Discusses how inferiority and superiority ego complexes make the hierarchy unsafe and challenges both nurses and doctors to reflect.
NursesGeneral NursingArticle
Recently on FB there was a lively discussion about this sign that was posted in a waiting room somewhere, it read, "Don't confuse your google search with my medical degree". Some found it funny, some thought it was informational, and I thought it had an obnoxious tone! I googled the message and found all sorts of shirts and coffee mugs proclaiming the same message.
There seems to be something more going on in this proclamation than simply a statement intended to inform or honor one's education. There's an underlying theme of superiority and inferiority going on here and I don't think it has anything to do with education at all! The language is polarizing and flies in the face of respectful communication and collaboration that are so necessary for safe, compassionate care and patient empowerment. I'm not against the hierarchy, but I am against power dynamics that feed our egos.
Discussions about the hierarchy in healthcare can quickly turn into a power struggle. Physicians who have long been at the top of all decision-making are reluctant to share power, nurses face increased accountability in taking more power on, and patients present along the entire spectrum from wanting to be in charge to totally dependent.
Although the old hierarchy makes sense sometimes, (such as during a cardiac arrest with the physician yelling out orders to the team) it has also contributed to ineffective communication and teamwork, poor conduct, and unsafe care. When the hierarchy is toxic these dangerous behaviors are all too common:
Nurses who are afraid to speak up or challenge authority
Physician's who don't know how or when to listen to others' expertise
Patients who withhold information or concerns because they are totally dependent on medical providers.
If we are going to have safe care, healthy workplaces and rewarding careers we need to ask ourselves and each other; What makes the hierarchy healthy? In my opinion we need the hierarchy for clinical decision-making and related use of expertise, but not for egos-driven goals involving power and status.
I'm referring to superiority and inferiority complexes that plague doctors and nurses respectively. Those with more power in the hierarchy falsely believe that they know more about what others need and want and listening is therefore unnecessary. Those on the other end have little faith in the value of their own ideas or observations and hesitate or worse don't speak up.
For the hierarchy to be healthy we need to balance it with collaborative leadership and followership. In such a system, the hierarchy is the structure and the collaboration is the process. The former requires knowledge and skills where the latter requires respectful communication and emotional intelligence. Healthcare professionals must be adept at both. Yes, physicians may lead more often than not and yes the nurses's assistant will follow more often than not, and nurses will be leading and following almost all the time, but we must all be able to do both! And with respect and grace.
Collaborative leaders at all levels are confident and emotionally mature. They use their expertise and authority for optimal clinical outcomes. They are not rattled when challenged by team members and are able to consider new input. If they input shifts care decisions they are grateful and if not they explain their reasoning, making it a teachable moment.
Collaborative leaders understand this dance of being in charge while listening and following as necessary and supporting others so they are able to bring their best to the table. Their egos are in tact and they are using the hierarchy with great wisdom. All the while making healthcare safer.
