Sunday, March 09, 2008

Being new

Being new

Caryn Salito, RN, MSN, MBA 1

In an article entitled The Challenges of Being New, Catherine Robinson-Walker, MBA, MCC 1 brings attention to the challenges a new nurse manager faces. Ms. Robinson-Walker identified that the biggest challenge of a new nurse manager is lack of support.

Most would probably consider me a new nurse with a mere 7 years of nursing experience. I am currently completing my MSN/MBA and have always had the desire to run a nursing unit in my area of expertise. Approximately 8 months ago I was given this exact opportunity. I was given the opportunity to manage a 27-bed inpatient nursing unit along with its coinciding outpatient clinic.

The decision I was faced with was not simple. I asked myself several times “Do I accept this opportunity or should I gain more experience and wait for the next opportunity to come along?”
Many factors would contribute to my decision. My commute would change from nonexistent to a 1-hour drive each way. My days would increase from 8 hours to whenever the job was done. I continuously questioned whether I am the right person to fill this position. Would I be able to maintain such a large inpatient unit and high volume clinic with no management experience? Would the staff accept me? Would the institution be a good fit for me? Most importantly, would I have the support and mentorship that would be necessary to allow me to succeed?

My thoughts kept racing, and the only question answered was “would I have the support and mentorship that would be necessary for me to succeed?” The answer I received time and time again was “Yes.”

From day one I knew I was in for the challenge of a lifetime. I felt as though the entire hospital was awaiting me, the new nurse manager. I knew no one, yet the whole hospital knew me. My eyes were overwhelmed with their stares. My mind was overwhelmed with what I assumed were their thoughts. My stomach was overwhelmed with nerves. My ears were overwhelmed with the abundance of names being sent through them. I was overwhelmed.

I continuously had to remind myself of the support I was guaranteed. Knowing that when it all became too much I would have someone to turn to and know she would give me the support I needed to get through. My support was my boss and a fellow nurse manager. The nurse manager assigned as my mentor was wonderful, but she, too, was a new nurse manager with less then a year of management experience on her resume. When I questioned how effective one new nurse manager could be as a mentor to another new nurse manager I was reminded that she had years of nursing experience to speak about at this very same institution.

In From Novice to Expert, Patricia Benner, RN, PhD 2 teaches nurses that a nurse will be successful personally and professionally when she is nurtured from novice to expert. To develop from novice to expert it is crucial that the novice have direction from others with more experience. In the profession of nursing, experience has traditionally been defined as the total years an individual has practiced as a nurse. Commonly, experience in a particular role within nursing is not considered. To assure nurse managers are successful it is pertinent they model after nurses with an abundance of management experience rather then many nursing years of experience. A nurse with 20 years of clinical nursing experience and 1 year of management experience is as novice as a nurse with 7 years of clinical experience and 8 months of management experience. A novice manager mentoring a novice manager will not allow for professional growth and success. What it will allow for is dissatisfaction, as well as mental and physical exhaustion.

With each day that passes I have been expected to do more and more. My mentoring sessions have dwindled from every week to “Hello, how are you doing?” while arriving at a meeting. My meetings with my boss take place on a biweekly basis with the expectation that I call when I am uncertain or I hit a bump in the road. If this were the case, I would never hang up the phone.
As a new nurse manager I would define support as a solid foundation composed of resources and individuals that allow a nurse manager the opportunity to grow both personally and professionally. Support is receiving proper and thorough training. It is knowing that as a manager you are being heard, it is knowing that others are being held accountable so yet another task does not fall into your lap as the manager, it is knowing that when you throw your hands in the air someone will come and help you through.

After reality set in and I realized that I was now a nurse manager, I did feel a sense of excitement in the midst of my nerves. I was excited about entering an institution at the brink of tremendous change. I was excited to add my thoughts and previous experience to their change process. I would be helping to make a difference, or at least I thought.

In an article entitled “The Change-Dazed Manager,” Katherine Vestal 3 nicely states that “today's nurse managers are experiencing the most intense, change laden roles that ever functioned in healthcare.” Vestal 3 goes on to state that “Nurse Managers manage healthcare organizations that are larger by revenue then most small businesses in America.”
I have found that running a multi-million dollar business alone is difficult. It is very difficult to lift my head out of my daily tasks. The needs of my staff take precedence, the schedule and payroll need to be completed and e-mails and phone calls need to be returned. On top of my day-to-day tasks, I find myself holding members of other departments accountable for completing their tasks. When their work is not complete and it affects my unit, I find myself completing their work.

Nursing management positions now require a minimum of an MSN. In 5 weeks I will have my MSN/MBA. Currently, I do not find myself using my degree. I do not have the time to work on projects that would require me to use the knowledge I have gained from my graduate course work.

It is now that the profession of nursing needs to conform to allow its new nurse managers the opportunity to be successful. It is the successful new nurse managers who will bring nursing to the next level of practice.

Footnotes1. Caryn Salito, RN, MSN, MBA, is a recent graduate of the MSN/MBA program at the Johns Hopkins University School of Nursing in Baltimore, Md.

References
1 Robinson-Walker C, The challenges of being new, Nurs Leader, Volume: 5, Issue: 1 (2007), pp. 8--9 Bibliographic Page Full text
2 Benner P, From novice to expert, (1985), Prentice Hall, New York.
3 Vestal K, The changed-dazed manager, Nurs Leader, Volume: 1, Issue: 5 (2003), pp. 6--7 Bibliographic Page Full text

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