Differences Between a Manager and a Foreman
Do You Have a Manager or a Foreman Leading Your Unit or Facility? by Donna Setterholm, RN. BSN, MN in HHSA – 02/17/2017
Registered nurses (RNs) are licensed by the state in which they are practicing. They operate under their license, not their manager’s license. RNs must be able to prioritize and execute the care for their patients when they accept responsibility for them. Most institutions say that they value critical thinking skills, which no one can deny is valuable in health care. Yet, some people in management often hinder their nurses from utilizing their education and experience to provide best outcomes through critical thinking. Listed are qualities for manager vs foreman.
Manager vs Foreman
- Supports staff members Supports his/her boss
- Listens to all involved before Listens to the first “tattler“ and making decisions decides he/she must be right
- Gathers all related data Knee jerk actions, puts out fires before acting due to lack of data
- Collaborative, promotes staff Competitive – may even eliminate perceived competitors
- Can learn from others Knows what’s best
- Asks for cooperation Dictates orders – tells staff what based on input to do without their input
- Negotiates Has final say without understanding
- Other oriented Self-promoting
- Objective Subjective
- Leader, assertive Boss, autocratic
- Evaluates staff from own Evaluates staff by selective observations “hearsay”
If an institution values critical thinking skills, then those skills must be nurtured, guided, supported and rewarded. Many nurses fear contact with their “managers” and get physically ill when they are called to receive their evaluations. Fear and punishment of any kind does not foster an environment to support critical thinking skills, nor does it allow for engagement.
Unfortunately, we have many foremen in our health related fields, coupled with some who have so little understanding of the workload “flow” affecting staff members. Many nurse “managers” choose not to be staff nurses themselves and have limited clinical experience; yet they believe they are qualified to evaluate experienced nurses. Support systems (diabetic educators, IV teams, catheter care teams, admission RN’s, education departments providing immediate on the job training, lift teams, 24/7 phlebotomy teams) are being decreased or discontinued without increasing nurse: patient ratios. It’s their staff nurses’ problem to solve. And providing more nursing assistants is not an option as their scope of help is limited. The rate of admissions, transfers and discharges is so rapid today that nurses cannot adequately plan or concentrate on their assignments in a given shift. Often when staff nurses discharge or transfer a patient off the unit, they quickly get an incoming transfer or admit added to their assignment.
Considerable time is needed to adequately discharge a patient with home instructions, final charting, gathering belongings, coordinating medications with the pharmacy, dressing and transporting, as well as communicating with the family or ambulance service. Sometimes a nurse has more than one discharge to accomplish. If a patient dies, the “discharge” is further complicated by preparing the body and communicating with doctors, supervisors, grieving family members, funeral homes, clergy, and the coroner.
Admissions also require considerable time to process, especially if they are direct admits to the unit (bypass emergency department). For example, a direct admit to a telemetry unit requires gowning, at least one IV started, blood for labs drawn, and monitoring capability set up before starting the long process of assessing vitals, weighing patient, notifying physician and gathering health data. (See admission data chart on EMR) When the new patient arrives to the unit, the nurse has to accept the patient and get report from the ED nurse or ambulance EMT, even if he/she is currently working with other assigned patients. The “game” is to constantly re-prioritize and run, often times forfeiting breaks and decreasing contact with other assigned patients because discharges & admits have become management’s priorities. Nurses need time for “a breather” to gather themselves before accepting more cases and responsibility. They need time to actually assess and care for the patients they are already responsible for.
There is a national shortage of nurses with projected needs of 800,000 more nurses by 20201. MN as a supplier state of nurses is slow to recognize the issue. However, MN will soon be affected as more nurses choose non-bedside options, nurses retire, young nurses find other jobs more palatable or less stressful, and fewer nurses immigrate to the US. Like firemen & policemen, nurses ought to be revered and supported so that supply & demand is balanced.
Below is a podcast from Dr. Evan Levine, MD, a cardiologist from Bronx, NY about the MN nurses strike – 2016.
http://realmedicine.podomatic.com/entry/2016-10-08T18_52_29-07_00
1 Sources: US Department of Health and Human Services Health Resources and Service Administration, Bureau of Health Professions (2002), Washington, DC. A graph of the supply, demand, and shortages of RNs is published in Fundamentals of Nursing, The Art and Science of Patient-Centered Nursing Care; eight edition by Taylor, Lillis, Lynn; publisher Wolters Kluwer – copyright 2015, page 19.
2 The Sociopath Next Door, by Dr. Martha Stout, PHD, clinical psychologist and Harvard professor, publisher: MJF Books, 2005.