time she is able to leave by 3ish to be able to be home with her kids. The stress is different than when working the floor, for it stays with all the time. Mostly you have more control over your day. The biggest hard thing that is different being the manager than a floor nurse is that physicians often become your biggest adversary. She has to tell them how to be compliant with Joint Commission (example: date & timing of orders, dc orders by 1000, etc). They do not see her as their equal or partner, nor staff. At times there are conflicts, and she has had to learn how best to make sure the right thing is done without burning bridges.
- If you can keep the staff happy, then typically the patients are happy. She tries very hard to keep the staff happy; one measure of this is the GALLOP survey. Last year the scores were not as high and she has made an action plan to help improve scores. The company’s mission and values guide what she does. She believes in service excellence, the floor’s plan/vision revolves around that. The yearly goals are set to measure our service excellence; this year the goals are unit goals. The progress will be measured by HCAHPS scores. It might not be obvious to an outside observer that my manager is definitely planning; she does it so second nature.
- See entries.
- See entries.
- See entries.
- I think that this is you Sean, or is it my preceptor?
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