I am a nurse manager for a busy surgical unit that has 4 charge nurses, 40 staff nurses, 8 travel nurses (interim, contract laborers) and 8 support personnel. I have already been meeting with my charge nurses every week (not even knowing what 1/1's were) but now that I've discovered manager-tools, I'm trying to figure out a way to make this work for all my staff. Honestly, I don't see this happening. My staff work extremely variable hours and it's difficult to get face-time with all of them.

Recently, I had an issue arise that had to be reported to the state. After my root cause analysis, part of my action plan was to speak to all personnel face-to-face to discuss the issue, ramifications, cost factor, etc ... Unfortunately, I have been working on this for about three weeks and have still not been able to meet with everyone yet.

I've been coming in early and staying late, as well as, scheduling appointments; however, if a patient is not doing well then I can't pull a staff member from the floor so it has been quite challenging.

Are 1/1's do-able in this type of environment?

cludlow's picture

Anyone with any input?

jhack's picture

My field is quite different, and I'm not sure how to provide guidance.


bug_girl's picture

I have a somewhat similar problem--I'm in different locations different days, so it's hard to schedule one-on-ones.

I think any meeting is better than no meeting; you just may not be able to do it as regularly as you like.

I'm sure there is someone in health care around here, and I definitely remember someone talking about shift workers here earlier. I'd wait for the holiday turkey to wear off before I give up on a response :)

galway's picture

I was involved in the thread about shift work 03s, I'll try to pass on some of the great recommendations that I read there.
The first thing that I took from it is to first clearly define who the direct reports are. I'm not familiar with health care, but you may find that your 4 charge nurses are the best examples of directs that you have. By developing excellent professional relationships with those people, you may be able to help them improve their relationships with their directs (if that's what staff nurses are). The result would be that all 44 nurses benefit and you sacrifice only 2hrs per week. I don't have any experience dealing with support workers or contract employees, but I'm sure that there are others on here who can help.


RobRedmond's picture

Several thoughts come to mind... perhaps I am getting some details wrong so please let me know if I am. I know nothing about health care other than I don't like to need to receive but would be dead without it. So, thanks for what you do, and I hope we do not meet at your office any time soon. :)

* 60 reports is absurd. Drucker says 5 or maybe 6 for the average manager. 14 was the largest team that Drucker had ever observed be successful, and it was a board of directors. It sounds like you have 4 distinct functions amongst your 60 directs. I recommend you break them into teams so that they can find more navigable waters and you will have an opportunity to actually MANAGE as opposed to merely SUPERVISING (article available on Monday, January 19, 2009). If you have the ability, assign team leads to these teams. Break the 40 nurses up into five teams of 8.

* Let those leads have the O3's with those team members.

* Focus your efforts on setting goals for each lead that they achieve by delegating to and directing the work of those on their team.

Are the charge nurses people who can act as leads of teams? Can you put a travel nurse on each of their teams, perhaps? Can a support person be assigned to each team? Can the teams be scheduled to operate together for the most part?

A lot of this depends on how much power you have to sway management to organize your department effectively.

If you have no ability to sway any of this, then meet weekly with some and bi-weekly with others. Reschedule the meetings repeatedly until they finally happen. My environment is pretty tight as well, and we have trouble making O3's, but we almost always make them happen.

Another thing - you should not have to pull someone away from a patient to have an O3. You put attendance on the direct. Let them know what time to be there, and unless someone needs a crash cart or has urgent issues, have them look at their watch and decide to come see you as scheduled.


430jan's picture

Hi, and first of all GOOD FOR YOU!!! I'm a nurse supervisor for public health, so we do not have the shift work issues, but I do have them out in the field all the time. I have 16 nurses I supervise at this point. I was put in charge of 2 offices 20 miles apart with the nursing staff fairly evenly divided. Frankly, I started O3s when I was put in charge of both offices instead of just one. I knew it would be crazy busy, but I also knew that communication would suffer first. Public health nurses are very hard to come by, so I need them all to stay (and we worked hard to weed out the ineffective ones).

I do the O3s every other week. Seems like you need to continue these with your charge nurses, but you also must have them do this with their directs. You can't do everybody. As a nurse, I know that we like to do it all, but if you have charge nurses then you have to manage them and get them to step up and take their leadership role. Get the podcasts on rolling out the trinity and be up front with your people about what you are doing. Then get your charge nurses to be accountable for their people. Nurses love to relate to each other so I think I have found really great success with these once the nurses knew that I really was going to expect them to show up. It was awkward at first, but keep on it!