10 Things (Part One): Program Management

[Ed: This week we forgo our usual Monday column for a 10 Things guest post from our friend Jen Pierce-Weeks. It’s actually a two-parter, so be sure to check in again tomorrow for the follow-up, which will assuredly be no less thought provoking. And as always, feel free to add your contributions in the comments suggestion–I’m certain some of you have a few words of wisdom on this topic to share.]

Ten Things to Consider in Managing a Clinical Forensic Nursing Program

I should preface this post with my thoughts prior to writing it.  For starters, I personally miss the “Ten Things” section of this web site.  So this is my contribution to its return.  Second, recently I have found myself fielding phone calls, emails and general questions that all point in the direction of program management.  I hope this can be helpful in some way to your own program’s success.

1.  Staff Evaluation of Management

Traditional evaluation of management comes from the top down.  Unfortunately in forensic nursing practice it is often true that the further up the chain you go, the less others know about the work you are doing.  This works fine if you are an accurate self-evaluator, but it tends to be problematic if you are someone unwilling to explore your own shortcomings (and let’s face it, we all have them).  One of the more effective ways to get a sense of yourself as manager is through staff evaluation.  None of us knows how our staff perceives our abilities or our leadership unless we ask them, preferably in a safe environment where they can honestly share their thoughts.  Intimidating though it may seem, who isn’t interested in improving?

2.  Out of Sight, Lose My Mind

The work we do with patients is difficult.  Often we practice alone.  Many forensic nurses are new in the field, which means they require (and want) ongoing support beyond orientation.  When we cannot see our support system, or we perceive we don’t have one, that absence can be easily translated by staff as management not caring about their work, regardless of whether this is true. For new forensic nurses, this can lead to a continual feeling of incompetence and lack of confidence, making it more difficult to keep them on the team (and engaged in our specialty).

3.  Being Accessible. 

This one is tough because as a manager, you don’t want to have a total absence of boundaries, but by the same token, the staff must believe they can come to you.  Indeed newer staff tend to have an extraordinary amount of questions that relate to the proper handling of clinical situations.  Being unavailable, or available strictly on your own timetable, may be perceived by the staff as you not considering them a priority.  And no matter where you work, all staff want to know they are a priority.  They understand that there may be one or two things that trump them, but they at least want to make the top 5.  Worse yet is the perception created that you don’t care about quality patient care, because in most circumstances, if staff are trying to reach you, it is a clinical issue they need answers to.

4.  Can You Hear Me Now?

We have learned about listening skills as a critical component of nursing practice since time immemorial, but when it comes to managing the issues your staff bring to you, listening goes beyond the textbook response of “I hear you.”  Personnel issues may preclude you from being able to provide explicit responses to every problem or concern that is brought to you. However, staff are tracking general changes made in response to their concerns and questions. They need to believe that you hear them, that you value their issues, and that you have a plan for change when one is deemed necessary or appropriate.  When possible, sharing why a change could not be made is also beneficial in maintaining healthy staff-management relations.

5.  The Last Time I Did an Exam?

That’s right, the last time you did an exam actually matters.  In this particular specialty we are both small in numbers and new in our roles.  Typically we are not managing hundreds of forensic nurses in large departments.  That means in order to maintain our own competency, as well as instill confidence of our competency in the staff we manage, we must practice.

6.  In Keeping with 5….

Does your staff see you on the clinical schedule? One of the things we all live with in this work is the relatively constant turnover, which generally means there are inevitable holes in the schedule.  Staff often feel more engaged with their manager and more part of a team when they see the willingness of the manager to also fill the holes staff are often expected to fill.  You don’t need to fill all of them, but a feeling that there is a shared distribution of work to meet the need will create a greater feeling of unity among the entire team.

 7.  Sharing the Vision

One of the key criteria for being a good manager for forensic nurses is your ability to articulate program vision.  How do you see the program now? How can the current program be improved?  Where do you see the program five years from now? Ten?  And what is the path or paths to that goal?  You can have all the management skills in world, but without a vision, you will maintain the status quo, not grow.

8.  Knowing When to Say When

Rest assured, whether you bring management expertise to the table or not, sooner or later, you will hire someone who doesn’t work out. You will, likely more than once, need to actually fire someone who “has the passion” but lacks the critical thinking necessary for the work.  This is not a reflection of you.  Again, this is not a reflection of you.  People interview well and perform poorly.  People think this is the work they want and find out its more than they bargained for.  If you stay in management you eventually have to fire someone. It’s that simple, and interestingly enough, it’s almost always in the best interest of the patients, if not the entire team.

9.  Being Sucked into the Black Hole

How many times have you heard people discussing the warm body approach to schedule coverage? This is not new material.  Not only is it not new to forensic nursing program management, it is not new to nursing generally.  Get drawn into the idea that schedule coverage is the number one program priority and you will find yourself sucked head first down the black hole of ignoring competency issues just to cover call. This results in potentially decreasing the quality of patient care delivered just to see names on a schedule.

10.  You Will Never Be The Sole Solution (I’m Sorry.  Really)

Programs rise and fall on the ability of the entire unit (manager and staff) to agree, agree to disagree, make concessions on things they can, identify things they are unwilling to concede, develop solutions to existing problems, and both individually and as a group be able to articulate their worth to both the institution and the community partners.  And worth always involves what is best for the patients we serve.

Jen Pierce-Weeks