Years ago, I worked as an Intravenous (IV) Therapist at a large teaching hospital in Hartford, Connecticut. Little did I know at the time that I worked in Shangri-La. The patients were well cared for, the employees were happy, and the administration was enlightened. To give you ahint of how progressive they were, not only were we given free meals when we worked on holidays, but we were also given four hours paid time off to go shopping in December.
When my new husband and I moved to Albany, NY in pursuit of his residency training in surgery, I left Shangri-La and landed a job at another large teaching hospital as the Supervisor of the IV Therapy Team. I was excited until my husband came home from a Saturday residents’ meeting and informed me that almost the entire meeting centered on complaints about the IV service: the IV therapists didn’t cover the intensive care wing, they didn’t answer pages on the night shift, and they all had an “attitude.” I had a sinking feeling in my stomach as I entered the door the following Monday, but incurable optimist that I am, I thought I could fix the team, make things better for the patients, the IV therapists and the residents.
Over the first year, I worked on every shift, sometimes covering the IVs and blood draws for the 1,000 bed hospital alone from 11 PM to 7 AM. I observed the day shift was over-staffed, the evening shift was barely covered, and the night shift was under-staffed. When I met with my boss, the head of the laboratory, she told me there was no need to change the staffing pattern; “those people” were making things up and were “lazy.” Granted, I did have to terminate a few people for insubordination and sleeping on the job. Several of them were medical students, the lab manager’s “pets.” But, I knew the majority of my employees were hard-working. I sat down with my team and we came up with a plan to change the lab manager’s mind. It was a simple one. We collected data.
Every day, each IV therapist saved the start and re-start IV slips, the blood draws, the extra work, the side jobs they were asked to do when no one else was on the floor to assist a patient back to bed. At the end of the first week it was clear that our IV starts and re-starts, unseen by the lab manager who only saw the blood test numbers, was equal to, and on some floors greater than the blood draws. When I met with my boss and showed her the results of our data collection, at first she did not believe me. So, I pulled out the box of slips from the nursing stations. Then she believed what I was telling her. My proudest moment was returning to my team to say, “We’ve been given permission to hire more IV therapists for the evening and night shifts.” My employees’ were thrilled and from that point on, they trusted me. Complaints about the IV service disappeared and I was happy in my job, knowing I had really done something good--with data.
Four years later, a friend who worked for the State of New York asked me to consider applying for a job working on a grant with her to study nursing job satisfaction and turnover. I told her I was happy where I was. Things were going great---until the hospital implemented their first ever written employee evaluations. When I sat down with my boss on a Friday, I anticipated praise for turning the IV service around from a nightmare into a dream. What I received was a sandbagging, ending with an overall “Unsatisfactory” rating. Why? The evidence was clear: “Sharon is too friendly with her employees.” That night, I called my friend and asked her if the Research Assistant position was still open. The following week I tendered my letter of resignation, much to the lab manager’s surprise.
Later when I returned to graduate school for my PhD in Health Resources Management, I learned the administrators of Shangri-La used something called, McGregor’s “Theory Y” management (Kopelmen, Prottas, & Davis, 2009; McGregor, 1960 & 1985). In this management model, people want to work and are satisfied with their jobs when they are productive, and the manager’s role is to remove obstacles from employees’ ability to perform their work. The slogan of a Theory Y manager is: “Get off the employees backs and get out of their way!” By contrast, the administrators (for sadly, the lab manager was not alone in her abusiveness) at the upstate New York medical center used “Theory X” management. In that model, all employees are viewed as lazy and unmotivated and must be beaten to work. The slogan of Theory X manager is: “Get on their backs and flog them.”
In a time of nursing and allied health professionals’ shortages and an impending physician shortage, we might think that hospital administrators have gotten on the Theory Y bandwagon. After all, don’t we have excellent recruitment and retention programs, as well as mentors for new nurses? Aren’t hospitals and healthcare organizations acutely aware of how valuable human resources are? The answer is, “It depends.” It depends on the economy, the margins, the budgets, the politics, etc, etc. Looking back over three decades of healthcare professional shortages, recessions, and political tides of change, the bottom line isn’t the bottom line, really. It’s about how we treat our employees. Do we respect them? Ask for their opinions? Value them as team members? If not, remember there are other opportunities awaiting these talented people.
And like me, they may just look back and thank their manager for being a bad boss.
Sharon B. Buchbinder, RN, PhD
Professor & Chair
Department of Health Science
Sharon Buchbinder is an Adjunct Professor of Nursing at Stevenson University in the Graduate and Professional School , and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of two books from Jones & Bartlett: Introduction to Health Care Management and Career Opportunities in Health Care Management.
Here are some references if you are interested in this topic.
Kopelman, R.E., Prottas, D.J., & Davis, A.L. (2008). Douglas McGregor’s Theory X and Y: Toward a construct-valid measure. Journal of Managerial Issues. 20 (2):255-271.
McGregor, D. (1960/1985). The Human Side of Enterprise. New York (NY): McGraw-Hill.