The Status Game is Killing Us. Literally.

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Please read Suzanne Gordon’s recent newsletter article called: Status Trumps Safety!  It is very revealing.  Like her, I am outraged.  As a nurse, I’m not surprised.  Here are two key excerpts, but please take a few moments and read it before considering my thoughts:

This very astute physician told me that SBAR was not used in his medical school because the physicians and residents don’t like it.  Why, I asked?  Because that’s the way the nurses talk.  It’s the formula which nurses are taught to use to suzanne gordoncommunicate information and since we’re physicians and above nurses we don’t want to talk like they do.  (He didn’t say that, but that was clearly what he meant). 

I left his office and, as is my wont, started to reflect.  Actually, I was pretty outraged.  Here is a physician who is really, really smart and who simply asserts that if physicians don’t like something, then no one has to do it.  What he described was the behavior of kindergarteners on the playground. If some of them don’t want to play a certain game because someone they don’t like or value is playing that game, well, neeneenee nee, we won’t play it. 

My thoughts?  What a mess.  A shameful one!  And w/ > 1000 preventable deaths per day in US hospitals?

Status is a fascinating topic.  I think it is inter-related with power and like power, can be useful or very very destructive.  In healthcare, I see how egos inform status and lead to unsafe care, wasted resources, professional burnout etc etc.  And, please, I’m generalizing here to make a point, but fragile egos on the part of both nurses and doctors contribute.  Nurses falsely believe they are inferior and physicians falsely believe they are superior.  WRONG!  If we can get our egos out of the mix, status might find a healthy place in our work.

As a nurse leader, I continue learning how I tend to give away my power in deferring to physicians.  It can be challenging work to practice assertiveness, even now.  I don’t mind stepping into a followership role in clinical situations, but otherwise it is totally unfounded!

It’s another reason to incorporate “Medical Improv” into healthcare education and training. There are many “status” games that can be adapted (Here’s one example).  I had the chance 80px-Power_symbol.svgto co-teach a few activities with Ninad Athale, MD a couple of years ago during a medical improv training.  I’ll save that story for another blog post, but it was a wonderful personal and professional growing experience.  You’ll also find some fun examples of status and improv at the end of the Medical Improv movie!  There is nothing like experiencing high and low status to help people connect with their strengths, build empathy, and use their power wisely.

Of course, as Suzanne so eloquently writes,

In healthcare, with some notable exceptions, the people in charge – of medical school and residency training, of hospitals and hospital systems, of Medicare and Medicaid, of insurance companies, of nursing and other health professional schools – have not said that enough is enough (enough being patient deaths and harm) and instituted programs and maintained them over the long term.  

I guess the question is, “Do ‘we’ want safe care?”.  When that becomes our priority, over egos, over money, that’s when we’ll get on the right track!  I know there are some of you out there that already get this and if I can help as a consultant, I will be honored to!

 

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This entry was posted in Assertiveness, Communication in Healthcare, Complexity in nursing, Holistic Health, Medical Improv, Nurse Leadership, Patient Advocacy, Patient Safety, Teambuilding. Bookmark the permalink.

3 Responses to The Status Game is Killing Us. Literally.

  1. Pingback: Using Status Behaviors Wisely as Clinicians

  2. Brad Myers says:

    Beth,
    This is a great perspective, however I’m not sure that “status” is the correct way to view this dilemma. As healthcare professionals, we all take extreme pride in what we do (caused by the amount of education, experiences, accomplishments, etc. that we each have). However, this sense of pride forces each individual to focus so much on there piece of the patient experience that they forget/undervalue the importance of a holistic view. I have witnessed physicians treat nurses the way this story depicts, while at the same time, I have watched nurses treat therapists in a similar manner, ( I.E. nursing vs. rehab in the skilled nursing setting), or CFOs telling physicians how to treat a patient because of “cost efficiency”. We all play a dynamic role in the patient experience, we just need to be more conscious of the roles and necessity of our peers in the healthcare setting.

    • Beth Boynton, RN, MS says:

      Hi Brad,
      Thanks for your comments. I think your point about status being the right word (or not) is one to consider. The way I’m using it includes elements of power and ego which can be healthy but aren’t always. I didn’t mean to imply that status is an issue solely between nurses and doctors. In fact, the examples you list are very true also. It is like a pecking order! Abusive behavior is more aggressive from people with more power/status and more passive-aggressive with those with lesser power/status. Unhealthy use of power or status is a bad thing and not unusual in healthcare systems.

What are your thoughts?