Now, before any one gets upset, the title of this editorial is, of course, an exaggeration. Most nurse managers are wonderful people, and I, for one, am glad they are there. I could never do their job. However, there are a very few who can be difficult (as in any profession). The readers provided the majority of cases I present here. The readers also identified several wonderful managers. So please sit back, get a refreshing beverage, and, I hope, get a few laughs. Remember, when things happen, they are seldom funny at the time. But time can make almost anything funny.
1. The nurse manager who decided a nurse is a nurse is a nurse is a nurse. This nurse executive, in an attempt to decrease the need for agency nurses, recently informed her nurse educators, clinical nurse specialists, IV nurses, quality assurance personnel, and so forth, that they would work 1 day a week on an unit of her choice. The staff never knew when they would be asked to work as a staff nurse or where they would work. Now, most of these nurses were pleased to pitch in and glad to work with patients again. However, this nurse executive was placing a critical care clinical nurse specialist in the obstetrics unit with no orientation. Now, I understand why floating is necessary. I do not like it, but I do understand it. Wouldn't it be better for all involved, mostly patients, if nurses were oriented to the unit first and had some experience in the care needed in such a unit? If you are going to float nurses, please orient them first. Also, try to place nurses in comparable positions. Rotate a critical care nurse to the emergency department, not obstetrics. All this nurse executive accomplished was about a 30% resignation rate.
2. The nurse management in a coronary care unit (CCU) who opted to float one nurse to a transitional care unit (TCU) leaving only one nurse left in the CCU who had less than 6 months nursing experience. This nurse manager wanted to leave the nurse with 6 months of experience alone with eight CCU patients. When the nurse she wanted to float to the TCU argued the merits of this case, the nurse executive did not change her mind. This nurse resigned the next day.
3. The nurse executive who supported hiring incentives for new staff but did not take measures for retention of staff. I know more than one executive who has done this. She will hire one nurse and give her or him a $5,000 hiring bonus while ignoring her current staff. This results in nurses leaving hospitals to obtain a hiring bonus. A local hospital offered a week-long vacation in Hawaii to nurses who would work at their hospital. This offer was not made to the current staff. Wouldn't it make more sense to work to keep the nurses you have?
4. The nurse executive who is a "yes" person to the hospital administrator is really difficult. This executive never acts as an advocate for the staff. I realize that the executives cannot win every battle, but they should try. Learn to choose your battles correctly.
5. The nurse executive who, without advance notice, told her staff that they would be working 12-hour shifts immediately-no exceptions. This particular nurse executive told her staff the next staffing plan would start in a week, and if anyone had problems with it, she or he should resign. Several did. Several went to a hospital that offered a laptop computer as a hiring incentive.
I truly appreciate the other 99.9% of nurse executives who fight for the rights of the patients and nurses. You have a difficult job because you are always in the middle between staff and upper management. This is not a position I would want. Please believe that the majority of us appreciate you and realize you do a very special and wonderful job.