The role of nurse manager becomes more challenging as quality standards are raised and patient costs are lowered. Managers shoulder the responsibilities of day-to-day operations of one or more units with expectations to recruit and retain staff, operate within a tight budget, respond appropriately and in a timely manner to all unit issues, and create an environment that's satisfying to patients, families, staff, and the administration. When staffing is short, the problem falls on the shoulders of the nurse manager. Inadequate staffing and overworked nurses can result in unit errors and increased nurse manager-intensive inquiries and explanations.1 Also, a budget crisis in Medicare and Medicaid is placing additional pressure on units to cut costs, which requires nurse managers to proactively plan the optimal use of resources every hour of every shift.2 When additional obligations of balancing work and family in a declining economy are added to daily mandates of patient safety and quality care, it's not surprising that many nurse managers are feeling stressed. For many, being a nurse manager has become more frustrating and less satisfying than ever.1

This article addresses some of the challenges nurse managers are facing and discusses strategies that can help you work more effectively and regain balance in work and home lifestyles.

Focus your time and energy

Identify specific goals for your unit, negotiate expectations with the administration, and discuss priorities with staff. Focus your energies and those of your staff on goals and objectives that are important to unit success. On your way to work, develop your plan of action for the day. Consider what you'd like to accomplish and identify steps for making it happen. If you don't have a plan, it's easy to get diverted. Maintain a to-do list. Use your mind for complex thinking and problem solving, but keep a list of things you need and want to accomplish. A pad of paper or a PDA that fits in your pocket is helpful when making rounds with staff or patients. Place electronic reminder alarms on your PDA calendar or a sticky note on your paper calendar to help you remember important tasks. While some recommend a to-do list be created each morning, nurse manager work schedules require that items may need to be added at a moment's notice. Prioritize the list and identify critical versus noncritical items. Rank them from most important to least important. Determine priorities that must be completed by you and identify others that may be delegated and delegate them. Remain flexible as priorities change throughout your day. Write items down and mark them off as needed.

Although most nurse managers wish to maintain an open door policy, you can certainly post specific times when you're available or unavailable. You might decide to post a schedule that includes times you prefer not to be disrupted or you might establish a signal, such as a closed office door or a "do not disturb" sign placed on your office door. A signal that works well for my office is an 8 x 11 piece of paper that states, "Participating in phone conference. Please do not disturb."

Communicate with your staff efficiently and succinctly

For staff meetings, use an agenda with time frames for each item and encourage staff to recommend agenda items at least 1 day before the meeting. Record staff meeting discussions, suggestions, and decisions by delineating what needs to be done, who will do it, and when it will be accomplished. Respond by e-mail or telephone when appropriate. When responding by e-mail, provide your response on the message you received because it provides a context for your reply. Never reply to all unless your message is important to everyone and don't request a read receipt. Take a moment to unsubscribe from messages you may receive that don't interest you. For telephone messages, record the caller's name, number, and message on a lined paper pad kept by the phone. Prioritize your responses, return calls, and place a check by the calls you either returned or for which you left a recorded response. Check e-mail and phone messages once per day and consider responding to e-mail and phone messages at a specific time each day.

Energize yourself at home

Work and unit responsibilities can impact your home life, so it's important to adopt strategies that blend a proper work-home balance. Nurses generally exhibit an altruistic nature of caring for others first and leaving little time for themselves. Nurse managers must make personal health a priority so they can provide optimal care for others. You must include strategies at home that energize you. Plan evenings and fun time with the family. Dedicate time with family and friends doing something you enjoy and limit responses to your e-mail, pager, or phone. If you enjoy reading, gardening, movies, or listening to music, include time for those activities in your evening and weekend schedules and don't forget that you can listen to an audio book or music CD on your way to and from work. You need to create a full and satisfying life away from work to balance the demands of the profession.3 Although 24-hour accountability can make dedicating personal time for yourself challenging, "me time" is crucial to your personal revival and survival.

Find daily respite

Relaxation is a necessity for the nurse manager.3 You need to find respite during the day, reconnect with life, and enjoy physical activities and relaxation techniques.3 Periodic breaks during the day are important for recovery and renewal.4 When you work for extended periods, you become less effective; just spending a few minutes each day in meditation or a quiet room can refresh and improve your performance. On some demanding days, even a few still moments in the linen closet can work wonders for the psyche. Literature indicates that physical activity lowers stress, improves health, and energizes the mind.5 Walking, using the stairs, or working out at a health fitness club are recommended stress reduction strategies. The ability to use several strategies for managing stress is important because work-related stress can have major implications for nurse manager health. The bottom line? It's important to take time each day to relax. This may include stretching, deep breathing, or meditation. In addition, massage therapy is an excellent and preferred strategy by many nurses for stress reduction.

Balancing act

The nurse manager role is filled with many challenges that can result in frustration at both work and at home. It's vital that you adopt strategies to help balance your work and home lifestyles. At work it's helpful to maximize and focus your time and energy, as well as communicate with your staff efficiently and succinctly. Revitalize yourself at home by participating in energizing and renewing activities. And plan respite strategies for work and home, such as physical activities, relaxation techniques, periodic breaks, or meditation, even if they're in small increments. Applying some of these techniques can assist you to balance the stressors and challenges of work and home.

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