Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Saturday, March 22, 2014

On Banning Bossy

It's snowing today and I'm catching up on some of the thoughts that I placed on the back burner all week.

There's been a lot of hype about the "Ban Bossy" campaign in the news lately, and the talk is all over the map. I was thinking about the Ban Bossy campaign in regards to health care, especially nursing, since nurses are notoriously "bossy", or at least referred to as such.

I can even remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, "You nurses are all alike: bossy". He was joking, and it was actually meant in a complimentary way, because he took my idea seriously. But in general, I think the "bossy" label is stuck to nurses like superglue.

Leadership means you help raise all ships. You encourage people to be their best. But the corporate world's aims are at odds with this. Maximizing profits and cutting costs does not encourage people to be their best. Nurses working short-staffed become short-tempered, even if they aren't "bossy" to begin with.

Managers find ways to cut staff, undermining people's efforts and encouraging backstabbing among peers to get people to leave, especially those who might question (threaten) the wisdom of their decisions.

There is a large gap between true leadership and bossy in nursing. There are so few real leaders, who help people to improve. Of course there are always the constructs of improvement or success to contend with. In the corporate world, they mean profits. And the way health care is reforming, with the conglomeration model, it's getting worse. It's a human factory, both on the patients' and staff's sides of the coin.

There's no time for real leadership activity when your staff are out there running themselves into the ground, and when your management duties require you to attend time-consuming meetings for additional propaganda "training", learning how to script your words to obscure the newly merged organization's pursuit of the bottom line despite it's carefully and expensively crafted mission statement.

The other thing management has to do in the new health care model is worry about numbers. Scores on every possible measure you could imagine. Patient satisfaction, readmissions, meaningful use, those are only a few of the newly coined terms that fly around in the hallowed hallways of the muckety-mucks in health care.

Bean counters and consulting firms are the gods, they are prioritized over staff who carry out the drudge work. The most valued players in the organization are the consultants who show shaky-handed executives how to navigate the new world of health care and preserve their well-paid spots backed up by golden parachutes.

You can either stuff your feelings and toe the line or get out. Simple as that. It doesn't matter how good you are with people, or how skilled you are as a leader. Doesn't matter if you're a good nurse with the patients. You have to keep your mouth shut and nod your head.

Yesterday I was in the parking lot of the grocery store and ran into a former colleague from the hospital. I liked working with him, and he was good at his job. He apparently didn't know I left. I asked him how things were going, and he replied, "still hanging in, coming up on 17 years. What else are you gonna do?"

I said, "I got out". He looked surprised, he obviously didn't know.

"What are you doing now?"

I told him about starting my business. It was like someone pulled the curtain back. I could see the amazement in his face, it was something he never even considered for himself. He had resigned himself to being stuck in that job and employer forever, according to his slumped shoulders and lowered head.

An old friend of mine was in the hospital across the country after having a complicated laparoscopic hysterectomy, and they kept her for just 23 hours post-surgery. It wasn't a simple procedure, the surgery took a few hours longer than they had anticipated. Still, they discharged her according to the insurance company's coverage and the original plan.

She was sharing a room with another patient whose behavior was not conducive to my friend's healing. Not only did my friend realize, in her post-anesthesia and poorly controlled pain -induced fog, that the nurses were understaffed and working their butts off, and unable to stay on top of her pain, but she saw other things too.

My friend noted the behavior of some people to milk the system. She noted that the family of an elderly person with dementia were trying to get the doctor to keep the woman there when there was nothing justifying her hospitalization.

The family probably just needed respite, and we don't do a good enough job providing resources for people who are caregivers. As the population ages we need to be able to provide these resources, but the system is busy cranking out dollars and minimizing costs, so the extra care and the services that are less profitable get cut, and people suffer.

When organizations are so focused on profit, bossy becomes the rule. Bossy in the sense of bullying and controlling. It's top down, hierarchical, and domineering. Those with poor people skills get ahead in these organizations. Time will tell how the new health care model pans out for the recipients (dare I say victims?) of it's excesses of profiteering. I predict we'll soon be circling the drain.

I'm not a fan of "Obamacare", because it is truly flawed. I never thought I'd hear myself using the derisive term "Obamacare" but I'm oh so skeptical, and not for the same reasons that conservatives use to bash it.

Insurance companies and health care executives are benefitting, but we have yet to see how much the people who were formerly uninsured benefit. Personally I think we need health care for all in a single payer system.

So in my opinion, banning bossy is a lot more complex than the effect of labeling on people's ambitions. I think we need to start by banning our love affair with power and greed.

That's my $.02.

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