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One of the best pieces of advice I received when I graduated from nursing school was to find a mentor.  One of my instructors told me to find a nurse that has been around for a while and can help you get through that tough first year and then help you get along when times are tough.

I did find a mentor when I was in my final semester of school.  He was my preceptor for one of clinical rotations.  He had only been a nurse for a few years, so he understood what I needed from him in the beginning of my career and he also knew the pitfalls I would find myself in as my career progressed.  When I was thinking about changing jobs or specialties, I knew I could go to him and get his honest opinion and that I could trust that he would not steer me wrong.

Once I got into management, I needed to find someone that could help me in this transition.  Although he was the one that helped me make the decision to jump from the floor into the office, he didn’t have the experience there that could help me.

I finally found a nurse that had been in management for about 10 years.  Her career was about the same as mine; she went into nursing with a previous career in business and knew that she wanted to get into management as quickly as possible.  She is now the one that is there for me when I need a little pat on the back when I think I am going the wrong direction with my management…and she is there to knock me down when I’m thinking I’m great when I ‘m actually screwing up pretty bad.

I truly appreciate both of my mentors for different reasons, but the most important thing they have done for me is just help me stay positive and remember why I wanted to be a nurse in the first place.

Do you have a great nurse mentor?

There was a day when most of these benefits could be negotiated.  You could tell the hospital recruiter how much you wanted to make and how much you wanted to pay for insurance….heck, you could even negotiate a hiring bonus.  But in these times, with a surplus of nurses graduating from school every day, the hospitals are now in a position that they don’t have to negotiate.  They can tell you what they will pay you. They may have room to move a couple of dollars per hour, but when it comes to the other benefits, they will tell you how much they will pay.

What I tell nurses is to look at hospitals that provide a good salary along with a great benefits package.  If you’re considering going back to school, make sure you find an employer that provides the most tuition reimbursement you can find.  If you’re getting ready to start a family and have a child, you may want to find a hospital that provides quality insurance and pays a large portion of your premiums.  If you have bad teeth…well, then dental is your focus.

Remember, salary is not the only part of what you want to receive from the hospital; you want to ensure the benefits you receive are what you really want and need for your position in life.

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As a parent I let my expectation be known to my child and they can work within those expectations when making decisions on her behavior (note:  it does not always work with a four year old, but it’s never to soon to get her learning).  As an ED nurse dealing with a large amount of psych and intoxicated patients, I let my expectations be known with them (note:  it does not always work with an intoxicated college kid, in fact even less than with a four year old).  And, as a manager I let my expectations be known to my staff.

On the first day I was on the unit, I told my staff what my expectations are.  They were pretty simple.  I expected everyone to be at work, to be at work on time, to do their jobs while they were here and to follow hospital policies to ensure we are providing safe and effective patient care.

I have found that expressing my expectations and listening to the expectations of my staff helps all us focus on what is important in our day to day operations.  They know where I am coming from and I know where they are coming from.

I found this is great practice as a nurse, too.  In the morning when I am introducing myself to my patients, I find out what their goals for the day are, or what they expect to get out of it and me.   And I am able to express my goals for them and I want expect from them to meet those goals.  Usually, are goals are pretty similar and things work out wonderfully.

By giving your expectations of kids, patients or staff, you are able to hold them accountable for their actions or behavior.  If you told them from day one that they you expect something from them and they can not, or refuse to, do that then you can hold their feet to the fire.  That also goes the other way if I am expected to do something by my staff and I don’t perform, I would expect them to call me out.

So, my expectation of all of you is to talk one idea from this and use it in your daily practice….and I will hold you all accountable.

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I like to reflect each year on this tragic anniversary on what life was like before, during and after the attacks.

I was driving to work at about 6:00 in the morning, listening to the radio when I heard the report of the first plane flying in to the World Trade Center.  I remember thinking it was a small plane like a Cessna and saying to myself, “some moron flew into a building.”  I even called my wife and said so.

I then heard the reports about the second plane, then the third plane at the Pentagon and the fourth in Pennsylvania while I was at work.  About that time I realized this was something big.  I could not get on to any news websites and could not get any information or pictures of what was happening.  And, my father was flying home that day too.

I had injured my back a few days before and was having a lot of pain and difficulty walking.  That night when I got home I watched the footage of the planes crashing and the towers collapsing over and over and over.  I was numb.  I was angry.  I was sad.  I was proud to be an American.

The next day I was watching the footage again.  There was a story about a Port Authority Officer, whose office was in the basement of the World Trade Center, and his dog never made it out.  That set me over the edge and I broke down crying.  When my wife came home, found me lying on the floor, unable to walk and crying hysterically, I lied to her and told her I was in pain from my back, when I really was overcome by emotion over what I was witnessing.

Witnessing the end of life as I had known it.  Witnessing a new world and a new way of life.  Witnessing the depravity of what some humans will do when they hate.  Witnessing the death of heros.

I knew from that day that I had made the right decision to become a nurse.  If I could use my abilities to help another person in a time when they need it, I could hold my head high.  I may never be a hero like those firefighters who ran up those buildings when they were falling in on them, but I can be the one who helps save the life they pull out of the destruction.

Thank you to all the firefighters, police, EMS, physicians and especially nurses who are all heroes to me.  I will be thinking of all you on Saturday.

God bless America!

We have all had those managers that sit in their office all day, are not engaged with the staff or patients and have no idea what is happening on the unit or with their staff. I vowed to myself that I would never be that type of manager. Although I have my duties I need to complete in my office, I still make the time each day to round on the unit — to talk to the patients, families and nurses to see what is happening or what is needed. I always make myself available to assist with that difficult IV and to teach the nurse what they can do different.

This is how I see excellence. I am able to see how the nurses interact with patients and families. I am able to see how they work together to create a team that makes patient safety a priority. I am able to see how they handle those difficult situations that present themselves each day.

I am also able to see who is struggling to keep up, and who is just not making it as part of the team. This gives me the opportunity to help them find the resources they need to be successful or to help them find a place where they fit in better.

I am proud of what I see from my staff everyday. They work hard and keep their patients safe.  That is excellence.

Do you know a nurse who needs to be recognized for going the extra mile? Nominate them for an Inspired Comfort Award.

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Not all managers are like me.  Some are mean, arrogant and don’t care about their staff.  That is not me…..I am better than that.

There will come a time, at least once, in your career where you will hit a wall when you are trying to deal with your manager.  They don’t listen to what you have to say, they don’t want to work with you or they are just completely unreasonable.  When that happens, what do you do?

Here are my suggestions, these would work with me.

First, before you go talk to them make sure you have all your ducks in a row. What I mean is, be ready to present you case. If your attendance has been perfect, show them. If you have been a team player by picking up extra shifts when there are holes, or you have joined committees, be ready to talk about that. On the flip side, if you call off a lot or are not engaged in the unit, be ready to explain.

Second, be honest and straightforward. If you need time off to go somewhere silly like a Star Trek convention, don’t lie and say you are going to your grandma’s funeral, because when she really dies or already has, you will have to explain that.

Third, be prepared for questions or even an answer of “NO!”.  Don’t get tongue-tied and start stuttering, and don’t start crying. Nothing is worse in my office than when somebody cries.

Don’t be afraid to ask questions. Ask why. Maybe there is something you don’t know about that the manager does know. Maybe a couple other nurses are on FMLA, maybe there is a new process implementation that week and they really need your leadership.  Found out what you can do to help them out as well.

If you do get a “no”, where do you go from there? Well, you have a couple of options: Try talking to them again, and make an even better case. Or, take your argument to the next level. But, be extra prepared for this course of action. The Director or CNO will probably back up the manager’s decision, just like your manager should back you up on a conflict.  So, you need to have a better presentation to give the next level of management if you want to get what you want.

Be prepared and be honest. When it comes to my staff I will listen to everyone’s case, and if that nurse is willing to help me out when needed, I will work with them.

But then again, I am awesome (that’s not arrogant, is it?).

I have a couple of examples of what I am talking about, I am sure you will see what you should be looking for in a manager, and what can hold you back in your career goals.

When I am welcoming new employees to my unit, I meet with them on the first day to discuss my expectations of them, and to learn about what their goals are.  I make it clear that I know that they are not going to be working for me for ever, and that I want to help them grow as a nurse while they are on our unit so they can reach those goals.  Whether that is moving to the ICU, the ED or L&D, I know they have goals, and if I know those goals, I can help them achieve them.

This is new for a lot of nurses who are used to their managers expecting them to stay on the unit forever.  They are not used to a leader helping them and coaching them to meet and hopefully exceed those goals they have set for themselves.

Contrast that to my situation.  My organization is going though a lot of changes in the department of nursing.  There are directors and higher up the organizational chart that have left opening new opportunities for those managers that are looking go move up to these positions, like myself.

Last week I sent an email to my boss explaining that I am interested in moving up the ladder.  I explained my goals and asked her if she could support me and mentor me in these new positions.  I explained why I felt that I would be the perfect candidate for one of these positions and the positive changes I could make.

I received an email back that really just shot me down.  She was completely unsupportive and did not provide any positive support or feedback.  I am disheartened, and disillusioned with her and this organization that I have put some many years into.  I am seriously considering leaving because of the lack of support given to me.

Which one would you like to have?  Somebody that wants to know your dreams and helps you to achieve them, or somebody that doesn’t ask, and doesn’t seem to care or support you when you tell them?

Pretty easy choice for me.

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For anybody that has been a nurse for a few years you have already learned this, especially if you have worked at more than one hospital.

Nurses, or even healthcare is general, is a pretty small and close knit group. If you are working in the same town you went to school in, then you probably know at least one nurse at every hospital in your town. If you have worked at other hospitals, then you probably know somebody at every hospital in your town. But it is definite that somebody you work with now knows at least one other nurse at every hospital in your town.

For this reason, I tell my nurses, don’t burn your bridges. What you say or do here will eventually make it to the hospital on the other side of town.  Here’s an example…with some details changed to protect the parties involved:

When I was staffing in the ED, the manager was interviewing a nurse. This nurse was somebody I went to school with.  She was an average student, but the know-it-all in the class (we all had one of those, the phlebotomist or EKG tech who think they know everything). She was a complete pain in school.

When he was giving her a tour of the unit, we ran into each other. She came over gave me a hug and was sweet as pie, although we never got along in school. After her interview, the manager came and asked me about her.  I told him the truth, I don’t know about her nursing skills, but she was a difficult person to deal with in school and I don’t think she would be a good fit for the team.

She didn’t get the job. This happened with two other people that I was asked about that I worked with in other EDs.

I don’t feel bad about it, because I don’t think they would have been successful here, and I don’t think they would have been a good fit for the team. It was their behavior that caused me to give a bad reference.

What I am saying is….we have hard jobs already. When you are feeling stressed and having a bad day, learn how to keep it in check. Because one day, you may not get a job in another department or hospital because of how you acted on your unit today.

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At what point in a new nurse’s orientation or career do they start to feel confident in themselves as a nurse and their skills?  The reason I am wondering is because I have a new graduate nurse who started a couple weeks ago and this is her main issue.

She has been on orientation for two full weeks now. Last week, she called me at home crying because she thought she was not doing well.  She said that she took care of two patients that day and was feeling overwhelmed.  She said she knew what she needed to do, but was constantly questioning herself.

I tried to explain to her that that was normal and that by comparing herself to her preceptor, who has several years of experience, she was only going to drive herself crazy.  I told her that I would be more concerned if she felt confident or overly confident at this point in her orientation. I even used my experience as a new grad as an example, explaining that I didn’t feel confident until at least nine months AFTER orientation ended, and even then I was just happy I didn’t kill somebody whenever I worked.

I had the nurse educator on the unit talk to her and explain it to her. I also talked with her preceptors and made sure they were helping to build her confidence. I asked one of my new grads who had just reached her one year mark to talk to her, too.

It’s difficult getting through to new nurses sometimes.  It’s been their dream for so long to be a nurse, and now that it’s a reality they realize they actually have people’s lives in their hands.

What I told her was true about being more concerned if she were over-confident.  I have seen too many new nurses fail because of their cockiness.  They end up facing the reality that they don’t know as much as they thought, or more likely doing something they think they know but really don’t and hurting a patient.

Mistakes are going to happen.  She’s going to make an error at some point in her career.  Being overly-cautious because of that fear is not going to change anything; in fact, I really feel it will make her even more likely to make a mistake.

How confident are you in your career?

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Here it is, the end of the year and I can’t think of anything to write about.  I am sitting here at my desk looking at all the stacks of papers on my desk demanding my attention.

Schedule requests and changes, incomplete performance evaluations, a list of employee issues I need to address and now a subpoena (that will be a story for another day).  I am looking at all this stuff trying to figure out what needs to be done immediately and what can wait, but as you can see by the fact that I am writing this, I have no intention of doing any of it.

Stacks are what guides the day of a nurse manager.  Every time a new project lands on your desk, a new stack is created.  Every time an issue pops up, a new stack is created.  Then each morning it is the job of the nurse manager to determine how to handle those stacks.

Being an ED nurse and having been an excellent triage nurse, I am able to quickly look over my stacks and make a decision.  That stack there is chest pain and needs to be seen right now.  The stack back there has been there for two weeks, obviously it is not emergent, I will deal with it in time (most likely that time will be when I put it in the recycle bin).

Right now I count seven stacks on my desk and none of them are my chest pains, so they can all sit in the waiting room and wait their turn.  I will get to them some day.