Under fire, nurses are being used to manage non-ICU departments
Stressed managers now supervise areas outside their expertise
Frontline management responsibilities for nurses are multiplying as acute-care hospitals squeeze more value out of their resources. Meanwhile, nurse managers, especially those in critical care, are feeling the brunt of the overload.
Experienced managers are being asked by hospitals to assume authority over multiple acute-care departments, including many units that fall outside the conventional purview of critical care, nurses say.
According to critics, veteran managers are being asked to run emergency departments and trauma centers, as well as overseeing outpatient clinics and physicians’ offices. If your workload has multiplied in recent months or years, it may not be a function of your unique managerial skills but more a matter of economic necessity, they add.
"To be sure, hospitals are consolidating departments and placing multiple units under one frontline management authority," says Sharon Lau, a health care consultant with Medical Management Planning in Los Angeles.
Administrators are cutting out layers of management bureaucracy while multiplying the authority of floor-level individuals, Lau says. And the trend has been hitting all hospitals with increasing rapidity.
The process has been ongoing for several years. But the difference now is that managers are being asked to run as many as three to four separate departments simultaneously.
Critical care experience an asset
Critical care nurses are especially high in demand, and the units they are often asked to run are as diverse as ambulatory surgery and home care programs.
The reason: Due to the scope and intensity of their patient-care backgrounds, experienced critical care managers are viewed as highly qualified to run diverse, less-intensive medical departments, managers say.
The trend is expected to continue, and while it may open up new career tracks for experienced RNs, the additional workload could simply turn into a fast track to burnout, according to Peter Mitchell, RN, MS, patient care manager at St. Elizabeth’s Medical Center in Boston.
Mitchell oversees nursing duties for a seven-bed combined respiratory and medical ICU, as well as an outpatient-inpatient endoscopy center that routinely sees medical ICU patients. He also manages a 37-bed medical unit with a six-bed critical-care stepdown.
"These kinds of responsibilities are becoming common in nursing management," Mitchell says. "It’s all about saving money."
A response to managed care
Licensing and regulatory agencies have not yet entered the discussion over whether these tactics are necessarily good for either nurses or patients. However, consultants such as Lau see the trend simply as an extension of a decade-old practice of hospital systems’ integration in response to cost-cutting and managed care.
The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, also has been mum on the subject. There are no provisions covering workload limits on nurse management in the organization’s Comprehensive Accreditation Manual for Hospitals, which covers most hospital operating standards. The chapter heading on nurse leadership touches on several management topics but not on workload limits.
Nevertheless, veteran ICU managers are concerned about the readiness of many nurses to tackle additional responsibilities when they’re already overextended in their present duties.
"There’s no hard evidence for this, but I’m not so sure it’s such a good thing for patients overall," Mitchell says.
Yet, nurse managers are likely to say they have trouble meeting short-term objectives and feel buried under tons of daily detail-work, according to managers contacted by Critical Care Management. (For tips on balancing a diverse workload, see article on p. 110.)
However, when these arrangements succeed, the team building and efficiency that result are generally good for the staff and hospital, Lau remarks.
Not sure trend is good for patients
Staff nurses say they have more direct contact with floor managers because they are perceived to have more authority in problem solving and a direct link to senior administration. The sense is that these managers have more clout, Lau adds.
But when the arrangements fail, it isn’t only one unit that suffers but several, says Mitchell.
"Sometimes we’re not the ones in control. The decision [of whether we run these additional units] may have already been made," says Debbie Keith, RN, a former critical care nurse who presently manages three noncritical care departments at St. Joseph Hospital in Augusta, GA.
Keith says that most critical care nurse managers are up to the task. But others, such as Myrna Mamaril, RN, MS, a nurse manager for three departments, including a post-anesthesia care unit, at St. Joseph Medical Center in Towson, MD, argue that candidates for the job must be carefully selected, extremely mature, and experienced.
"It isn’t something that just any nurse manager can walk into and do well," Mamaril adds.
Lack of training a concern
Lau is concerned that hospitals aren’t adequately training managers to handle the increased responsibilities. Most experienced managers don’t get formal in-hospital training to smoothly integrate additional departments, she says.
Whatever training they receive usually stems from their own initiative in attending continuing education or management seminars. "Hospitals haven’t done a good job in training managers for added responsibilities," Lau says.
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