I think there is problem with the way nursing management is structured in the U.S. The problem is that nurse managers do not actually work in the units they manage, so they often don’t experience first hand the problems they need to help solve. For example, in our hospital, and in almost all U.S. hospitals, the chief of neonatology takes his turn working in the NICU just like the other neonatologists, rounding and taking night calls. The same is true for the chiefs of other clinical departments. But the nurse manager of our NICU never does a shift alongside the NICU nurses. She never does the same work the other nurses do. Instead, she spends most of her time in the office dealing with scheduling, policy, and other matters.
As a result, I and the other neonatologists know more about her nursing staff than she does. We know which nurses are good and which are not. We have to inform her when they are doing a good job or making mistakes. I’m not sure why nursing management has evolved this way, while physician management has kept the chief doing the same work as the others, but it should change. I think every nurse manager should do at least one shift every week or two simply doing the regular work of a unit.
Don’t get me wrong. Our nurse manager is an excellent person, but the structure of her job is flawed. Also, this is not a diatribe against nursing. Most of our nurses are good, and working with a good nurse is very gratifying, knowing you can trust them to do what is best for the patient, and knowing they’ll probably catch something if you miss it. But this is one instance where I think the medical model is better.