What I Learned About Leadership This Week

(noon. – promoted by ek hornbeck)

When you work night shift at a hospital, you are bound to have a bad week. What I was not expecting to experience was “the moment”, the moment when you have very little time to think or plan.

We had a perfect storm. Normally we have more than one supervisor. I was supposed to work half a shift and take a class in the morning but alas everybody was also sick. I was also sick, that stomach thing going around, but functional. Just tired. When I came in the day shift said,”Houston we have a problem” and laid out all the issues. We all rolled our eyes at one another. Day shift said,”hey man want us to stay a few minutes and make out the schedules for the next day.” I accepted which turned out to be a good idea. They offered which turned out to be critical because as it turned out I wouldn’t have time to do it.

I told myself,”Well, I won’t be bored tonight.” I told the staff I was apologizing in advance that if I did not answer their pages right away it was simply because I was tied up but I would still be available. Eye rolls. They were very busy and I often help them make clinical decisions as well as tactical ones.

At one point I wondered if I had forgot deodorant because I was sweaty and vaguely smelly. I ran all over the place. They ran all over the place. The doctors did not have time to do rounds. They paged me. I paged them.

A brand new patient I had been expecting all night shows up. Patient registration is closed after hours so I have to the general hospital consents and then come back and do more specific consents for treatments. The nurse taking care of them can do some of them but we decided she would be too busy. And the doctor working that night likes me to do them when he works. When you are a nurse and a nursing supervisor you have to know the individual personalities of your docs and manipulate them to get what you want. This guy lets me manipulate him because I saved his ass when he was new. And he knows I like him. I can yell at him and he can yell at me and it isn’t personal. Sorta like we are married except he is gay and I am happily married and I have met his boyfriend who is a fucking saint to put up with him. Work and politics really are about relationships. You need to have a relationship, a real one in order to get things done when things are less than ideal. And how often are the circumstances of creation ideal? Ever?

As I am consenting my new patient who is an ultra cute one with a tired but pleasant mother I get “the phone call”.

“This is XXX, there is a gas and water leak in XXX. The building could blow up. This is not a drill. Evacuate.”

I say to the parent,”My apologies, I have to go.” I walk out to the nurses station and say,”I have to evacuate XXX.” We go to the office so she can grab the emergency plan, it isn’t there, it is being revised. I think *&^%$#@ well, I know what the theory is…. I call the XXX building and say,”prepare for patient and staff evacuation, this is not a drill.”

The health unit coordinator who DOES NOT work in the XXX building follows me through the double doors that connect  the two buildings and we are hit with a profoundly strong smell of gas.

I think to myself: there is very little time. Despite running there is a time gap between my initial phone call my arrival on the scene.

We arrive. I start giving instructions. I explain to the staff and families we must move quickly and efficiently, that this is real. People who hate me and hate one another follow my directions and also offer very good suggestions. I make a quick phone call to my boss with a promise to follow up shortly. I am not thinking. I inform them everybody will move to spot X.

After it appears all humans are out I go back to make sure all humans are out. One of the doctors comes with me even though he shouldn’t and I tell the head of security to get the fuck out of the building because it isn’t any safer for him than it is for anybody else and he can come back in when the fire department says it is alright. The fire department nods in agreement.

During this time the head of health and safety calls me tells me he is on his way and asks me if I want to activate a meeting of the disaster team. I tell him I do not want to do that because it is possible we will have to evacuate everybody else if there is structural damage and fire from building X and at this moment in time I have to find places to put the evacuated patients. Because we still have to deliver care until we determine if further removal is necessary. The doctors tell me who they think are the sickest who need to go to ICU overflow. Boom they go. I decide where everybody else goes, apparently I told my boss in a phone during this time that I am “putting people all over hell’s half acre but they will have a nurse and a space.” I also tell one of the doctors that if we admit any patients in the next two hours when we have no beds I will have issues with him and he and I will have to triage them in the lobby until they can be transported elsewhere. I don’t recall telling him this. I make several phone calls. I argue with a Manager who says she is coming in because ,”I have it under control”, she tells me she is coming in to plan for the rest of the day. A friend who is also a supervisor calls me to tell me she is coming in. Somebody texted her from their iphone.

I touch base with all the nurses and evacuated families to ask if they are alright. I tell everybody what an outstanding job they have done.

Big dogs including my boss arrive.

They want details and a time line. I have since received a phone call that while nobody can enter building X without my permission, the structural damage will not result in a loss of building integrity. I give permission for a few people to retrieve items for families.

I have to meet with the medical director of the hospital. I have never meet him. While I am unable to provide exact time lines I can describe what happened. One of the nurses who is studying to be a doctor jumps in to provide times. He seems satisfied. I tell him,” whatever was done incorrectly is entirely my responsibility, whatever was done correctly is entirely credited to the staff. He tells me not to torment myself. I tell him when one is the night supervisor, somewhere in the job description is the need to torment/be ruthlessly self critical. There are several mini meetings/situational evaluations of the situation and implications for the rest of the day. When we are in shift hand off report there are a crowd of people in our office, one of my doctor buddies drops by because I paged him to ask when he was working again so I could change my hours to avoid bad karma. He comes around to signal we will have a drink in the near future. He has a reputation of being not very helpful but he was. My boss is shocked to hear this because she can’t get him to do anything.

What I learned……

People keep telling me to “take the credit” for outstanding leadership. Some email went out doing that. My boss did to her credit list ever single person who was there to help at my request in the email.

“Taking credit”, is a waste of time. Taking credit is for ego. If you are any kind of half way good leader, the people you supervise are also good leaders and innovative thinkers. If people aren’t developing leadership abilities it is your job as a leader to find what they need in order to reach that.

Being smart is all well and nice but that night I worked with several people who aren’t considered “smart” who did a lovely job. I am also not all that bright compared to many people I work with.

Even unreliable people have the potential to be reliable if you hand them the opportunity to step up. Often we label people as unreliable and then continue to reinforce that by failing to give them new experiences.

Don’t always trust your instincts about others. They are often wrong. Until that night I thought of the head of health and safety as a stick up the ass type who was hard to work with. Turns out being the head of health and safety requires one to be that way. He was pleasant and calm.

You can be fearful and calm at the same time. As I entered the scene, I had visions of an explosion in my head.

Friendship matters. Three of the people who stepped up to do things to assist are friends.

Friendship doesn’t matter. Most of them would cross the street to avoid me outside of work.

Belief systems matter. Before my unexpected event happened at the very start of the night, I took a moment at the beginning of the night to chant for focus. Later there was much discussion about God guiding us. It doesn’t matter as much what you believe in as long as you have some framework. One of the things I am constantly admonished for in evaluations: thinking I am personally responsible for everything that happens at work that leads me to constantly ruminate over errors and what I could have done differently drove the fuck out of me to do what I did and it drove the fuck out of everybody else to act.

Ordinary people are not ordinary. Given the opportunity they will illustrate their abilities if only somebody thinks to do so. In this situation it was circumstance.

People who work night shift are slightly crazy and that is who you want to work with when things are not going well. Slightly weird people can be your best friend.

We chose the right person to be the medical director of our hospital. He acted as if it was perfectly normal to have his ass dragged in to complete controlled chaos at an off hour. Sometimes institutions actually do chose the right people to lead.

I work at the hospital with the best staff in the universe from bottom up.

I have learned I do not want to move higher up in my institution.

I have learned that my ambition to wish to continue to develop my leadership abilities was not a waste of time.

I was very shocked to find out a majority of people I supervise were quote ” not very surprised I was calm in a crisis because I tend to flip out over little things not big things” which has led me to  assess how much more work I have to do in the area of self control. The lesson is that while I thought I had made progress, there is much to be made.

I thought I was a good judge of character and while I am good at “reading” people, actually I am not. I could have never predicted how many people I considered irritating or difficult where not in that situation.

Ultimately, I learned how much more I have to learn. Humans are amazingly complicated, messy, and mysterious. Apparently, the universe decided I needed a timely reminder.