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.

Image: Stockbyte/Stockbyte/Getty Images

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.

Image: Jack Hollingsworth | Photodisc | Thinkstock

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?

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.

Kone | Veer + Stockbyte | Thinkstock

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.

Image: Jochen Sands | Digital Vision | Thinkstock

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.

Image: Terry Vine | Blend Images | Getty Images

This was kind of a rough week at work.  I was rushing around trying to get things done since I was going to be out of the office for a few days.  Getting the schedule out to my staff (have I ever told you all how much I truly hate the schedule), making sure everything was off my desk before I leave for this trip I am taking and then having to terminate two of my employees.

This week I had to let two of my employees go.  One had it coming, it was really just a matter of time until he had to move along.  But the other was tough.  The other was a great nurse who was a great leader on my team, was a resource to the younger staff and was dependable.  Unfortunately for her and my team, things in her personal life started to spill over into her professional life and that affected her ability to work.

I know this is part of my job to deal with these kinds of things, that doesn’t make it any easier.  I get paid well to solve problems, and unfortunately to help people move on to another job from time to time.

Just one week I would love to not have any drama.  I would like to have everybody come to work, do their job and get along.  Is that too much to ask for?

Image: Comstock Images | Getty Images

This week I had a big issue with a couple of my CNAs.  I was extremely angry.  Rather than taking them into my office right then and yelling and probably making the situation worse, I chose to wait until the next day.  When I left I told them both, “I will talk to you tomorrow.”

That night when I was on Facebook, one of the CNAs posted the “Top 5 things to being a good Boss” and “Top five things not to do as a boss.”  These were obviously directed at me, and of course angered me even more.  Not that they can’t say what they want, but they chose this venue to talk about it, when they knew I was going to talk to them about the next day when I was calmed down.

This got me thinking, what are the top five things I want my boss to do or not to do?

Here is my list of the five things I want my boss to do:

1. Communicate openly, calmly and rationally with me.
2. Give me the autonomy to make decisions as a professional nurse and leader.
3. Be a resource for me when I need direction.
4. Back me up when I make a decision.
5. Be honest.

I think these are pretty good. I am currently on the committee that is interviewing candidates for the Director of Acute Care Nursing, and these are basically what I tell them too.  I feel that if you had the confidence to hire me, or keep me in this position, then these should be pretty easy to allow me.

Here is my list of five things I do not want my boss to do:

1. Do not talk down to me.  Save the conversation for when you are calm and can discuss it rationally.
2. Do not micromanage me.
3. Do not be unavailable when I tell you I need help.
4. Unless I am breaking a law, a regulation or a policy, do not second guess my decisions.
5. Never, ever lie to me.

As you can see my dos and don’ts are pretty much opposites to each other.  I expect these items from my manager, my staff and myself as a leader.

These are not the things she said about me, though.

This got me thinking about what would be appropriate for a person to post about their work.

Obviously, never, EVER post any patient information.  This could get you in tons of trouble and possibly cause you to lose your job, and even legal issues.  I know we want to post funny things that happen at work, but do not use patient names, describe them or give any information that could identify them to others.  If for some reason I post something like that, I even try to change the sex of the patient.

When it comes to your boss or job, you may want to get online and complain when you think your boss did something unfair, or when you have a bad day at work.  But try not using their name, your hospital and/or unit name.  This will make your boss, unit and organization look bad to others.  Maybe it is just a personal thing between the two of you and your boss will get along great with somebody else.  It can also give patients an inappropriate view of the type of care they will receive or had received there at one time.

What I would suggest…..keep work at work.  The best way to keep yourself from possibly getting in trouble is to just not talk about it in a public forum.

Somos/Veer | Somos Collection | Getty Images

I recently took a test to measure my strengths as a leader.  This test gives you top five strengths and how to use those to improve yourself overall. One of my strengths is as a ‘relater.’ It stated that I am strong at creating relationships with my employees and maintaining those relationships by getting to actually know my staff and relate to them.

At first I thought that was nonsense, but then I sat back and thought about it. I do take the time to get to know each of my employees.  If they want to sit in my office and chit-chat, I don’t discourage it. If they want to stop me in the hall to tell me about their personal life, I will sit down and listen to every word. I never thought about it as a skill, I was just doing what came naturally…..guess that’s why it’s considered a skill.

But how far do I take it? Should I talk about my personal life? Should I get involved in their lives? Should I allow them to be my friends on Facebook?

This is a tough place for a manager. On one hand you want to be a good boss and help them with whatever you can, even dealing with personal issues, but then you don’t want to become too involved and drag yourself into their issues. On one hand you want to let them know you as a person, but you don’t want the staff to become too involved in your life.

It’s a fine line to balance…being there for your staff while keeping them at arm’s length.

I care about my staff. I know when each of them is down or having problems and I try to support them the best I can. And I celebrate their accomplishments with them as well.  Sometimes they tell me more than I want or need to know….sometimes I do, too.