Wednesday, November 3, 2010

Managing the Gap

When I first started working in nursing I actually thought that maybe, someday I would end up in management. You know.... years down the line when I was tired and burnt out from bedside nursing I could switch over to the administrative side of things and still feel useful in my career.


The more nursing experience I have the more I realize that management in nursing is the exact opposite of everything I love about the job. I recently want to a "Journey to Magnet Excellence" conference through my hospital and it was surprisingly disheartening. Now, I know I tend to be a critical person... I am an ICU nurse after all, but I did actually go to this event with high hopes. I enjoy a challenge. I enjoy taking pride in my work and I enjoy being pushed to always become better. Still, the reality between the ideal and the actual is so far and wide. 
I know that in the nursing profession, research is important; it's what makes us better as a whole and individually and it improves patient outcomes. At least that's the idea, right?

I think I'm finding though, that what is done at the bedside and what is done in everyday practice is so completely different than what nursing executives try to implement into hospital policy. What is expected of the everyday bedside nurse is sometimes just not possible! 

Save money, prevent infections, work short staffed, but make sure you find time to take a break so that you never call in sick and waste the hospital's money. Audit charts and physician orders, document on time and with incredible detail. Reduce patient falls but also reduce the amount of restraint use. Decrease the amount of sedatives and chemical restraints used on patients but live without simple resources that will make it a safer work environment for patients and staff. 
Seriously, by the end of the conference I was so disheartened.  I felt like my job was impossible... being a good nurse according to your patient and being a good nurse according to your boss......
two very separate and often times unrelated things.

There are so many roles we fill as nurses. We are the front line workers. We are the ones who coordinate between all of the different services. We are the ones who know more about the patient than probably anyone else on the unit. We are the ones who put up with verbal and sometimes physical abuse from patients and family members. We are the ones that go without bathroom breaks and food for sometimes an entire day. We are the ones that have to be patient advocates....

But who advocates for us?

I am lucky to be in an area where nurses are paid well and because I work for the government I have good benefits. I love my job and I will always try to become a better nurse than I am today. Still, its hard not to look at the bar above and wonder just how in the world we will ever jump that high.


  1. I have a friend who is a nurse in labor and delivery, and she often talks about days like you're talking about - where she never gets a break, just going from one patient to another. I don't know how you all do it, but I'm grateful for the fact you do. You all really are the ones that patients and families rely on. We take you for granted too often.

  2. my dad is always asking, "don't you want to be in management? a supervisor or something?" I'm like NO... all they seem to care about is statistics and pt. satisfaction scores, how to make the hospital look better and have to deal with pt complaints or crazy staff or blah blah blah... i get tired of it all. Let me just do my job.

  3. oh man... it's amazing how much i'm learning about policy implementation and you've basically described the outcome of every policy class we've had so far this term. alas, it is still my goal to change policy somehow. girl, i don't know how you do it but i will always be amazed that you do.