Leadership,  Nursing and Healthcare

Should Nurse Managers Be Advocates For Their Staff?

Nurses are so often told to be advocates for our patients. We advocate for them with doctors. We advocate for them with the very organizations we work for. We advocate for them with their families. We advocate for them with insurance companies. I think you get the idea. Nurses advocate for their patients.

This is not just something we are told to do, it is something we actually DO. It is a natural part of being a nurse. I don’t know if it has something to do the personality type that would become a nurse. I don’t know if it has something to do with our training. I don’t know if it has something to do with the things we experience. Maybe it even has something to do with constantly being told that we should be advocates for our patients. Regardless of the reason, this is just something that nurses do.

But what about us?

It almost seems selfish to ask this, but who is advocating for nurses? We could say that there are a variety of nursing organizations advocating for us. From the ANA, American Nurses Association, to all the speciality organizations like the ENA, Emergency Nurses Association, or ONS, Oncology Nursing Society these organizations fight for us on a large scale. They work to change legislation to improve working conditions for us. At least that’s what they say they do. How effective they may be at that is another discussion and a topic for another post.

But, what about us?

The things these organizations do could have great potential to affect the nursing industry as a whole. But, who is fighting for me within the hospital or other healthcare company I work for? Who is advocating for me within the very organization that I practice in? We, as nurses, are told over and over again to be advocates for our patients. We are told to fight for what is best for our patients. And we DO IT. We fight relentlessly, under ever increasing pressures and ever deteriorating working conditions, to ensure the best care possible for our patients. Yet, we are often left feeling that no one is fighting for us.

Emergency appendectomy = disciplinary action

A nurse I know once had to have an emergency appendectomy. This happened late on a Sunday afternoon. That nurse then missed a week of work, due to this very legitimate medical condition. Upon returning to work the following week, there was no discussion of FMLA or any other actions that needed to be taken. This nurse was not told that the company required a “return to work certification” before returning to work. This nurse was, however, told that, according to the attendance policy, missing five days of work counted as two “occurrences”. In fact, the manager never even brought up FMLA. The nurse had to ASK. shouldn’t the manager have been the one to bring it up?

This instance certainly qualifies for FMLA. This nurse definitely had a responsibility to find out what needed to be done to make that happen. However, shouldn’t the manager have instructed the nurse to fill out whatever appropriate paperwork needed to be done to make the FMLA happen? Instead of informing the nurse that there were two more “occurrences” on the attendance record, shouldn’t the manager have worked with the nurse to make sure the necessary resources were available to clear this up?

This nurse then asked the manager if completing the FMLA process would make those two occurrences go away. The manager responded that she did not know, but would find out. She then never got back with that nurse.

Had this been left completely up to the manager, this nurse would still be left with two dings in the attendance record.

Shouldn’t our managers be advocates for US?

I’d love to say that the experience of this nurse with the appendectomy was an anomaly. I’d love to say that this was a rare instance. Sadly, in over 20 years in healthcare I have seen this become much more the norm. I have seen this sort of scene become more and more common. Early in my career there was very much a feeling of family in nursing. This was not just among the staff, but included the managers and even administrators. When you passed the Director of Nursing in the hall, she knew your name and would say hello. Over the past several years I have seen a gradual decline in this till now it’s very much every man for themselves.

I know a nurse working in an the outpatient setting. The company she works for got a new regional director. This regional director was positioned just a couple rungs up the corporate ladder from the nurse. Yet, even after two or three months in the position, the director has yet to have an actual conversation with that nurse. In fact, the nurse watched as the director had a lengthy conversation with a vendor. This same director has never even spoken more than a passing “hi” to the nurse.

Maybe I’m dreaming. Maybe I’m an idealist. But, I feel that, even as we need to be advocates for our patients, our managers should be advocates for us. YES, we have a responsibility to take care of ourselves. YES, we have a responsibility to make sure things get done for us that need to get done. Even with that I don’t think that managers should be satisfied simply writing up an employee for the time they missed from an EMERGENCY APPENDECTOMY. I’m not saying that the manager has to fill out the paperwork for that employee. I’m not even saying that the manager should provide that paperwork. BUT, the manager should help that employee get the necessary forms. Maybe even follow up with that nurse to make sure it’s been taken care of. A reminder that, without the paperwork, this counts as two occurrences against their attendance is fine, but should not be the end of the discussion.

My team was MY team

I spent a few years as charge nurse in the ER. During that time, I truly considered my team to be MY team. I felt it my responsibility to care for, protect, and even fight for the staff that I oversaw. While I was a bedside nurse my responsibility was to care for, protect, and fight for my patients. BUT, when I moved away from the bedside, that responsibility moved to my team.

I don’t say any of this  to pat myself on the back, or tell what a wonderful charge nurse I was. That’s not the point. The point is that I was committed to caring for my team. Sadly, I don’t see this to be true in many cases in nursing today.

Bottom line

Day in and day out nurses and other members of the healthcare team fight for the lives of our patients. We pour out of ourselves and into others. However, just like any other vessel, if we continue to pour out without anything being pour in, then we WILL run out. Sadly, as I look around at my fellow nurses, I see this happening sooner and sooner. Likewise, if we are always fighting for someone else, and no one is fighting for us, then we will eventually run out of fight.

What happens when all the nurses lose their ability to pour into patients, or run out of fight?

Husband, father, pastor, nurse, freelance writer, overall nice guy. "I believe the healthcare experience can be great for patients, families, and all members of the healthcare team." - Matt Norman

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