"I am a registered nurse and just recently changed jobs due to a bad manager in a clinical setting," says a nurse who works in the cosmetic services field. "There were multiple reasons, but the biggest was that the manger just could not do her job."
And, she notes, she wasn't the only one to leave - two other non-clinical staff members also recently left. "Ultimately, it hurts the patients and the doctor's productivity to have this type of turnover," she says.
Barb Przybylowicz, LPN, has had boss experiences, too, and noted these experiences aren't all bad.
Pzybylowicz is president of SafetyBunns, LLC, in Amherst, OH. She said she's had her share of bad boss experiences over 34 years of nursing.
But, she adds, "Looking back I am grateful for these experiences because that is what made me a great boss as I worked my way from clinical areas of nursing to director."
Of course, few organizations - especially healthcare organizations - don't value the importance of ensuring positive relationships between managers and employees.
Lee Vikre is senior vice president of organizational development and consulting at BestCompaniesAZ in Mesa, AZ. The company focuses on helping other companies that want to build "great place to work" cultures, and specializes in healthcare.
"While managers in general have a significant impact on the workplace, bad bosses have an even stronger effect in healthcare," noted Vikre.
"Nurses have to give of themselves more than most workers, so they need to receive more respect and caring in order to provide the required level of care to patients," she says.
"A good boss cares about his or her direct reports as people. Anything less leads to compassion fatigue and burnout."
Jill Jarufe, MBA, a nursing recruiter with Kaye Bassman International, in the Dallas/Fort Worth area, agrees.
"In my opinion, nurses are a very unique and special group," she says. "Typically, what is most important to nurses and their leaders is having managers who are really focused on patient care and quality." In addition, she said nurses highly value flexibility around their work schedules.
That need for flexibility can be particularly vexing for nurse managers, said Jackie Larson, vice president of client services at Avantas, an Omaha, NE-based labor management consulting and technology company specializing in the healthcare industry.
Larson noted that up to 70 percent of many nurse managers' time can be taken up by scheduling and staffing activities to accommodate absences, both planned and unexpected.
The challenges of managing nursing staff in healthcare environments can be significantly compounded, said Jarufe, by the fact that nurses "by nature, are caregivers so what they look for in their leaders is someone who can be somewhat flexible and sensitive to their personal situations."
Not all are.
What Makes a Boss Bad?
Bad bosses, said Jarufe, are those who demonstrate a lack of flexibility, are insensitive to personal situations, tend to micro-manage and lack the ability to articulate a compelling vision to their staff. The inability to seek and act upon input is also a common trait among ineffective managers, she said.
Healthcare organizations should be concerned about the quality of their management staff for both their employees - and their patients.
"Higher levels of patient satisfaction are found in hospitals with happy nurses," said Vikre.
In addition, noted Asher Adelman, founder and CEO of eBoss Watch, a career resource for evaluating employers and job candidates, "unhappy employees are a lot less productive than happy ones, which negatively impacts the organization."
And, sometimes, they leave.
"That comment that 'people don't leave their jobs, they leave their bosses,' is very true," saids Adelman. "Employers should make sure there's a positive, healthy, respectful work environment."
Unfortunately, bad bosses are everywhere said Roberta Chinsky Matuson, author of Suddenly in Charge (Nicholas Brealey Publishing, 2011), and they come in different versions.
- The indecisive boss who tells you to do one thing, then questions why you're doing exactly what they said to do. "It can be maddening, as you can waste hours trying to please someone who simply can't be pleased," said Chinsky Matuson.
- Bosses who play favorites. "It seems like no matter how great a job you do, the boss's pet will do better. Very demotivating for those who don't make the favored employee list," she noted.
- Micromanagers. "These are the bosses who believe no one can do things the way they can do them."
Good managers represent the flip side of these attributes, said Leigh Steere, co-founder of Managing People Better, LLC, in Boulder, CO.
Attributes of Effective Managers
Good management requires knowing how and when to use two broad skill sets, Steere said. They are:
- relating, which encompasses relationship-building behaviors: asking, listening, including, coaching and encouraging; and
- requiring, which refers to results-oriented activities: creating expectations, focusing on goals, insisting on excellence, setting appropriate controls, asserting your views and confronting problems.
"Bosses are bad when they fail to develop trust with those who report to them," said Vikre. "A lack of trust comes from poor communication - especially poor listening - favoritism and an overall lack of respect. Bosses who don't do what they say they'll do lose credibility. Credibility, fairness and respect add up to trust."
Jarufe added that what makes a boss great is someone who has a collaborative leadership style. "These are true leaders - they're not managers; they really make people want to go the extra mile and they usually also refer their friends to come work with them."
Healthcare organizations with great bosses become magnets for talent, noted Vikre. "Hospitals in small towns, such as Casa Grande Regional Medical Center in Casa Grande, AZ, and the Southern Ohio Medical Center in Portsmouth, OH, have become talent magnets because of their emphasis on creating a great workplace culture," she said.
Bad bosses, particularly in healthcare, noted Vikre, should receive appropriate coaching. But, ultimately, if they are not responsive to this coaching: "They should be shown the door."
Process vs. People
Importantly, noted Larson, people are not always the crux of the problem when it comes to poor management.
Avantas' work with healthcare organizations indicates about 70 percent of nurse managers' time is spent on scheduling and staffing activities, limiting their ability to spend time on critical management issues like coaching and mentoring staff, providing clear and timely feedback, and being the advocate for their departments to doctors and hospital administration, among other key activities.
"One of the things that we say creates bad bosses is the inability to do away with all of the administrative waste," she said.
Another area of negative impact is the inconsistent application of policies across departments that can cause staff dissatisfaction, poor morale and, ultimately, turnover.
Working with organizations on applying technology to accommodate staffing and scheduling needs, and to aid consistency in the application of policies and procedures, has resulted in measurable benefits, said Larson. One customer reported that their managers gained an additional 7 hours per pay period due to gained efficiencies.
Healthcare organizations should take the time to ensure their own processes, policies and procedures aren't contributing to negative work environments. Individuals can have an impact as well.
From an individual perspective, said Jarufe, nurses can help manage the relationship effectively from the very outset.
"When a nurse first goes into a new job, [she should] sit down with the person who she's going to be working for and say, 'these are my expectations-what are yours?' and establish that from the beginning." At the end of the day, Jarufe noted, it's really all about communication.
Lin Grensing-Pophal is a frequent contributor to ADVANCE.