Wednesday, September 15, 2010

Gettin' to the comment-section questions....

First, a couple of nursing-related queries:

Katie asked, "Is it possible to be a good nurse-manager? If so, HOW?"

Yes. Yes, it is.

As to how to do it, I think--and keep in mind here that I'm totally talking out of my hat, because I've never been a nurse manager--you'd need to keep three things in mind: fairness, free flow of information, and what the nurses you're working with go through.

Fairness is a far-reaching concept. Every unit is going to have little niggling things, like the person who only works twice a week and yet wants to be first-cancelled *every time they work*, that are going to drive people on the unit crazy. I would bet that if something can be quantified and put into a rotation, it should be. Who worked last with the crazy-sick, heavy patient with the difficult doctor? Put a new nurse on that patient. Who took an extra shift last Christmas Eve? That person gets off this Christmas Eve.

Find the niggling things that drive your nurses crazy, then find a way to standardize the hell so it's evenly distributed. People will complain at first, but will later realize that fairness is good.

Free flow of information is essential. When we get another piece of paperwork (or another piece of computer-work, these days) or another audit we have to do, we get annoyed. If a manager explains to us why we're having to do these things, though, it helps keep the annoyance at bay and increases cooperation.

Likewise, rumors are bad. If a manager can be straight-up with their employees about why upper management isn't giving out raises, or is giving out promotions, or *whatever*, it stops rumors in their tracks and lessens the chances somebody will get grumpy.

And finally? Remember what it was like when you were on the floor. There will be personal disputes between nurses: keep an eye out for which nurse it is who *keeps coming back* to your office with interpersonal problems. Keep an eye out for the patients or patients' families who are likely to be trouble. If you're unfortunate enough to have an abusive family or patient, stand up for your nurse first. We're not stupid: we're not going to hurl bottles of drugs across the room or do any of the other things I've been accused of.

Elsie asked why I didn't want sedation during my dental work, and if propfol automatically equalled intubation.

No, it doesn't. Propofol is a fantastic sedative to use for intubated patients, but people can breathe on their own when given small amounts of it. The whole reason I didn't want to be sedated was that I thought this was going to be a quick in-and-out biopsy. The drama of having Cap'n Lumpy have to be removed on the fly was something neither I nor the doc expected.

NurseXY asks "How can a graduate nurse present themselves when interviewing for a job so that they'll actually be considered over an experienced candidate?" (paraphrased)

Emphasize stuff you've done outside of nursing school, for one. If you've got loads of experience being a project manager for GinormoCorp, LLC, then be sure to mention that on your resume. If you've got loads of experience managing people, mention that.

Emphasize particularly things that make you look responsible, accountable, and like a team player. (What a sentence; sorry, the drugs are kicking in.) Training a new nurse, while expensive, is the easy part. Finding a person who fits in with the existing culture on the floor is the hard part. You can have the best nurse in the world, but if she or he doesn't have a good fit with the other folks on the unit, he or she will never last.

Also, keep in mind that a lot of specialty areas (CCU, NICU, transplant) really like to train their nurses the way that they want them. Don't be afraid of specialty areas; nothing in the world says you have to work med-surg (now a specialty in itself) for X number of years before you specialize. In most cases, I would argue against that, in fact, because you'd lose knowledge without gaining specialized skills.

Oh! Elsie had a second part to her question that I missed before: Do redheads have a lower tolerance for pain?

Actually, no. We do, though, have a greater resistance both to local and general anesthetics. I remember reading that a couple of years ago in some journal and feeling vindicated. Natural blondes, by the way, also have the same resistance. Nobody knows why. The way to deal with this is to express clearly your dislike for pain and your desire for lots and lots and lots of local anesthetic and semi-sedation.

Oh, and Elsie? The minor-to-moderate pain I'm experiencing in my soft palate is way the hell better than what you'd experience if you let your gums recede further. Just sayin'.

Finally, Penny had a question that I'll just reprint here in its entirety. Please have at all of these questions, especially hers, in the comments:

It's getting to be crunch time for me, and I'm going to have to decide if I'm going to A.) stick with my tenuous career and pray I make it to retirement, or B.) cash out my 401(k) cry and cry for days over how much money I lost out of it and use the scant balance so that I can quit work and go to nursing school.

There are NO jobs for new grads in the Denver area. NONE. Are there jobs for new grads elsewhere? WILL there be jobs for new grads in two years?

Discuss. Please. I need all the input I can get.

Personal posts and info about the critters and redecorating will happen later!


Christine said...

re: Penny -

I'd like some clarification, as I work in the med field in Denver. Do you mean no jobs for new RN grads, or no jobs for new grads across all fields? Because you mention both the new grad thing AND retirement, I'm a bit confused on where you are in the spectrum!
If you are interested in going to nursing school, most hospitals offer tuition forgiveness - definitely look into it.

Elsie said...

Thanks for responding to my questions! Interesting point of clarification regarding pain tolerance vs resistance to anesthetics. This last bit explains a few things about some dental experiences I've had. Now I must gird myself to make that phone call to the oral surgeon for a consultation. Thanks so much for continuing to post this week. As always it's informative and entertaining!

messymimi said...

Penny, remember, if you are told the need for people in a certain career is huge, do not go into that now. By the time you are trained, there will be a glut.

Also, there are jobs for new grads who excel, and work hard, and are willing to pound the pavement. You might not get something in your exact area of training, but so what? Over 60% of college graduates do not work in the area of their major.

Don't get desperate. An employer can smell desperate, and they don't like it. Be confident, instead.

I'm sure others will have some even better info for you.

Holly said...

My mom in North Dakota tells me the job market is pretty open there. Then again, that may just be one of her many attempts to get me to move back. There's a reason why the jobs are plentiful there. :)

coulrophobic agnostic said...

what does "first-canceled" mean? I mean, I know the words, obviously, but in this context.

Anonymous said...

"First-canceled" means that if there are not enough patients to justify the number of nurses scheduled, someone has to stay home. Sometimes you are "on-call" in case there are more patients that come to the unit after the shift begins, sometimes not. Usually you can use your vacation time to cover the lost wages for that shift but alternatively you might elect to not get paid and save up your vacation time for actual vacation but then your paycheck is that much smaller.

Katie said...

Thank you. I appreciate the words of wisdom and good sense you share.

My kids are 2 and 5 and I have been flex time very happily... but my hospital is having a budget crisis combined with a low census problem and my department is being eliminated, along with cuts throughout the hospital. It is a rural area and just not many jobs.

I'm just not sure what to do. I need to work, I LOVE my co-workers and would like to "do right" by them (we've had a new manager basically every two years) but oh, I don't know what to do.

Thanks for taking the time to respond. Hope your are feeling better. Still praying.

Anonymous said...

Penny- The situation for new grads in all large cities right now is very difficult, but it's really impossible to make blanket generalizations about so broad a subject. Only a couple of areas report lots of vacancies, one being Texas where HN would know the landscape, the other Fresno-Merced, California.

I hear many people speculate that this is a cyclic economy related downturn, but I've been a nurse since 1975 and I've never seen anything like this.

I don't want to sound like a total buzzkill, but since you have potentially so much at stake with your 401K assets, thoroughly research your intended city of employment.

I would never tell anyone that nursing school is a waste of time, though. Standout new grads will be hired- just realize there is an element of competition that wasn't there in the past. Best wishes whatever you decide.--