A Day in the Life of a First-Level Manager
As the manager for a surgical intensive care unit (SICU), Jamal Johnson is routinely responsible for supervising patient care, trouble shooting, maintain- ing compliance with standards, and giving guidance and direction as needed. In addition, he has fiscal and committee responsibilities and is accountable to the organization for maintaining its philosophies and ob- jectives. The following exemplifies a typical day.
As Jamal came on duty, he learned that there had been a multiple vehicle accident and that three of the victims were currently in the operating room and destined for the unit. The assistant manager for nights had secured more staff for days: two part-time SICU nurses and a staff nurse from the surgical floor. However, she had not had time to arrange for two more patients to be moved out of the unit. From their assigned nurses, Jamal obtained an update on the pa- tients who were candidates for transfer from the SICU to another floor and, in consultation with his assistant, made the appropriate arrangements for the transfers.
Other staffing problems were at hand: in addition to the nurse who had been pulled from the surgical floor, there were two orientees, and the staff needed to attend a safety in-service. As soon as the charge nurse came in, Jamal apprised her of the situation. Together, they reviewed the operating room schedule and identified staffing arrangements. Fortunately, Jamal had only one meeting today and would be avail- able for backup staffing. In the meantime, he would work on evaluations.
After his discussions with the charge nurse, Jamal met with each of the night nurses to get an update on the status of the other patients. Then he went to his office to review his messages and plan his day. Tamera, an RN, had just learned she was pregnant but stated that she planned to work until delivery. Jamal learned that his budget hearing had been scheduled for the following Monday at 10 A.M. A pharmaceutical
representative wanted to provide an in-service for the unit. Fortunately, there were no immediate crises.
Jamal called his supervisor to inform her of the status of affairs on the unit and learned that two other individuals in the accident had been transported to another hospital; one had since died. They discussed the ethical and legal ramifications. Jamal would need to review the policies on relations with the press and law enforcement and update his staff.
As the first patient returned from surgery, Jamal went to help admit the patient and receive a report. Learning that the patient was stable, he informed Lu- cinda, the charge nurse, that the patient they had just received was likely to be charged with manslaughter and reviewed media and legal policies with her. They also discussed how the staff were doing. There were some equipment problems in room 2110; Lucinda had temporarily placed the patient in that room on a transport monitor and was waiting for a biomedi- cal technology staff member to check the monitor. Could Jamal follow up? Jamal agreed and commended Lucinda for her problem solving. She reminded Jamal they would need backup for lunch and in-services.
As Jamal returned to his office, he noted that the alarms were turned off on one of the patients. He pulled aside the nurse assigned to the patient and re- minded her of the necessity to keep the alarms on at all times. Finally, back in his office, he called biomedical technology to ascertain their plans to check the monitor and made notes regarding the charge nurse’s problem- solving abilities and the staff nurse’s negligence.
He reviewed staffing for the next 24 hours and noted that an extra nurse was needed for both the evening and night shifts because of the increased workload. After finding staff, he was able to finish one evaluation before covering for the in-services and lunch and then attending the policy and procedure team meeting.
CHAPTER 4 • LEADING, MANAGING, FOLLOWING 51
Questions about the differences between a clinical nurse specialist and the CNL are also raised. While the CNS is assigned hospital-wide, the CNL is unit based. Ignatius (2010) sug- gests that hospitals are designed for the 19th century with little accommodation for the coordina- tion of care needed in this century. CNLs can help bridge that gap.
Followership: An Essential Component of Leadership Leaders cannot lead without followers in much the same way that instructors need students to teach. Nor is anyone a leader all the time; everyone is a follower as well. Even the hospital CEO follows the board of directors’ instructions.
Followership is interactive and complementary to leadership, and the follower is an active participant in the relationship with the leader. A skilled, self-directed, energetic staff member is an invaluable complement to the leader and to the group. Most leaders welcome active follow- ers; they help leaders accomplish their goals and the team succeed.
Followers are powerful contributors to the relationship with their leaders. Followers can in- fluence leaders in negative ways, as government cover-ups, Medicare fraud, and corporate law- breaking attest. The reverse is also true. Poor managers can undermine good followers by direct and indirect ways, such as criticizing, belittling, or ignoring positive contributions to the team (Arnold & Pulich, 2008). To counter such behaviors, you should note incidents that you experi- ence, enlist others to help, and remain in control of yourself. (See Chapter 21 for more about handling difficult problems, such as bullying.)
Miller (2007) describes followership along two continuums: participative and thinking. Par- ticipation can vary from passive (ineffective follower) to active (successful follower). Thinking can fluctuate between dependent and uncritical to independent and critical. Courage to be active contributors to the team and to the leader characterizes the effective follower.
Followership is fluid in another way. The nurse may be a leader at one moment and become a follower soon afterward. In fact, the ability to move along the continuum of degrees of fol- lowership is a must for successful teamwork. The nurse is a leader with subordinate staff and a follower of the nurse manager, possibly at the same time.