Reflections of a Nurse Manager on Today’s Leadership Challenges

By Mike Spiros, MALD, MS, APRN, AGACNP-BC, NE-BC

Today, I am publishing a guest blog written by a nurse manager. Mike Spiros is an APRN currently serving as nurse manager for an acute care unit in Portland, Oregon. He has previously worked for hospital systems in Florida and Massachusetts. He describes his leadership philosophy as a hybrid blend of intent-based and servant leadership, with global influences from his pre-nursing life as a US military officer and journalist.

Below are Mike’s thoughtful reflections on Nurse Manager Challenges in Meeting the Complex Needs of Staff in a Turbulent Healthcare Environment. 

Nursing is hard.

As nurses, we must often help our patients navigate some of the worst periods of their lives. We soothe the hurt, both physical and mental. We advocate for those who have lost their voice or who feel like their voice isn’t heard. We comfort the dying. We stand long hours and lift heavy loads. All too often, that stress takes its toll. It’s no secret that Nursing has become harder, but we can’t just blame it all on Covid.

For me, nursing leadership has always been about balancing the competing priorities between meeting the needs of our patients, and meeting the needs of our staff. None of that is new. In the past this was easy: “the needs of our patients come first” (to borrow the famous Mayo Clinic mission line). Nurses were expected to sacrifice their own personal well-being for their patients. We skipped lunches, went 8-10 hours without bathroom breaks, and flexed large assignments, all because that’s what nurses do. We laughed off the dementia patient constantly hitting us. We put up families yelling at us because the physician team changed the plan of care without telling them. It was all part of being a nurse. Ours was a calling, and our sacrifice for others was worth the hurt. We celebrated as the nursing profession remaining the most trusted and respected profession in the United States for 22 years in a row.(1)

But let’s face it – we’ve lost that lovin’ feelin’. Our patient populations have more comorbidities. Patients are more acute, and are more impacted by their own traumas. We’re not the same heroes people banged their pots and pans for. Physical and mental abuse by patient and families regularly occurs multiple times a shift. The US Bureau of Labor Statistics showed in 2020 health care and social assistance workers had an incidence rate of 10.3 (out of 10,000 full time workers) for injuries resulting from assaults and violent acts by other persons. The rate for nursing was 21.8. (2)  Now flexing that larger assignment to help the patient flow adds that extra layer of stress to the bed-side life, maybe at the cost of their lunch break. Charge nurses ask their teams to take one more admission, cover one extra patient….3 shifts in a row. Nursing remains the most respected profession, but the U.S. public now rates us 10% below our 2020 high. Compounding this loss of trust, nursing now faces some of the highest rates of non-lethal work place violence, even surpassing the rates of police officers, and doubling over the past 10 years.(3)

Staff are exhausted. Burned out. Crisped by the needs of our patients. Though the “Great Resignation” is technically over, we haven’t recovered in nursing. Nationally, the hospital RN turnover rate remains at 22.5%.(4)

As a nurse manager I believe my primary job to be that first line support system for our team. I try and dedicate at least ½ of each day to leader rounding: listening to the staff, checking in. Let them vent. Let them cry. Tell them “I’m sorry….” I have officially or informally led nursing teams in 3 corners of the US: Massachusetts, Florida, and now Oregon. The concerns, stress, and venting commentary I hear are almost exactly the same (only the accents are different). I could easily interchange the staff and they would have the same daily concerns about patients, coverage loads, pay levels, and overall feelings of burnout and stress. I’m a big believer in constant reassessment, and sometimes (honestly, maybe too often) I do self-reflection and think, “it must be my fault” as the unit leader. I wonder, “what am I not doing enough of to meet their needs?” Though I know this mental outlook is only a negative downward spiral, it’s still easier for me to try and take ownership of the situation – though rationally I know I have maybe a 15% sphere of true control over what’s going on.

In 1943 Abraham Maslow described the human hierarchy of needs. Most nurse leaders are familiar with this pyramid: basic physiological needs form the base, then move up to safety and security. Once those basic needs are met we move into the acquired emotional needs of love and belonging, then self-esteem, and finally self-actualization. Ideally, one expects the “basic” needs should be the easiest for leaders to meet. Make sure your staff get food and water, take breaks, and leave on time at the end of their shift so they can get some sleep.  Yet we all too often focus our energies on the higher areas believing this sets our institutions apart from each other.  I would argue we need to get back to the basics. As nurse leaders we can shift the focus back on our staff’s basic physiological needs, along with their safety and security. Once our staff feel secure in their basic needs, then we can focus on the hospital family, status and recognition, and building up nurse self-actualization.

Finally, Mike offers the following advice on how we as nurse leaders should balance the challenge of meeting the needs of our patients and meeting the needs of our staff? He urges leaders to focus on staff first. If we take care of the needs of our staff, he writes, they will take care of the needs of our patients. These are important words of wisdom from a committed nurse manager who has been at the frontlines of care throughout this turbulent time.

References

1. Brenan, Megan. “Nurses Retain Top Ethics Rating in U.S., but Below 2020 High.” Gallup News. January 10, 2023.

2. 2021 U.S. Bureau of Labor Statistics. Injuries, Illnesses, and Fatalities. https://www.bls.gov/iif/home.htm

3.  Jones, Melissa. “Preventing Workplace Violence in Healthcare.” American Association of Critical Care Nurses. May 17, 2021. https://www.aacn.org/blog/preventing-workplace-violence-in-healthcare

4.  2023. NSI National Health Care Retention & RN Staffing Report. NSI Nursing Solutions, Inc. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

© emergingrnleader.com 2023

Bring the Nurse Leader Coach Workshop to Your Facility Virtually or Onsite   Click Here for the Nurse Leader Coach WS Flyer

 

 

 

 

 

Other Programs/Books Your Leaders May Find Valuable

From Traditional Nurse Leader to Nurse Leader Coach – Click Here for the Flyer

For new leaders and emerging leaders, consider doing The Nuts and Bolts of Nursing Leadership Program – Click Here for the Nuts and Bolts Flyer Final

New Leader Development Option in 2023 – Team Coaching Designed to the Unique Needs of Your Organization  Leader Coaching Brochure

Read the Nurse Leader Coach – Available at Amazon and Other Book Sellers

Recommended Book by the Association of Critical Care Nurses – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success