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July 07, 2008

What Changes Those Who Enter Nursing Administration?

Question72x701 Have you ever questioned who those nurses are who leave bedside clinical nursing to become nursing administrators? Lately, after watching the picket lines at New York – Presbyterian, I have wondered more and more if those in nursing administration are really nurses? Have they lost touch with bedside nursing? They all seem to reside in posh, mahogany oval offices. (No, not the one in the White House!)

Over the years, I have watched fellow colleagues rise through the ranks, beginning in the role of a bedside nurse like myself with visions of  "being a dedicated nurse," eventually graduating to the role of nurse manager, becoming an advanced practice nurse,  specialist, or risk manager, then Director of Nursing, and finally moving into the coveted role of VP or CEO of Nursing in a large medical facility. As they rise through the ranks, their contact with bedside nurses seems to become less important. No longer are grand rounds conducted or walk-abouts performed, just to see how former colleagues are doing when assignment acuity rises, along with nurses' sick calls.   

I have met some nursing administrators who bring new ideas into a system, just to see their ideas pounced upon by other nursing directors. Are there too many directors within nursing administration today? Are they doing what they are supposed to do? I can never see myself in this role -- losing the compassion, clinical skills, and the reality of everyday nursing would be too distressing to me. Yet, it happens to many nursing administrators.

Why do they change? Is their focus no longer on those of us in the daily trenches or are they instead focusing attention to the bottom line – profits?

Your thoughts?

July 7, 2008 in Beka | Permalink


A very worthful chapter for nurse administrators.A wonderful knowledge. Thank you.

Posted by: Miss Rajasree Baruah. | Feb 11, 2011 2:46:27 AM

I've read your comments with interest. I am on the other end of the spectrum. I am an active duty Nurse in the military; 24 years. Several at the bedside as an elisted technician and RN, but the past 12 predominately in nursing administration. I WANT to work in direct patient care. However, because of my seniority, am placed in positions of nurse manager or department head. I feel ball and chained to my desk due to the avalance of paperwork and bureuracy that I deal with on a daily basis. I rarely get to do patient care, although I try to help my staff by offering support with cleaning rooms, v/s, etc. Although I've been an RN for 17 years, I feel that I have lost most of my nursing skills. I am retiring in Feb '10 and want to work on the floor again, preferably mother/baby (I have an OB background) or pediatrics. I maintain all of my certifications and try to attend inservices often, but it's not the same. This may sound crazy, but I would LOVE to be back on 12-hr shifts and take care of my patients without all of the management issues. I'm afraid that when's it's time to apply for a job, I won't be considered for anything but management although I believe my critical thinking and patient assessment skills are intact; it's just all of the new meds, machines, etc. Does anyone who may read this have any suggestions?

Posted by: Heather | May 27, 2009 10:07:28 AM

I am working in Saudi Arabia as DON in a mental health and addiction hospital. I am an adult NP as well and until this job never worked in nursing administration. In fact, I was only out of nursing school three years when I went on to become an NP.

As the only westerner working in my facility I have to have a presence in the units and there is no one at my level of clinical experience so I must keep on eye on nursing care, which in our hospital is much lower than in the States.

A South African DON in a nearby hospital once said, "We don't manage behind a desk, we manage at the bedside". While I agree, it can be a challenge to get on the units sometimes. It is easy to get caught up in administrative issues, reports, research, ad nosium and in my experience, I have to push myself to be a frequent sight in patient care areas. But, it is worth it in order to know what is really going on and good for patients as well so they feel they have a serious ear to speak too when they often feel they complaints or problems have not been taken seriously.Also, they're comments offer an insight to nursing behavior and practice, which at times is correct. Of course, in psych and addiction there are other issues that color patient complaints but listening intently and taking action with feedback to the client builds trust and that is part of my job, at least in my hospital

Posted by: Saifudin | Aug 27, 2008 11:13:27 AM

It is impossible to wear more than one hat at a time, and that is why the title "nurse manager" is an oxymoron. The focus of a nurse is the patient, a manager focuses on the organization; what is in the best interest of a patient may not be in the best interest of the organization. When one has to choose, the dominant allegiance emerges. I believe a certain number of hours providing hands on patient care, as well as continuing education, should be required for all managers and/or administrators who wish to maintain an active nursing license.

Posted by: Nadine | Aug 27, 2008 9:30:07 AM

I am fortunate to have recently worked for the past three and a half years for a wonderful Director of nursing in a SNL. I could have never made it through another year of school if it were not for her understanding, compassion and excellent leadership skills. She always has time for the patients, even if it just a special touch or word to make their stay with us better. She has always looked at whats best for the patient and never fails to intervene when a staff member has lost their compassion. She does all of this while still making schedules to please her staff and works with many that have returned to college. At the same time she juggles all those budgeting issues that some of us bedside nurses never even see. She has been absolutely amazing in her role as Director. She takes time to educate, mentor and council her staff. She has been there during my own personal crisis's to listen and encourage me to continue with my education at times I felt like giving up. Would it great if all nurses in administration positions could be like this?

Posted by: Shanna | Jul 26, 2008 4:58:11 PM

This was a hard topic to read for me. I am one of those nurses who swore up and down that I would NEVER, EVER want to be in admin. Just being a charge nurse in ICU was always enough for me. I got burned out, and decided to switch career paths and ended up in a skilled nursing facility (which I also swore I would never work in) as a charge nurse. I was promoted to Risk Manager, and 2 years ago, to the Director of Nursing Services.

I have never lost touch with the line staff, and spend about half of every day out on the floor. I consider my staff to be just as important from a customer service aspect as our patients. They all know my door is always open (literally and figuratively), and don't hesitate to come to me with issues. I give them "love" every day, CNAs, and nurses. I remember my first DNS, and remember her mainly because I never saw her.

Nurse executive are in a difficult position. We have to manage our staffs, our budgets, and make sure that we have regulatory compliance as well. And yes, we have to deal with our management company as well. It's a real ball juggle.

But, I always, always put my line staff first. They make ME look good, not the other way around.

Thanks for a thoughtful topic.

Posted by: NurseExec | Jul 26, 2008 9:46:43 AM

I was just commenting on this same subject last week to a friend at work. One of our own went from part time icu nurse to supervisor to CNS. She has totally forgot where she started and I see it in her comments that are made to bedside nurses. It didn't take long for her attitude to change. As always those that are not at the bedside on a daily basis, want to tell those of us that are what is best.

Posted by: An ICU nurse | Jul 24, 2008 9:00:33 PM

Well, let's hear a few more stories about nursing administrators. There must be a few who are not in the constant "them versus us " mode ? Aren't there ???


Posted by: beka | Jul 24, 2008 8:47:14 AM

Let's see, our administrator is going after magnet status in our hospital (a whole different blog subject) when we are running our butts off with 8-9 patients a piece, no breaks or lunch. They are cutting back on nursing education, expecting most of it to be done on work time (when????) and don't want input from the staff into anything. HHHMMMM, does that tell you anything about how out of touch she is?

Posted by: samsaunt | Jul 22, 2008 10:48:41 PM

I found this blog on a google search and boy am I glad I did. I thought I heard someone mention it in a free chat room.
Awesome read!

Posted by: Free Chat | Jul 21, 2008 4:17:17 AM

What type of nurse are you? Are you an ICU nurse, oncology nurse, or, perhaps endoscopy nurse. Or harsh as it may seem, if you do not have 5 minutes to touch a patient, I submit that you are no longer a nurse or nurse administrator, you are an administrator. I'm sorry your desk is old, your carpet is old, some of the "others" have nicer offices, and there are those headaches, but it is a choice you made. I wonder if your nurses are working 12 hour shifts, overtime, maybe actually getting away from the unit for a whole half hour lunch break, have adequate staff to do patient care and not just tasks. Do your patient's call lights get answered by an educated RN in a timely manner, an aide, or maybe not as quickly as the patient perceives needed? Do you know your nurses names and do you compliment them and thank them for a job well done, or do you give out a key fob or cup holder with the hospital name on it for Nurse's Day?

Posted by: Terence | Jul 18, 2008 7:53:31 PM

But, Nancy , do you really not have those 5 minutes to spare to hold that patients' hand ? Isn't that a choice you DO have ? Then, who do you have a responsibility more to - RNs or the Corporation ? I would imagine that meeting the role responsibilities of both is difficult. But, do take time to hold that patients' hand.


Posted by: beka | Jul 17, 2008 5:16:33 PM

This is very sad for me to read. As a nurse administrator, I have 3 customers I have to please: 1) the staff, 2)Corporate, and 3) those who pay corporate. I cannot ever forget how I got to where I am! Those who were my peers need to know that I am looking out for their best interest. Those who are or represent the patients need the same respect. And Corporate needs to know that I believe in the company values. It is truely a challenge to balance these entities. But it is one I enjoy. I feel I am fortunate to work in a social or service model facility vs a medical model; I think that helps me keep this triad of customers in focus. Of course not everyone is cut out for management, I really had very little training when in nursing school- neither in the ASN nor the BSN programs I completed. And I think that is sad. Whether you choose the path of management or not, it is important that you have some inkling of the things that might cross the desk of someone in that role. I sit behind a desk that is 20+ years old, in an office that hasn't been painted in 7 with carpet as old as the desk- as do several of my peers in the same administrative hallway. But the rest of our building is pretty sharp- especially the offices that are only 2 years old. I also share bits and pieces of the "headaches" that come across administrators' desks with my staff and they are thankful they don't have to deal with percentage of "ugly" things we do. There are times when I wish that I had the opportunity to hold the hand of an ill patient for 5 minutes. There is no chair, no office window view that can replace that. Please enjoy that for me.

Posted by: Nancy | Jul 16, 2008 3:23:18 PM

We recently interviewed a few staff nurses who had applied for the position of our unit manager. We asked why they wanted the position, hoping to hear something about a vision for progress in staff knowledge, advancement of collaboration, higher levels of practice, etc. What we heard from every single one--"It's a good career move". I think that answers your question.

Posted by: Rae | Jul 14, 2008 4:42:38 AM

If we want the focus in health care back on the patients and what is good for them, then we NEED more nurses in the upper tiers of management. Nurses, I dare say, know better than any what patients need and how best to provide NURSING care. It's time we let NURSES make the NURSING decisions about what is safe and adequate patient care. The only way to do that is to support our nurse executives, not reject them.
"A house divided against itself cannot stand."- Abraham Lincoln

Posted by: Kathy | Jul 10, 2008 10:41:56 AM

We used to joke that it had something to do with the air in the DON's office. I don't know what it is but when your focus goes from the patient's welfare to the corporate coffers, there's something really wrong. I understand that some really good people get into management, but I also understand that the culture of productivity, patient hours per nurse, answering to stockholders and corporate entities poisons even the best. After all, if you won't do what you're told, we'll find someone who will. I love my profession and I love patient care but until the patient once again becomes the primary focus, I and many of my colleagues will continue to be a major part of the "Nursing Shortage" because we refuse to work under the conditions found in hospitals and health care facilities today.

Posted by: Terence Mason | Jul 9, 2008 5:15:44 PM

If our profession is going to survive, our thoughts about nursing future must begin with each one of us. Having been on both sides of nursing dilemma's-(staff nurse to management), I decided to make a difference and focused on nursing education within my institution.
As a "seasoned" nurse, I believe one should never forget why one decided to get into the nursing profession in the first place. As with many nurses, my choice to enter the profession was because I wanted to make difference by helping those less fortunate than me in the most vulnerable situation.
As an educator, I still maintain that concept when it comes to caring for the patient, but I also wanted to share my many years of experience with both novice and experienced nurses alike because I believe nursing is a "shared governance" that will only enhance patient outcomes.
Grumbling behind the scenes benefits no one. Regardless if one holds a position at the top in Administration or is a dedicated bedside nurse, teamwork must be our focus for nursing's future. Without team work, the nursing profession will continue to deteriorate.
Many great ideas stem from bedside nursing, but in order to promote a positive change, one must "get involved and share ideas" that work for everyone by assessing the situation with nurse managers and administrators, implement changes, and evaluate outcomes that are not only beneficial to the team, but also the patient.
It is up to each and everyone of us to constructively voice an opinion to promote positive change within our profession, and the first place to start is by aking yourself- "Are you up for the challenge to make a positive change?" If you answered yes-then do so by reclaiming priorities. Join a committee within your institution or voice a constructive opinion to make a change that works.

Posted by: Karen | Jul 9, 2008 9:49:21 AM

The "us vs. them" mentality is very strong in nursing culture. When a nurse leaves the bedside position, he/she is then cut off from the pack, no longer "one of us". That rejection is palpable, and it hurts. For a woman, rejection by one's colleagues is especially painful, as women crave the social connectedness. It may occur subconciously that she avoids the walking rounds and the interaction with the bedside colleagues because she is reminded that she is no longer welcome as part of their social group and that they no longer consider her their colleague. It creates a disconnect that over time, becomes a seemingly uncrossable rift, and leads to a distrustful relationship. I'm reminded of an old episode of "M.A.S.H." where the character Margaret Houlihan is confronted by the nursing staff under her command, words are exchanged and Margaret answers in tears, "did you ever include me in your late night bull sessions..........did you ever offer me a lousy cup of coffee?" Her staff nurse answers her, "We thought you wouldn't accept." Margaret answers, "Well...... you were wrong."

Posted by: Kathy | Jul 8, 2008 4:49:46 PM

I hate to generalise but it may come down to each manager's perception of "caring". I have often thought of going into "management". Not because I want to give up the clinical component of my nursing but because I want to influence the environment that nurses work in. We have to be very careful not to be drawn into the "them and us" syndrome that affects so many potentially effective relationships. Imagine the power potential if we worked with our nurse managers to positively change the systems rather than moan about how they just expect us to do/work/ more.The environment must effect all but the strongest- those it doesnt change I guess are the strong nurse "leaders" we look up to. Donna Diers springs to mind...her capacity to "care" is still very evident from the short time I have spent in her company.It does seem that there aretoo many admisnistrators these days-may be it is teh establishments way of divide and conquer?! Lets stuff that up and have nurses stick together!

Posted by: Rosemary | Jul 8, 2008 11:17:30 AM

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