Dear Madeleine,
I am a charge nurse for a large metropolitan hospital. I tend to get the same nurses on my shifts (with some fluctuation, of course) and I get to know my nurses very well.
There is a general sense that the job gets harder every day. This feels accurate due to never-ending budget cuts, understaffing, and constant new rules and regulations. Also, the complexity of delivering care and documenting activities seemingly requires us to learn a new system every five minutes.
As you might guess, it is the most caring and empathetic nurses who suffer more when patients don’t do well.
I have young nurse who is clearly gifted in terms of IQ and communication skills; she connects easily with almost everyone. My issue is that she melts down and calls out sick at the last minute for about one out of every ten shifts.
I have tried to stress that one of the key measures of success here is reliability, but she burns herself out and needs to reset far more than average.
My boss, the nursing administrator, is pressuring me to impose consequences, but I just don’t see how that would do any good. How can I help this nurse protect herself from this cycle? I see a great future for her and want to develop her to be a leader, but this pattern is worrisome. I almost want to ask her to give less, but that seems wrong, too.
Any thoughts on this?
Protective
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Dear Protective,
First: thank you. I have so much respect for all nurses, and am so grateful for what you do. Anyone who has ever needed care or sat with a loved one who did cannot be unaffected by the power of competence and concern among dedicated health care professionals. I appreciate that you want to help your talented young nurse (TYN), and I hope she appreciates your support.
I agree that asking TYN to give less is probably sending the wrong message. Perhaps the answer is to flip that and ask her to take care of herself more. From a practical standpoint, I wonder if you could simply schedule TYN for fewer shifts to accommodate her need to reset. Of course, she would need to admit to herself just how much more time she needs to do that, whereas right now she is hoping—but failing—to be able to keep up with the schedule. Hope is a poor planning tool, whereas reality tends to be friendlier.
As a manager, it can be tricky to get into the details of how your people spend their time away from work and to try to support them to stay focused on activities that feed them instead of demanding more from them. Much as you want to protect TYN from herself, if I’ve learned anything it is that you can’t fix people’s personal lives and you can’t save people. All you can do is offer them support in making whatever changes they need to make to achieve what they want.
You can certainly share the reality of the havoc that her calling out sick at the last minute is wreaking with your shifts. She must know, but maybe is applying a bit of magical thinking. So what next? Telling her what you need might be a next step, although it sounds like you have done that.
What might work is to ask some classic coaching questions that will plant the seeds and get TYN to think about her long-term goals and how she will sustain herself over the long haul. A coaching question is an open-ended question that provokes insight or reflection. The best ones usually start with what or how. Examples that might suit your situation are:
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- What might you do to make each of your shifts a little less draining?
- Is there anyone you work with who might be a role model for doing an amazing job without becoming overly stressed? Would it be useful to ask them how they cope?
- What support could help you build your resilience and sustain your energy over the long haul?
- Given the reality of how draining many shifts in a row can be for you, how might adjusting your schedule ease the intensity?
- How can you take care of yourself between shifts so that you are more able to stay with the schedule you have committed to?
- Is there anything else that might help you?
You can find more on coaching here.
Finally, you can share your perspective on all of her positive attributes: remind her how talented she is, how valued her ability to connect with patients is, how you see her as leadership material, etc. You can point out that so much talent deserves to be properly defended and nurtured and you are doing everything you can on your end. It is clear that you have her back and want the best for her, and it never hurts to tell her.
In the meantime, take care of yourself, too. The world needs you and your people now more than ever.
Love, Madeleine
About Ask Madeleine
Ask Madeleine is a regular Saturday feature for a very select group: well intentioned managers. Leadership is hard—and the more you care, the harder it gets. Join us here each week for insight, resources, and conversation.
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