From Med/Surg to Management — A Path Not Expected

October 13th, 2011

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By , BSN, RN

For some nurses, the goal is to get into management, get off the floors and out of direct patient care as their careers progress. Ann Maguire, BSN, RN is not one of those people. From the day she started nursing school she wanted to do hands-on care; she graduated with the aim of being a floor nurse on an Med/Surg floor, probably one of the most demanding jobs in a hospital. In a matter of weeks, her career trajectory was altered, and now she manages a unit in a specialty she never even considered.

"I finished nursing school in December of 2000 and went to work at Baylor University Medical Center. I had always wanted to be a Med/Surg nurse, but two months after I started work there, it was announced my unit was going to transition to a cardiovascular (CV) unit. I liked the people I had started working with so I decided to stay."

What did that transition entail?

"I had done four weeks of orientation and had been working for four weeks when I went back into orientation for CV, another 13 weeks of training. It was a combined class, CV and ICU nurses, and then we would break off when there were things we didn't need to learn, like CV nurses don't do art lines. We had to learn to identify every heart rhythm and how to interpret them. We had to learn all the CV medications and drips, concentrations, maximum doses, how to titrate the drugs. We had to participate in mock codes and complete ACLS (Advanced Cardiac Life Support). After all the training, I stayed five years."

Did you like being in CV or did you stay just because that's what you knew how to do now?

"It turned out that I really like CV. Where others struggled, it was easy for me. I couldn't understand what was so hard. It seemed for other nurses what they were seeing on the rhythm strips didn't always translate to what was happening in the heart, and there was a struggle to understand how the meds affect those rhythms and symptoms. I can generally detect if there is some kind murmur when others cannot. I think it's really cool, and it makes me want to know what's going on; is it stenosis, is it regurgitation, and from which valves?"

When you moved to another city, did you seek out another CV nursing job?

"When I moved to a new hospital, I found their cardiac unit much less challenging than my time at Baylor. Patients were moved to the ICU for more serious problems, which I had been used to managing before. I think it may have been the difference between working at a big, urban, teaching hospital versus a non-teaching, community hospital. However, while there, I became a team leader for my two-wing unit. I was barely familiar with the policies and procedures when two months after becoming TL they asked me to train for charge nurse. "

That was your first foray into management — what happened next?

"I had been there a while when my manager moved to a new hospital opening a new cardiovascular unit. She called me and asked me to follow her and help set up the new unit, interview potential staff and work with education programs. I came over as a charge nurse.

When we originally opened the doors, the hospital was getting guidance on cost reduction measures. There was one manager over two units and 56 beds. But that really meant being a manager of 140-150 employees. With all the strict reimbursement rules and focus on core quality measures, one manager couldn't keep up with meeting all the measures. The hospital asked if I was interested in taking on the management position in my unit, and I said, "No." I had no desire to be management, never had. In nursing school I used to tell everyone, "I just want to be a Med/Surg nurse and I never want to be management." Anyway, after a few months and still no qualified candidates, the hospital came back to me and asked me to take the manager's job on an interim basis. I've been here ever since."

So, is there anything you really enjoy now about being a manager?

"Having access to the knowledge of how decisions are made. In the past, I just saw change with no rationale for why. It has been very enlightening to see how and why changes are made. I feel I am a good representative for my nurses when these changes are decided. "

What don't you like about being a manager?

"I absolutely hate working Monday-Friday, 8-5. It's a drawback to my life. I know lots of people want that kind of schedule, but since my significant other is retired, I always looked forward to those extra days off each week to spend with him. I hate doing regular weekend things all packed into a two-day weekend. I had never had a traditional job, and it doesn't suit my lifestyle. "

What are your goals for this job?

"I've always been a person who wants to do a good job at whatever I am doing. I want to maintain a strong department, maintain staff. The challenge is keeping up with all the governmental rules. And, I want to work less. I am dedicated to quality and I am still learning, so I don't finish everything in an 8-hour day. I want to get better at that, help others advance in their roles so I can delegate more."

Do you miss being on the floor?

"The other day I wore scrubs instead of street clothes to the hospital. A patient said to me, 'I see you came to work today.' I like to meet the patients. I make patient rounds every day. I also make employee rounds every day. I come in to the hospital each day at 6:30a.m. so that I can see the night shift and address any concerns they have. I want to be accessible, to both the patients and my staff."

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