My clinical director and I don't get along. The details are not terribly important, and I've been through this sort of conflict before. Most of the problem is that she does not believe, as I do, that those nurses who do not give direct bedside care exist to serve and support those of us that do. Too many managers think of themselves as the head of a police state, spending a lot of time working the nurses over, instead of problem-solving to see why a particular nurse (or group of nurses) is behaving not according to plan. What eventually happens is that the nurses get tired of this, and realize that, with a license to practice as a registered nurse, and especially if willing to work on certain non-specialty floors, a nurse should be able to walk into any hospital HR office and get a job starting immediately.
All this speaks volumes about the national trend that most new-grad nurses are no longer practicing traditional bedside nursing after 5 years. There is data suggesting that half are quitting after just their first year.
Some of these are, obviously, people who did not get a real exposure to inpatient care during their clinical rotations. Their instructors shielded them from the "challenging" patients, opting instead for classic presentation of symptoms in alert and oriented patients. Obviously, some of this makes sense, because we don't want up-coming nurses to get hurt in the learning environment. But some might be too protective.
Another reason why new nurses leave is that nursing truly is as much an art as a science. There are nursing skills, particularly interpersonal skills, that people can't be "trained" to reproduce. I think new graduates might want to excel, and accumulate the knowledge and content information to practice safely, but patients behave in erratic, spontaneous and unexpected ways. The nurse either learns how to deal with these effectively without losing their sense of self, or they get upset by the commotion and go home after work to spend a restless night mulling things over, burning acid holes in their stomach, while contemplating what it would be like to be a school nurse, or parrish nurse, or home health care, or whatever. (By the way, all of these nurses are true nurses, and I don't mean any disrespect.)
Some will decide to go on to management. According to my lifetime (26-year) study, I find that 10% of these will be gifted, and will enhance the working environment, making the job of nursing more pleasant and efficient. 45% of the remainder will be "benign" managers: neither helping nor hurting the effort, pushing the necessary paperwork effectively, keeping nurses rotating through the revolving door. The last 45% are bad managers, and make life miserable for those of us trying to perform bedside care within a hostile and non-supportive environment. These managers are the most dangerous, because they can cause an exodus of nurses, usually of the most experienced nurses, leaving a floor run by mostly new graduates (I'm not knocking them either, you have to start somewhere, and when you do, you can't know it all), Travelers (who require time to accustom themselves to the environment, and who must depend on seasoned nurses to give them a feel for the department's strengths and weaknesses), and Agency nurses (a wild potpourri of well-trained seasoned nurses who enjoy the challenge of working in many environments, vs. nurses that have gotten in trouble at too many local hospitals to get a regular job and rotate around before anyone figures out they are dangerous).
Again, this dynamic fluctiation in staffing will depend almost singularly on the capabilities of your unit director.
I've worked with a few superlative directors, who have taught me a lot about how nurses work, how they are affected by emotional circumstances, and what type of support most nurses need. But I've also worked with some real ho-bags. My advice to you if you are currently working under the administration of a ho-bag:
Consider yourself an employee of the patient, and of your co-workers. Think of the clinical director the way you'd think of the current President. Remember they usually burn out of the position after a few years, especially the ho-bag ones:
Keep impeccable records of interactions with bad directors. Include dates, circumstances, peer witnesses, and any details regarding a lax in patient care. When asked for specific details, at least you'll have something to say.
Many bad directors will use write-ups to try to get you to "step back in line." Many nurses do not enter anything as a personal response. I would suggest you do so, or else it could be assumed you agree with the write-up. Use the opportunity to display shortcomings in the director's ill-made plans, or ways that a situation is unfair.
As much as you can, participate in committees that are composed of more than one department. Keep an eye out for what other departments are going through. Get to know who if any of the other members are clinical directors or charge nurses with influence, and rub elbows with them so they learn your name. Contribute skillfully so that you give the impression of confident effective leadership. Even if you can't attend the meetings due to your personal schedule, find out who is on it, and contribute by writing ideas for your floor rep to bring to the table, or work "behind the scenes" helping get their initiatives through. They will recognize good workers because most of the members are attending for the free food.
Once you have networked properly within your own organization, don't be scared to disregard the chain of command when something important happens that the director is not addressing. Do this after you've made an attempt to work it through with your director, but if you get no response, then someone above her may want to hear your ideas.
Serve your patients and your peers well. Never forget that you are a nurse, with one of the most important responsibilities in the world. Spend a lot of time doing the right things, in the right order (and on the right patient). Be known for being a support system for other nurses. Know what you are talking about, or admit quickly that you don't so everyone can find the answer somewhere else.
In staff meetings, challenge assumptions that seem unrealistic. Yes it will cause conflict, but your director will know she hasn't pulled the screens over everyone's eyes, and you might find you have a lot of supporters in the room waiting for someone to "go first."
When people leave, try to learn why they left and record their responses. This data is crucial when you are talking about a matter that will become the most important one over the next 15 years -- nurse retention.
Be constructive. Not "this won't work" but "this might work better." Try to speak as politically neutral as you can. Give the director some room to negotiate toward your position. If she gets defensive, you can still bring her the cure for Alzheimers and she'll just flush it down the toilet.
If possible, attend professional conferences. Your hospital might pay for this. Also, you will be immersing yourself in an environment that is very pro-nursing. You will feel good. Networking also shows that the grass may be greener elsewhere, or at least the re-assurance that it is not. You may also find that what you need is not greener grass, but different grass.
Create an outlet not involved in work. I suggest blogs and journals because they have a powerful calming effect for me. But most other nurses don't know why I blog, and wouldn't care to start one on their own. But there are other outlets: Internet Newsgroups, Yahoo Groups, Meetup.com, or simply socializing with your co-workers.
Publish what you think. You can do this with your own blog, or by writing/contributing to a newsletter.
Do favors for others whenever you can. This is more the Golden Rule for Nursing. The point here is that humans are always going to need favors, and we tend to remember that we "owe someone" when a favor is granted. It's good to have a bank of favors you can ask in return. Create indebtedness.
OK, back to fighting.