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Pandemic Middle Management: Balancing Patient and Staff Needs

Latoya L. Stewart, MSN, RN

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September 17, 2021

Everyone loves an Oreo until you find yourself being the cream between the executive team and the nurses at the bedside. Depending on your hospital's structure, your title may be director, assistant director, or manager. Whatever your staff calls you, I'm sure you're all too familiar with the feeling of being stuck in the middle.

Each day, you stand before your staff and reiterate the values and expectations of the hospital while being empathetic to the plight of the nurses at the bedside. You receive the brunt on both ends while juggling patient satisfaction and employee satisfaction. Each day you try your hardest to rally the troops to face new challenges while keeping the needs of the hospital administration and overall throughput at the forefront of your mind.

As middle management, you learn to walk the tightrope of what sometimes feels like unbelievably high expectations while keeping a poker face. The internal struggle of doing what's needed and doing what's right can sometimes feel unbearable in healthcare.

Reusable Plastics and Brown Paper Bags

The day my middle management brethren and I stood before our exhausted staff to say we would be moving toward reusing our isolation gowns and N95 masks will forever go down in infamy. The gasps, sighs, and flat-out disbelief that came from our staff may be etched in our minds for a long time.

We couldn't dare tell them we felt the same way. Instead, we listened and tried our best to quell their fears by reiterating the facts given by the CDC and our infection prevention team. I personally took advantage of every opportunity the infection prevention team offered to come and speak with my staff during our daily huddles. As a symbol of partnership, many managers would often be seen going into COVID rooms to offer assistance to their struggling team. These acts weren't done out of direction from upper management but out of our true desire to assist.

Now, I'm well aware of how many bedside nurses feel during COVID, from the anger of reusing personal protective equipment to the growing disdain of pizza, not to mention the love/hate relationship with travel nurses. Healthcare is changing and the new normal is unconventional. As managers, the squeeze of being in the middle is tighter than ever.

The Empty Cup

In no way can I say that I fully understand, or even feel, what a nurse that has been at the bedside during the pandemic feels. As middle management, we were given the directive to improve the morale of our staff. In a sense, we've become unlicensed therapists. But in reality, we are in need of a couch and a thick notepad ourselves. Like so many managers, I have sat with my staff whether in groups or in personal one-on-one sessions where conversations often mimicked that of war veterans. I believe it is safe to say that healthcare is no longer what we knew it to be even 2 years ago.

Many hospitals have taken unusual measures to show their appreciation while some struggle to play catch-up. Some healthcare systems have opted to participate in free food trucks for their staff and increased the availability of therapists. Other healthcare systems struggle and appear to fall short, ending up being torn apart in Instagram nursing groups for giving out a fruit a day.

Nothing, and I mean nothing, has tested the core strength of a manager's leadership skills like the pandemic. The truth is that healthcare needs didn't come to a pause because of the pandemic. We still had to keep the staff up-to-date on their online education, certification renewals, new device training, and last but definitely not least, their vaccination statuses.

Managing from the middle has become more difficult and employee appreciation usually isn't focused on their needs. Though most won't verbalize it, because somehow we've been trained to internalize, there are many managers feeling the effects of pouring from an empty cup.

How have you been handling managing during a pandemic? Please share your experiences in the comments.

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About Latoya L. Stewart
Latoya Stewart is Jamaica-born and New Jersey–raised, this millennial mom of two is navigating her way through middle management while quieting her middle-child syndrome. A graduate of UMDNJ and Rutgers University, she received her bachelor's in journalism, history, and nursing as well as her master's of science in nursing. Like most nurses, she believes she has a heart of gold and the mouth of a drunken sailor. Follow her on Instagram: @mindoftoya

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