1. Doucette, Jeffrey N. DNP, RN, CEN, NEA-BC, FACHE

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How to "manage" being a manager

Q I'm a nurse manager who's feeling completely overwhelmed with the role. Do you have any suggestions for how I can streamline my work?

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This is a very difficult question that many nurse managers are dealing with nationally. I've always said that the nurse manager role is one of the most demanding in the healthcare system. Nurse managers are pulled by every single constituency-patients, staff, administrators, and physicians. In the new reimbursement landscape of value-based payments, the majority of the work related to an organization's financial performance falls squarely on the shoulders of the nurse manager at the sharp edge of care. Couple this with 24/7 responsibility for staffing, human resources, budget, and equipment/supply management, and it's easy to see why so many nurse managers feel exactly the way you do. Here are some ideas for bringing a little more balance to your life.


1. The first and most important step in this process is to have a conversation with your senior nurse executive about how you're feeling about your role. This conversation should focus on redesigning the work in a way that leaves you feeling less overwhelmed. Possible points to address include your meeting schedule, your commitments outside of work, the number of phone calls that you receive on a daily basis and after hours, and how you're involved in staffing and scheduling.


2. One major source of dissatisfaction for nurse managers is the fact that they're never really off. The nonstop accountability is overwhelming. One idea for reframing the nurse manager role is to readjust to a 4-day, 10-hour work week. Next, create a rotation of nurse managers so that each has a day off during the week. Doing this in a rotating fashion ensures that the same person isn't off every Friday or Monday, for example.


3. Another significant irritation for nurse managers is constantly being on call. One strategy for reducing this burden is to create a weekly call schedule for all of the organization's nurse leaders. With a dedicated nurse manager on call every day, you ease the responsibility of everyone being on call 24/7. In this model, each nurse manager takes 1 week of call time from 5 p.m. to 7 a.m. during the week and 5 p.m. Friday to 7 a.m. Monday. Nursing supervisors then work with the nurse manager on call for issues related to staffing, patient care, and operations versus calling each individual unit's manager. Although this model may make for a very busy week for the nurse manager who's on call, most managers would gladly accept a busy week in exchange for several weeks without the burden of being on call. The challenge with this model is getting everyone to agree that when the on-call nurse manager makes a decision for a unit, there's no Monday morning quarterbacking of decisions made after hours and on the weekend.


4. One additional, critically important step to ensuring role manageability is reducing the number of meetings that nurse managers are expected to attend. I recently saw an Internet meme that said "I just survived another meeting that could've been an e-mail." This struck a chord with me as I considered my day and the many meetings I attend that could be handled in different ways. We're stuck in the mindset that we all have to be sitting around the same table to make decisions. My recommendation is to look at the nurse manager team as a whole and, much like the call schedule, determine if it's really necessary that every nurse manager attend every meeting in which patient care is discussed. Is it possible for you to have rotating nurse manager representatives at meetings who then report back during a centralized nurse manager meeting once or twice a month?



The nurse manager role is increasingly complex and absolutely vital for an organization to be successful under the value-based model. What I've presented here are some quick ways for you to have an early win in redefining your work and improving work-life balance at your organization.