The hospital at which I work is much more than just a building. It is a bureaucratic organization of interrelated statuses and roles stratified upon a hierarchy of authority and power coordinated to provide health care to our community. Most members of the community only see the end result. When they are sick or injured, they come to us and we care for them.
What the community doesn't see or see often is the corporate culture embraced by some elements of the organization. This culture is characterized by all the slap and tickle, buzzwords, and managerial guru crap popular in corporate culture these days. Some at my hospital are completely ga-ga for it.
Take for instance their newest corporate embrace, a program supposedly designed to "hardwire excellence," whatever that means. (Don't ask them, unless you want to be drowned in a sea of corporate cliches, 7 habits, and all those cool folks you're supposed to meet in heaven!)
The program is the infamous source of the low-middle-high performance assessment tool. And what a handy tool it is...for determining not so much the worth of employees as their allegiance to corporate authority and their willingness to agree with and align their own interests with managers and administration, even against their own ethics and best interests.
Fully 75% of the assessment tool in this program is subjective! Questions like, how much does this employee accept and support the decisions of his/her managers? How comfortable do I (the boss) feel when this employee is on shift? What is the attitude of the employee toward his/her workplace, manager, administration?
Now, if ours was a totalitarian organization, I could see where these questions might truly reflect the value of an employee. Or at least ferret out those who need to be eliminated. But, let's be honest, these questions have very little to do with how well an employee does his/her job!
Objective questions could do that, and would be easier to defend as a true performance assessment, while keeping the subjectivity of like and dislike out of it. Why wouldn't a health care organization that wants to provide quality nursing services be more interested in how well nurses perform rather than how well they mouth the words of the corporate line (for they really don't want nurses to say anything)?
One reason is that an assessment tool of objective criteria of nursing performance is harder to devise than one based on subjectivity. You can't really get it out of a guru's book, and I'm not sure that they are smart enough to do it themselves.
A second reason has more to do with the manner in which the subjective assessment tool can strike fear into the workplace of those who have it used capriciously against them (see the most recent two entries). No objective criteria to tell me I'm a bad nurse? Just tell me I have a negative attitude! That's a great reason to fire a good nurse, despite this era of nursing shortages.
Of course, as I mentioned in the last entry, the low-middle-high assessment tool is a one way street: those at the top evaluate those underneath them, and never have to be evaluated by them. That means, the top dog is the one whose attitude and belief system is what everyone else in the organization has to agree with or at least espouse, at least at work. But the top dog isn't the pope, doesn't wear a funny hate, and isn't infallible. Excellence hardwired doesn't seem to account much for that fact.
And, if you're not the top dog, don't go mentioning it; you'll be labeled a low-performer.
Saturday, June 7, 2008
Friday, June 6, 2008
Labor Remembers (For P.R.)
On a more somber note, the same administrative players who attempted to terminate me turned around and did the same number on my boss, the ER director. Oddly enough, one of their complaints about her, what they say made her such a "low performing" manager, was that she failed to leave a paper trail long and deep enough for them to fire me without fear of a wrongful termination lawsuit.
Of course, they didn't say it in so many words.
The fact that both events occurred within the same week and the fact that it was the CNO's last week of employment in the organization suggests to me that both were attempted hatchet jobs. The fact that the CNO chose her last day and her last two hours of work to attempt to discipline my ER boss suggests that she (the CNO), and not my boss, had done her job poorly.
Think about it.
You are the Chief Nursing Officer in an organization, the tallest hog at the RN trough, and yet you tolerate and fail to reprimand two "negative" and "malcontent" nursing employees for almost two years, waiting only until your last week on the job to do anything about their "divisive" behavior? Talk about a bad manager! Low performer, indeed!
But Idaho is a "right-to-work" state (read: right to be fired at will for any reason at all) and so I guess you don't have to be good at managing or administrating in order to fire an employee any time you want to, regardless of whether or not you've followed your own organizational policies (which, in fact, in my case, they didn't). Power seems to be the administrative remedy for lack of competence, finesse, or adherence to organizational rules.
My boss and I took different paths, however. I chose to fight back and keep my job. My boss chose to tell the CEO (for the CNO had already cut and run) to take the job and their evaluation of her and shove 'em.
I respect her for that, and for sticking up for me when she did. Just goes to show, the ethical aren't always the winners, and those at the top who think they've won aren't always ethical, or winners.
In fact, if I had to rate their administrative performance, I'd say they're pretty low performers because they really made a mess out of this. Not only am I still an employee, but now the ER is in shambles for lack of a director. Makes me wonder who is the greater threat to the organization's ability to meet its stated goal of quality and compassionate health care.
Of course, they didn't say it in so many words.
The fact that both events occurred within the same week and the fact that it was the CNO's last week of employment in the organization suggests to me that both were attempted hatchet jobs. The fact that the CNO chose her last day and her last two hours of work to attempt to discipline my ER boss suggests that she (the CNO), and not my boss, had done her job poorly.
Think about it.
You are the Chief Nursing Officer in an organization, the tallest hog at the RN trough, and yet you tolerate and fail to reprimand two "negative" and "malcontent" nursing employees for almost two years, waiting only until your last week on the job to do anything about their "divisive" behavior? Talk about a bad manager! Low performer, indeed!
But Idaho is a "right-to-work" state (read: right to be fired at will for any reason at all) and so I guess you don't have to be good at managing or administrating in order to fire an employee any time you want to, regardless of whether or not you've followed your own organizational policies (which, in fact, in my case, they didn't). Power seems to be the administrative remedy for lack of competence, finesse, or adherence to organizational rules.
My boss and I took different paths, however. I chose to fight back and keep my job. My boss chose to tell the CEO (for the CNO had already cut and run) to take the job and their evaluation of her and shove 'em.
I respect her for that, and for sticking up for me when she did. Just goes to show, the ethical aren't always the winners, and those at the top who think they've won aren't always ethical, or winners.
In fact, if I had to rate their administrative performance, I'd say they're pretty low performers because they really made a mess out of this. Not only am I still an employee, but now the ER is in shambles for lack of a director. Makes me wonder who is the greater threat to the organization's ability to meet its stated goal of quality and compassionate health care.
Sunday, June 1, 2008
Nursing Interventions for Corporate Amnesia
"I am not a critical person by nature."
I said this a lot when I was in graduate school studying sociology. My friends noticed about me a propensity to be hyper-critical when it came to examining the hypocrisy and unfairness of power structures. In saying this about myself, my point was that it is not natural to be so critical...one has to learn the skill. I learned it well.
No longer a social scientist by trade, I have not been able to shake off the critical legacy of those years. Even as a nurse, when faced with bureaucracy, hierarchy, and corporatism, I tend to revert to my sociological underpinnings to reveal the negative aspects of these realities in my workplace.
Others around me--nurses and administration--don't seem to understand this, and I am not sure why. Wouldn't my nursing and my understanding of the organizational context within which I do it be different if I brought to it a different background: literature, law, mortuary science? Of course.
In short, some don't understand why I think about such things. More specifically, administration does not understand why I, as a nurse, think at all.
Recently, I was fired. Ostensibly, the reason for the termination was said to be "insubordination," a euphemism (in my opinion) for having a different opinion.
In fact, the reasons stipulated on the disciplinary action plan that they eventually agreed to after tempting me to voluntarily resign rather than face termination, had more to do with subjective interpretations of my words and attitudes than they do any objective assessment of my nursing skills, performance, or any realistic "threat" I present to the administration or the organization, in general.
Ironically, the overall attitudinal problem they seem to think I have is that of believing the organization is divided into two main groups, nursing staff and administration, and that when problems arise, this division often plays out as a "them versus us" scenario. Ironic because the very concept they accuse me of believing and espousing (at times) is the reality they were using to try to eliminate me as an employee!
As Yosarian said, "That's some catch, that Catch-22!"
Okay. Am I a member of the same bureaucratic organization as they are? Does the same hierarchy of power exist in their world as mine? Does one's position--them on the top, me/us near the bottom--really blind one to an understanding of the nature of authority and the perceived inviolability of command?
What dream world do they live in?
I once heard--and I think E. P. Thompson, the famous English labor historian originally said it--that the real difference between owners and workers, between corporations and labor unions, is that the latter have memory while the former exhibit selective amnesia. In corporate hospital culture, even though in this case it is a non-for-profit corporation, the same is true.
How else to explain how the CEO and CNO can tell me I'm fired one day and then several days later confront me with smiles on their faces, wanting to chat about how things are in my life? If they are just trying to save face, I wonder what sort of face they see in the mirror.
Call it my negative attitude, call it my dark humor, call it my knee-jerk reaction to authority. But don't sweep it under the rug! Challenge me, make me explain myself, TELL ME I'M WRONG!!!
No. It's easier for them to say I'm rude or sarcastic...so much easier than saying I'm mistaken, or wrong, or a bad nurse.
What is the cure for this corporate amnesia? Learn to be critical, learn to be honest, learn to speak truth to power. That's what I've tried to do with my life. I did it when I was a social scientist; I'll do it now as a nurse. For I didn't leave everything behind when I became a nurse.
Wonder why they don't understand this?
I said this a lot when I was in graduate school studying sociology. My friends noticed about me a propensity to be hyper-critical when it came to examining the hypocrisy and unfairness of power structures. In saying this about myself, my point was that it is not natural to be so critical...one has to learn the skill. I learned it well.
No longer a social scientist by trade, I have not been able to shake off the critical legacy of those years. Even as a nurse, when faced with bureaucracy, hierarchy, and corporatism, I tend to revert to my sociological underpinnings to reveal the negative aspects of these realities in my workplace.
Others around me--nurses and administration--don't seem to understand this, and I am not sure why. Wouldn't my nursing and my understanding of the organizational context within which I do it be different if I brought to it a different background: literature, law, mortuary science? Of course.
In short, some don't understand why I think about such things. More specifically, administration does not understand why I, as a nurse, think at all.
Recently, I was fired. Ostensibly, the reason for the termination was said to be "insubordination," a euphemism (in my opinion) for having a different opinion.
In fact, the reasons stipulated on the disciplinary action plan that they eventually agreed to after tempting me to voluntarily resign rather than face termination, had more to do with subjective interpretations of my words and attitudes than they do any objective assessment of my nursing skills, performance, or any realistic "threat" I present to the administration or the organization, in general.
Ironically, the overall attitudinal problem they seem to think I have is that of believing the organization is divided into two main groups, nursing staff and administration, and that when problems arise, this division often plays out as a "them versus us" scenario. Ironic because the very concept they accuse me of believing and espousing (at times) is the reality they were using to try to eliminate me as an employee!
As Yosarian said, "That's some catch, that Catch-22!"
Okay. Am I a member of the same bureaucratic organization as they are? Does the same hierarchy of power exist in their world as mine? Does one's position--them on the top, me/us near the bottom--really blind one to an understanding of the nature of authority and the perceived inviolability of command?
What dream world do they live in?
I once heard--and I think E. P. Thompson, the famous English labor historian originally said it--that the real difference between owners and workers, between corporations and labor unions, is that the latter have memory while the former exhibit selective amnesia. In corporate hospital culture, even though in this case it is a non-for-profit corporation, the same is true.
How else to explain how the CEO and CNO can tell me I'm fired one day and then several days later confront me with smiles on their faces, wanting to chat about how things are in my life? If they are just trying to save face, I wonder what sort of face they see in the mirror.
Call it my negative attitude, call it my dark humor, call it my knee-jerk reaction to authority. But don't sweep it under the rug! Challenge me, make me explain myself, TELL ME I'M WRONG!!!
No. It's easier for them to say I'm rude or sarcastic...so much easier than saying I'm mistaken, or wrong, or a bad nurse.
What is the cure for this corporate amnesia? Learn to be critical, learn to be honest, learn to speak truth to power. That's what I've tried to do with my life. I did it when I was a social scientist; I'll do it now as a nurse. For I didn't leave everything behind when I became a nurse.
Wonder why they don't understand this?
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