Sunday, August 13, 2006

learning to manage from a new perspective

I'd like to tell you a little bit about where I work since the past few shifts I've been the charge nurse on day shift for my first few times, and this post will be about my first impressions. I work on an oncology unit at the University of Washington Medical Center. We have 28 patient beds on my unit, and during day shifts usually a staff of 9-10 nurses to care for these patients when the patient beds are full or nearly full, and one nurse's aide for the entire floor.

I've been an RN for about 3 yrs and understand my role well. I can anticipate problems and prevent them, the tougher problems I can usually troubleshoot, or find the resources I need to solve them. I know when I can manage to get away from the floor and take a break. I know what I need to do to successfully get through my day; I sometimes seek the opinions of my coworkers for certain situations but almost never now do I *have* to seek out others to determine the proper course of action or assess the situation. I trust my intuition about patients or circumstances in addition to routine physical assessments, as my intuition usually guides me well. I don't say this to boast or illustrate that I operate on auto-pilot, just that I can function independently with patients and their families have achieved a level of comfort with this.

So these past 4 days I've been working, (3 of the 4 as the charge RN for 8 hours of the 12 hour shift) it's been a learning curve with some surprising realizations about my coworkers, the dynamics of shuffling patients around the hospital, and the ever-present problem of keeping the unit staffed with an unusual number of sick calls and nearly full floor. One of the most frustrating things to me is that just when I figure out my staffing, patient assignments (etc) someboday calls in sick! Or a patient that was doing well and considered 'light' is no longer so, and the assignment needs to be adjusted accordingly. I've realized that as soon as I *think* I have it figured out, it most likely can (and will) change.

I have always been a hard worker, and meticulous with details. (Probably metiulcous to a fault at times). While working on the floor, I have witnessed my coworkers provide thoughtful care to their patients and manage difficult assignments. Most of our patients have complex issues, usually both medical and psychosocial; and the job of a nurse is taxing physically, mentally, and sometimes emotionally. I enjoy my coworkers and salute them all for taking on this enormously challenging task everyday.

From a charge nurse perspective, I am seeing things differently. I make myself available and take the initiative to help my nurses on the floor when I do not need to be involved in management responsibilities; however I am finding that generally those who tend to have more efficient working habits tend to manage their assignments more capably and are rarely in need of or requesting help; and these nurses are often the ones with slightly heavier assignments... I've found that what generally winds up happening is that when a more efficient nurse asks for help, since it is less frequent that they ask for help, it is more likely that I will have to say no and find another nurse to help them; whereas those who tend to ask for help more frequently are more likely to receive that assistance. It doesn't seem fair, and I'm hopeful that once that management part is more routine and less challenging for me I'll be able to become more consistently available and better at directing other resources to them when appropriate.

I'm not saying this to reflect poorly on any of the folks I work with. And I realize that I can certainly not know with 100% certainty exactly what that nurse is experiencing; this is just my one-sided observations. This will also help me to be more supportive of the charge nurses and the types of decision they make when I am on the floor, as I can know more readily understand what kind of issues they may be dealing with.

1 comment:

Jen said...

Charge nursing...hhmmm. It's both stressful and rewarding (at times). Good luck!