Differences between banning bossy and true leadership in health care

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 it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.

I can 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, but it was meant in a complimentary way. 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 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. In the corporate world the constructs of improvement and success mean profits. The way health care is reforming, with a conglomeration model, it’s a human factory, both on the patient and staff sides of the coin.

There’s no time for real leadership activity when your staff are running themselves into the ground, but 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 is worry about numbers. Scores on every possible measure you could imagine. Patient satisfaction, readmissions, meaningful use, those are only a few of the benchmarks that fly around in the hallowed hallways of the muckety-mucks.

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.

Recently I ran into a former colleague from the hospital. I liked working with him, and he was good at his job. I asked him how things were going, and he replied, “Still hanging in, coming up on 15 years. What else are you gonna do?”

I said, “I got out.” He looked surprised, he obviously didn’t know I left.

“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 downcast face.

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 after surgery. It wasn’t a simple procedure, the surgery took much longer than they had anticipated.

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 tails off, and unable to stay on top of her pain, but she saw other things too.

My friend noted the behavior of some people she felt were milking the system, a family of an elderly person with dementia was 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 profits 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, in the sense of bullying and controlling, 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 excesses of profiteering. I predict we’ll soon be circling the drain.

Insurance companies and health care executives are benefiting, but we have yet to see how much the people who were formerly uninsured benefit. Banning bossy is a lot more complex than the effect of labeling on people’s ambitions. We need to start by banning our love affair with power and greed.

Alene Nitzky is a registered nurse who blogs at Journey to Badwater.

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