“I am a Patient Care Manager. Do they even know I exist?”
By Liliane de Vries
It’s a common experience for patient care managers to feel as if they’re trapped in a paradox, exhaustively searching for a compromise to bridge two sides that appear diametrically opposed.
“It’s like we are sandwiched between the two and nobody sees us, except when they need something!”
On one hand, the front-line staff is feeling burned out, overwhelmed and unappreciated with little time to be understood or acknowledged for their tremendous efforts in keeping up with more complex and demanding clients and skills. They are looking to their patient care managers to champion and advocate for a better working environment. “More staff!” is commonly the ask to fix what they perceive as the easy solution. They see their patient care managers as the leaders responsible for their happiness and they as the followers who have no choice.
On the other hand, healthcare is a business. For the patient care manager, their upper management is stressed with the demands to improve efficiency and reduce costs in an ever-changing system. There are constant shifts happening as mergers and change in management occurs. Energy is repeatedly put into new mission statements, new values and new strategic plans. This can take 1-2 years while the patient care managers are trying to hold ‘the fort’ together and perform their jobs with a constant state of uncertainty. They are expected to lead their team, provide a safe environment and deliver stellar care to the patients while remaining on budget. They feel dumped on, not seen and not involved in some crucial decision making, as they see it.
It is not uncommon for a patient care manager to feel responsible to keep both sides happy.
“But how do I do my job and make everyone happy without feeling like I am being pulled from every end? I feel like I am drowning, and nobody even sees me. I feel like I just can’t do this anymore! Do they even know I exist?”
Patient care managers struggle with establishing their power and role within the system. Not being given enough free room to make decisions is another challenge they encounter daily.
Expressing an all-too-common sentiment, a senior nurse said: “I’d like the autonomy to run my service. I don’t need to justify putting staff on a ward. Let me run my business. The flexibility has gone out of the role. Everybody has a say in the running of my department.”
This struggle is a tale as old as time and negatively impacts patient care managers in Canada as well as all over. At Columbia University, researchers surveyed nearly 22,000 full-time workers and discovered that 18% of supervisors/managers reported symptoms of depression.
On top of that, increasing workloads, excruciatingly long shifts, a fast pace, constant demands, and intense work lead to fatigue, burnout, and mistakes. This alarming reality has far-reaching consequences, and in the medical field, it is a recipe for disaster.
Improving conditions for Patient Care Management
Each major problem facing patient care management shares one distinct quality: a lack of understanding surrounding their needs. Fortunately, the resulting stressors can be resolved by introducing more communication between middle management, staff, and upper management. To achieve stronger communication, coaching cultivates fruitful discussions and develops realistic expectations as well as a shared understanding for colleagues across the board.
Listening is pivotal to achieve meaningful communication between team members. We should invite top management to listen to middle managers (who know more about operational issues) and also invite staff to listen to middle managers, so they can better understand their perspective.
The Co-Active Coaching Institute distinguishes among three levels of listening. Level One listening occurs when we are only half-hearing — while in Level Two listening — we are focused on what the other person is saying. However, Level Three listening is what we should aim for. It’s when we not only pick up words but also subtext: body language, inflexions, tone of voice, and hesitations. With Level Three listening, we understand both the intent of the message and what the speaker may be holding back.
We should all strive to achieve Level Three listening when discussing our job issues. The ability to put ourselves in other’s shoes — not just listening but feeling what the other person is feeling — is crucial for a healthy working environment.
At the same time, expressing ourselves clearly is equally as important.
As a nurse myself, I felt that, too many times, I was not specific about my needs. My fellow nurses and I never talked about our needs openly with our managers. Instead, we would just channel our discontent with rolling eyes, confronting responses, and passive-aggressive behaviour.
Patient managers, after setting the philosophy and expectations with the team, must prompt the staff to talk more openly and reflectively about the way they feel — what they would like to change and how they would like to change it. This may need to be done one on one, in small groups or as a larger team. Remember to always begin with appreciative inquiry – reminding each other of what is working well and what we appreciate about each other. This builds trust as we begin to see, hear and acknowledge each other.
We must express the impact actions, words, non-action or lack of communication are having on us. We must clear assumptions.
WE MUST TALK to each other without blame, defensiveness, contempt or stonewalling.
Let’s stop relying on the idea that any one person is responsible for everyone else. We should start behaving like we are solely responsible for ourselves ; not only, but we should all take ownership and be accountable. May I suggest that the patient care manager is responsible to relay that philosophy to their team and upper management and call forth, holding people accountable to the joint success.
Think as a team
Naming what the impact is on the success of the team if some choose to behave with toxic behaviours needs to be voiced.
Getting them involved in how to handle situations when staff is not engaging is vitally important. “How are WE going to deal with…” Furthermore, patient care managers need to remind and encourage everyone to think as a system, rather than only in terms of their own good. “How do WE have control of what will improve our team?” “How does this impact, not only our department, but healthcare as a whole?” Ask them to think bigger than themselves as individuals or even as a team. Make them proud to take ownership of their healthcare system.
Everyone, managers and staff alike, are collectively responsible for finding solutions to improve their overall working environment, and our organisations must be structured with this sentiment as their foundation. Let’s take ownership of that!