Taking Clinical Assignments as a Manager

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A new nurse manager recently sought guidance on how much time she spent in direct care. Her unit is very short-staffed. She feels guilty about her nurse-patient ratios.  Her solution has been to do direct care herself. The staff loves that she is so supportive of her. But here is the problem, she is burning out. She has no time to do her administrative work, has fallen behind in scheduling recruitment interviews, and feels like a failure in the manager role. She brings her administrative work home and gets texts from staff 24/7.

This manager’s story is crucial to how new leaders struggle with work-life balance after assuming the role, especially now. Staffing is so short in many health systems that leaders get sucked into the staffing vortex – some every day. Many with young families work well into the evening hours, often ignoring their children and spouses. An old adage about this is true – the only people who will remember how much extra you worked are your kids.

For many nurse leaders, the most challenging parts of the job are managing themselves and putting boundaries around their work.  This is especially true for new leaders struggling to accomplish everything expected of them in their leadership roles. It is common to find that some leaders work 10-12 hours each day and then continue to answer texts and emails on the weekend.

The problem with not having boundaries is that the pace of work can become unsustainable. Left unchecked, new managers often feel that the only way out is to leave the position.  We have a culture in many settings today where this level of direct care is now an expectation of leaders. The fallout of this is seen with staff, many of whom are burned out and disengaged. Nurses look to their leaders to role model good work-life balance, but they often see quite the opposite.

My answer to this leader is that she cannot routinely take patient care assignments and expect to be successful in the role. Spending an hour or two on the unit supporting staff with their assignments differs from taking a complete patient care assignment. We should not expect this from our leaders. Four recommended steps in setting boundaries include the following:

1. Identify your limits – we are often our own worst enemies when it comes to working and can have challenges saying no.  Getting clear about your limits–emotional, mental, physical, spiritual, etc. is an essential first step. Limits are a very individual and may vary considerably among leaders depending on their stage of life.
2. Pay attention to your feelings – feelings are an influential gauge of whether we have moved into overdrive with our work.  Pay close attention when you feel discomfort, resentment, and guilt. These feelings are often cues to yourself that a boundary issue may be present. If you repeatedly have these feelings, it is time to restructure your boundaries.
3. Permit yourself to set boundaries – nurse leaders often feel they should cope with a situation and say yes because that is what they are expected to do.  You may question whether you even have the right or deserve to set boundaries in the first place. When these doubts occur, reaffirm to yourself that you have this right, so permit yourself to do so and work to preserve them. The only one that can set boundaries for your work is you.
4. Consider your environment – work environment context plays a crucial role in how comfortable leaders may be in setting boundaries.  Your environment can either support your setting boundaries–making it easier for you–or present obstacles to boundary setting–making it more challenging for you. Nurse executives play a key role in making it OK (even demanding it) for their leaders to set boundaries.

I am sure this manager is not alone with the question of when to step in and back. Consider beginning your next leadership meeting with the question, “How do you make decisions today about when to take a direct care assignment? I have learned that nurse managers learn best from each other. Take the time to help them reflect on what they are doing and listen to the experiences of others.

© emergingrnleader.com 2023

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Other Programs/Books Your Leaders May Find Valuable

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

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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