Remote teams offer great talent at the right price, but managing these workers can be tricky. These tips can help.
Location can work against you, whether you are far from a major city, or in a city flush with hospitals, and academic teaching centers.
If your hospital is in a rural area, you've probably fantasized about having a vast candidate pool from which to draw employees. And if you work in an urban area, you've probably struggled to find top talent within your hiring budget—which is a challenging proposition when your candidates are paying big-city rents.
A potential answer to both of these geographical problems is to hire remote workers—making location a non-issue, and allowing for broader applicant pools, cost savings, and greater flexibility in available hours.
As telehealth continues to be adopted by providers large and small, chances are that your organization will launch at least a few remote teams—if they haven't already.
Since 42% of hospitals already offer some sort of telehealth services—a number that doesn't take into account other remote workers, including patient relations staff, collections teams, triage nurses and other remote employees, you'll certainly be in good company.
But managing workers remotely—especially clinicians—is not easy. Beware these potential pitfalls.
1. Don't Start Too Big
"The best practice is to start small, with a pilot," says Bruce Carothers, vice president of telehealth solutions at AMN Healthcare, a healthcare recruiting firm. "Learn from that, make adjustments, and scale up from there."
Start with one remote team in one department. Learn from each implementation—what do you wish you had done differently? How were you ill-prepared? Was the leadership the right choice? How would you hire if you could do it over again?
Listen closely to managers and other leaders from departments that are going remote. What issues are they hearing about? Have there been patient complaints? Are remote customer service employees delivering the same quality as on-site workers?
Keep in mind is that every implementation and every team will be different. It's vital to coordinate with each team leader at the start of the remote team implementation. Ask what they will need, what their goals are and to watch for fresh problems and concerns as the project unfolds.
2. Build Comradery Promoting coworker relations is tough when the coworkers are miles away from each other. "This is an area telehealth has struggled with," says Carothers. "It's a challenge that has to be overcome."
There are many different ways to bridge the gap between remote workers. A popular option is an employee chat portal where remote workers can ask their peers questions, discuss work-related matters, or even socialize and get to know each other a bit— A sort of virtual water cooler.
Team building exercises aren't only possible remotely, but can also be a lot of fun. Instruct managers to host a brief trivia game at the start of every conference call. The non-work related interests of team members will come out as they find out who the sports fans, movie buffs and music lovers in the group are. This will help build rapport and relationships that are important for any team—but especially a distributed one.
Additionally, services like Skype, FaceTime, and Google Hangouts are all great ways to help employees get to know each other that give a sense of "face-to-face" communication.
3. Don't Get Lost in Translation There will be miscommunications—but you can work to keep them to a bare minimum.
"Make sure the remote [employee's] schedule and availability is clear and understood by all parties," warns Carothers, adding that scheduling mix-ups are a frequent complaint of both hospitals and remote employees.
Another challenge can be caused by lack of body language and facial expressions when reading an email or talking on the phone. Tell managers not to just guess at what the employee said or meant—they need to ask for clarification, additional information, or for the employee to explain what they meant.
At the end of every phone or online conversation, recap what was discussed (which is not a bad idea for in-person conversations as well) to ensure that you're all on the same page.
4. Hire With Care "The local team needs to have trust and confidence in the remote [employees]," advises Carothers. Remote employees should be seasoned veterans in their fields—it's a bit much to ask someone to come up to speed in a new profession remotely.
For some clinicians, a remote role is the last step in a gradual wind-down before retirement. While many remote employees won't be anywhere near retirement age, they should come to a remote role with several years of experience.
Ask potential remote employees how they prioritize tasks and stay organized, about their daily work rituals and how they feel about not physically going to an office or hospital every day.
Remote work isn't for everybody—some employees need the direction of a manager nearby, others need to be surrounded by colleagues to feel satisfied in a job. Make sure potential new hires know what they're getting into—it's better for them to find out it's not their cup of tea now rather than later, after they've realized they're feeling isolated and miserable.
Another important interview step that will help determine preparedness for a remote position: Ask the potential employee to either show you their dedicated workspace during a video interview, or take a picture of it and send it via smartphone or email.
Any serious remote employee should have a home office, or, at very least, an office nook where they can focus on their tasks.
Remote teams can benefit all parties involved, allowing convenience and flexibility to the employee, cost savings and a broader candidate pool to healthcare systems. Just don't forget that, even in this virtual business world, distance can always be an obstacle.
Make employee engagement more than a buzzword by offering tangible, measurable benefits and creating meaningful interactions that really earn employee loyalty.
Free pizza, delivered to nurses' stations. Dessert carts wheeled by C-level executives. Mid-day dance breaks. The HR world is rife with "fun" suggestions for improving team morale and keeping your employees satisfied, engaged, and not actively plotting their escape.
William Beaumont Army Medical Center Labor
and Delivery staff nurses enjoy ice cream in celebration of a record-setting birth rate in August. Source: US Army
Whether these initiatives actually accomplish anything beneficial helpful has long been debated. But there is one measure by which they do seem to be paying off: Higher levels of employee engagement lead to improved HCAHPS scores and those scores translate into improved patient experience.
"You can't do one without the other," says Kevin Gwin, vice president of patient experience and communications at Ardent Health Services, a nationwide provider of hospital and healthcare services. "You just can't generate loyalty among patients without loyalty among your employees."
Patty McKay, senior director of learning and talent development at AMN Healthcare, a staffing, recruitment and HR consulting firm, agrees. "Disengaged employees will often have lower productivity and increased errors in their work products, which can ultimately lead to unwanted turnover," she says. "Additionally, the negative attitude of disengaged employees often has the potential to spread among their peers."
Measuring Happiness Both Gwin and McKay both say their organizations use surveys as metrics to measure the engagement and satisfaction of their employees.
"We do two surveys a year," says Gwin. "We measure employee engagement toward their job and their facility. We ask them about their feelings toward their immediate supervisor and upper management… and we benchmark [based on the responses]."
Ardent Health's surveys are anonymous, identified only by team. Gwin believes that surveys, however, should only be a small piece of the engagement puzzle. The best measure of engagement, he says, is knowing your team, their personalities, and the issues and barriers they are facing.
"People know people in their workgroups. They know who has a good attitude, who is open to feedback. [It's] that intuitive knowing your group." Most managers have a pretty good idea what the survey results are going to look like before they get them, says Gwin—they simply confirm what they already knew or provide further insight into the details of the situation.
Ardent Health also uses Net Promoter Score to measure employee loyalty. The more likely an employee is to recommend working within their organization to a family member or friend, the engaged they probably are.
AMN Healthcare also conducts internal inventories of employee satisfaction, says McKay, including a yearly employee engagement survey "to get a big-picture understanding of employee sentiment," and separate "pulse" surveys every four months. "Company leaders are then required to create tailored action plans based on the resulting data for their respective teams," says McKay.
Meaningful Interactions = Engaged Employees
So, where do employee appreciation events and initiatives fit in to the employee engagement picture?
"I like employee events—we have an opportunity to learn something about each other that's not in a work environment, but in a more social setting," says Gwin. "Because if we get to know each other, and there's some trust there, they're going to really tell me how things are going. They're going to confide in me about a compliance issue, or something that should have been reported anyway, or they're going to let me know how we can help them. That's how you move morale."
In addition to building trust, it's incredibly moving to many employees to have higher-ups recognize them in the hallways or the cafeteria and remember details about them and their families.
Remembering that they have a son who plays football or a daughter who is heading off to college soon, or asking about aging parents are meaningful interactions for hospital leadership to have with employees.
Additionally, says Gwin, the gimmicky stuff—wheeling dessert carts by the desks of the employees or personally delivering pizza—can be very powerful, if leadership involves themselves in the right way.
"When the CEO pushes the ice cream cart around and hands [staff] ice cream, it gives us an opportunity to serve them and to let them know how much we appreciate them. They can actually see us saying the words, looking them in the eye and serving them. I think there's a lot of value in that… any time we have an opportunity where leadership can serve frontline staff, we need to take full advantage of it."
But, adds Gwin, the interaction must be genuine. "It's on us to really believe it. You can't fake this stuff. It's got to be real." But appreciating your employees isn't just about dance breaks or pizza. It's about listening to your staff, caring about their problems, and removing barriers to doing their jobs. Both Gwin and McKay speak of the importance of ensuring employees have competitive pay, benefits, paid time off and opportunities for advancement.
If you choose to use surveys to measure employee engagement within your organization, it is paramount that you use them to find what obstacles your employees face daily. Is their equipment modern? Does it work? Does their supervisor have a positive attitude, and is he or she fair? This is an opportunity for honest feedback you won't get every day, so use it to its full potential.
"I love the gimmicks, but I don't want to just do the gimmicks," says Gwin. "We need to be available to them when they've got a problem. Employees want to know—how are you going to support me when I have an issue?"
Working around supplier allocations has become a regular part of the job for pharmacists in hospitals and there's no end in sight to the fluids shortage
As flu season looms, materials management and pharmacy teams are anxiously watching their IV fluid supplies. Despite hopes that the months-long saline solution shortage would clear up over the summer, the situation has not improved and there are indications that it has worsened.
"The [saline shortage] has not resolved, and has actually expanded into other IV solutions, including lactated ringers solution, which is almost universally used during surgical procedures," says David Jaspan, RPh, director of pharmacy and materials management at Union Hospital of Cecil County in Elkton, MD. He estimates that three out of every four patients require IV solutions of some sort during their hospital stay.
"Additionally, we have recently seen that sterile irrigation solutions, also used in surgical procedures, have been affected," Jaspan says. "Today, we ran out of available saline solution. We get our delivery of saline and other IV fluids on Thursday, and today is Tuesday. When this happens, we have to find alternatives."
Finding alternatives has become a typical part of Jaspan's week. Toward the end of the week, "we find ourselves struggling to manage with what we have. We ask physicians to use different IV solutions. Often [we compound] dextrose and half normal solution [in our pharmacy]," he explains.
"It's been a very challenging market," agrees Ron Hartmann, senior vice president of pharmacy with MedAssets, a healthcare performance improvement consultancy. "Things started to get tight toward the end of last year. It really has persisted throughout the year."
It's not just saline solution that's in short supply. Hartmann says peritoneal dialysis solution is also scarce—which means some organizations have to perform kidney dialysis with other irrigation solutions, exacerbating spot shortages of versatile solutions.
He notes that the three US manufacturers of IV fluids, BBraun, Hospira and Baxter all have their existing clients on allocation. Union hospital has been put on an allocation by its IV supplier. It "provides us only about 50% of our normal monthly utilization," says Jaspan.
"Every IV fluid manufacturer has their fluids on allocation. That's been ongoing since the first quarter of the year," confirms Gary Freeman, vice president of pharmacy atAmerinet, a group purchasing organization. Asked how many hospitals are affected by the shortage, he replied, "all of them."
Increased Demand, Increased Costs "[Our former supplier] wanted to give us a $200,000 price increase [yearly] for saline solution alone. That's for a 125-bed hospital. It would have been 300% increase in price," says Jaspan. His hospital opted to switch to a different supplier, which allowed the hospital to maintain its costs close to previous levels.
But many organizations have not been so lucky.
While Hartmann says the typical price increase for IV fluids is between 40% and 50%, some hospitals and healthcare systems are paying double what they used to for saline. Additionally, manufacturers have been turning away new customers, leaving them at the mercy of their current supplier.
"People should be aware of that if they are interested in exploring options, the current dynamics may not support it," he says.
While the FDA maintains that the shortages should end in the first quarter of 2015, few veteran clinicians are confident that is the case, especially since the FDA's permission to import saline from European manufacturers will expire at the end of December, and there continue to be setbacks in fluid production stateside.
"[Sterile irrigation products] are starting to go into shortage," says Freeman. "There was a recall… in the last couple weeks which has affected the irrigation solutions…. these shortages could get very bad during the winter—that's when this all started…. I don't foresee [the allocation] changing any time soon."
"Now," he says, "people are gearing up for the coming winter and flu season. But I can't say people are stocking up, because there isn't much to stock up with."
Jaspan shares Freeman's concern. "The continuation of allocation means we are running out of IV solutions at the end of each week, every week. Each week, the end of the week will get more difficult—until this constant limit of available product ends," he says.
Mergers and acquisitions can be anxiety-provoking for leadership and staff. Here are four common mistakes to avoid while overseeing these strategic transitions.
Steve Gelineau
Senior VP of Camden Group
Ok, I'll say it: No one enjoys mergers. They're anxiety inducing, morale-busting and likely to cause high turnover. But they're also a necessary evil. In a 2012 survey, three out of four hospitals said they were considering a merger or acquisition deal, often in an effort to keep healthcare affordable, be better prepared to approach new healthcare regulations, or to improve quality of care for patients.
Many organizations report that growth and partnerships are simply the best way to survive and thrive in a post-PPACA market, and the deals keep coming.
But there's a right way to go about these things and HR leaders are in a unique position to help make the most of a merger, or to put their people through the proverbial grinder.
Steve Gelineau, senior vice president at the Camden Group, specializes in overseeing mergers and acquisitions in the healthcare space. Over time, he's seen plenty of mergers administered smoothly—and has seen plenty of mistakes. He shared merger survival tips with me last month. Today he cautions HR leaders to watch out for four things.
1. Don't Assume Your Employees Don't Know What's Going On
No matter how remote or isolated your facility is, chances are that your employees read trade publications, attended conferences, and interact with peers at other organizations about the current state of the industry. They probably won't be as surprised to hear about an upcoming merger or acquisition as you might expect, says Gelineau.
"There's been significant growth in acceptance with employees around these things. They're better informed than they were 20 years ago," he says. Chances are, they have likely experienced a merger or acquisition before, know someone who has, or have seen one coming.
Treat your employees like adults and be prepared to answer some questions. Employees won't blindly trust HR or hospital leadership like they might have done in bygone days, so have real answers ready for their toughest inquiries.
2. Don't Misrepresent the Reality of the Situation
"It is an enormous mistake to say something like, 'nobody is going to lose their job,'" cautions Gelineau. This sets employees up with unrealistic expectations, and, when someone inevitably does leave—even if they coincidentally happen to retire at this time or are let go for completely unrelated reasons—the rumor mill will churn.
"It doesn't matter how they occur, whether through normal attrition, retirements, et cetera—if there are going to be reductions, don't misrepresent the reality of the situation. Say instead: 'we will do everything we can to minimize turnover or layoffs,'" he proposes.
Other promises to avoid include denying that
Changes in management are coming,
Benefits won't change
Hospitals or other facilities in the healthcare system won't close.
In simple terms: Don't make promises you can't keep. And if you don't know if there will be layoffs or other changes, be honest with your employees and tell them that you don't know yet.
3. Don't Hide From Your Employees
The last thing you want to be during this tough time is inaccessible, says Gelineau. Now is not the time to work from home a couple days a week, take a week-long romp through Tuscany or barricade yourself in your office with the door closed.
As an HR leader, it's up to you to set the tone during this change. If you act like a member of the team and make an effort to continually reach out to your employees, they will take notice, and will respond with loyalty, which will help cut down on turnover and improve retention rates.
Make yourself available to employees in all forms during this time. Share your cell and home phone numbers, your email address, and your instant messenger and Twitter handles. Make sure you're around to talk about their concerns, fears, hopes and anxieties. Show up during the late shift, make road trips to satellite offices, and come in on weekends. Make sure employees see that you are in the trenches with them.
4. Don't Ignore the Culture of Either Organization
"Don't assume that culture can be easily managed," warns Gelineau. "Culture is the embodiment of many different things, including managerial styles… the connection between the managers and employees, the connection and respect that exists between physicians and clinical care providers… and the sense of purpose that exists in an organization."
Your organization's culture arose as a result of many different factors, including location, non-or-for-profit status, religious affiliation, the population it serves, and its mission. While many leaders downplay the importance of culture, the numbers disagree. Incompatible cultures are the most commonly cited reason as to why mergers and acquisitions are called off in healthcare.
"Culture clash can be one of the more destructive components in a merger if incorrectly addressed," says Gelineau.
Especially if you are on the acquiring side, don't try to change the culture too quickly, or employees will bristle. It's important to develop a cultural change plan with equal input from members of both organizations.
Additionally, just because the two organizations have similar roots—two non-profits, for example, or have the same religious affiliation—doesn't mean differences won't arise. Be prepared for them.
As Baby Boomers move toward reduced work hours and retirement, it's crucial to attract younger employees to take their places. But to keep them on the job, hiring managers need a few strategic tips.
Lazy. Entitled. Self-absorbed. Obsessed with taking selfies and posting them on social networking sites. These are the stereotypes frequently applied to the millennial generation (currently between the ages of 18 – 33).
But many are actually very conscientious and hard workers—if you can engage them on their terms.
It's no secret that healthcare is aging. One in three physicians is over the age of 50, and one in four is over 60. The average nurse is 47. Ten-thousand baby boomers (those born between 1946 and 1965) retire daily.
It is estimated that millennials will outnumber baby boomers in the workplace by next year. And while younger employees have traditionally developed the skills to fill the gaps as each elder generation moved on, the generation X talent pool just isn't large enough to backfill all the positions that belong to departing boomers. This means that some millennials will leapfrog into senior positions too soon.
These statistics don't have to be scary. "Each [generation] has its unique traits, assets, and needs," says Michelle K. Lee, a consultant with talent search firm Witt/Kieffer, which specializes in placing leadership candidates with both healthcare organizations and startups.
"I find them to be quite engaged and interested in contributing," she told me. "They just have a different approach."
With this changing of the guards, HR departments have to be ready for swift changes, both culturally and procedurally. You're going to have to hire a lot of younger workers to replace the old generation—but that's nothing compared to the challenge of holding on to them.
Unlike previous generations, if millennials don't feel appreciated, they will leave—the average millennial worker spends two years in each job, in contrast to seven years' tenure for boomers and five for Gen Xers (born 1965 to 1984).
So retention-minded HR leaders need to get hip—fast.
1. Allow For Customization
Consider the number of drink options at Starbucks. Not only can you choose from an array of beverages, but you can customize each drink to be exactly the drink you want—from a "skinny" caramel macchiato made with a low-fat caramel sauce to an iced coffee with just the right amount of hazelnut syrup and a splash of soy milk.
While earlier generations have just looked at the menu and made a selection based on which pre-defined option appealed to them most, millennials have spent most of their lives able to customize anything from their headphones to their eyeglassesbackpacks and messenger bags. And most of them see no reason why this shouldn't carry over to their careers as well.
"[Millennials look for] freedom to express themselves in their work. Balancing work is important, but it's just one facet of their lives," explains Lee. "How they are impacting the world around them through their self-expression seems to be another piece of it."
Millennials demand flexibility—89% say they would prefer to choose when and where they work rather than being a traditional nine-to-fiver, and 45% value workplace flexibility more than pay. A whopping 93% of millennials say they want a job where they can be themselves at work, and 79% think they should be able to wear jeans at least some of the time.
The solution is easy. Give them what they want. Maybe it's time to relax a no-visible-tattoos-dress code if you want to attract bright young clinicians. Let the receptionists wear jeans with dressy shoes on Fridays and weekends.
For roles where it's appropriate, let employees work from home occasionally. Of course, every hospital and healthcare organization is different, and the above might not work in your environment—but allowing employees to feel that they're being themselves at work can go a long way toward retention.
2. Encourage Diversity and an Egalitarian Team
Millenials grew up being told that they could be anything they wanted, and that racism, sexism, and homophobia were unacceptable and backward. Diversity, inclusion, and open-mindedness mean something to this generation.
This generation does not appreciate or immediately respect rigid hierarchies or bureaucracy. Working for someone who harbors a closed mind, obsesses over hierarchy, or otherwise thinks like a dinosaur will send most millennials running.
"Retention strategies should be more focused on exposing them to as many opportunities to learn and grow and work in different environments within both diverse cultures and with different team dynamics," urges Lee. "They seem to be comfortable with, and even enjoy change, and take issue with stagnation or the status quo."
Organizations that have strong policies toward workplace diversity will be ahead of the game in retaining millennials. Additionally, team leaders and managers should be urged to encourage employees to share their thoughts and ideas. Millennials want to know that their opinions are respected and appreciated.
3. Feedback, Feedback, Feedback
As a rule of thumb, Millennials want feedback, and they love data-- dashboards, scorecards, and just about anything else that will give them more insight into their performance. They don't just expect a review or two a year—they want a constant flow of information telling them where they stand.
"They still want to know how and where they fit in," says Lee. Most millennials are still fairly new in their roles and want reassurance that they're doing their job right.
However, "the way the feedback is presented is important," says Lee. Don't come down on them in a harsh, authoritarian way—just tell them how they're doing and what they need to improve.
Your retention efforts will be well worth it, says Lee, as millennials are showing promise as employees, and leaders of tomorrow. "Millennials are generally self-assured, yet curious. They tend to be independent thinkers with an eye for improvement [and] how to make things better. Even if the approach is a bit unorthodox."
Social media is a powerful tool for communicating with patients, building your healthcare organization's brand, and extending its reach. This isn't kid stuff, so use care in choosing the best job candidates to fill these roles.
A common misperception among hiring managers and human resources leaders is that social media management is an ideal job for someone new to marketing or public relations, a recent college grad, or even worse—an intern.
Cynthia Floyd Manley
Director of Content Strategy,
Vanderbilt University Medical Center
This kind of thinking leads to bad HR moves according to Cynthia Floyd Manley, director of content strategy at Vanderbilt University Medical Center. "I absolutely don't think you should put an intern or entry level person in charge of your social media," she says. "There's a certain level of experience and news judgment required that is very unusual to find in people fresh out of school."
It is vital, she believes, to hire someone who is ready for a great responsibility and who will take it seriously. Social media jobs require specialized training, experience, and maturity. So before you hire your golf buddy's son who is "on Facebook 24/7" to represent your hospital or healthcare system online, review these tips:
1. Hire For Your Audience A frequent, yet misplaced hope is that recent grads or interns are fully versed in the social media strategies and tactics a health system or hospital needs. The thinking is that these young people have a good understanding of social media and will require little training.
This assumption, however, is based on generational stereotypes. Presuming that a young person is proficient in social media for a specific industry rarely leads to good results. Likewise, presuming that middle-aged or older professionals lack social media proficiency is also a bad call.
There are older professionals who are adept with social media, just as there are twenty-somethings who readily admit that they just don't get it.
A better strategy is to select social media managers who are familiar with your target demographic. "Think about your audience," urges Manley. She says staffing with the target demographic in mind gives teams a good instinct for what would interest the audience.
Additionally, you should hire someone who is passionate and knowledgeable about healthcare—a field in which few recent graduates have much experience.
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2. Don't Underestimate Experience Speaking of experience, you should be looking for someone with a lot of it to fill this role. "Journalism experience, public relations, and community relations experience are all good fits," says Manley, who would also consider a candidate with a marketing background.
The qualified candidate is someone with impeccable writing skills, While there are plenty of so-called "digital natives" who can tweet something like, "OMG, IDC B/C YOLO-- #BFFS4EVER!!" that's not what you're looking for.
Organizations looking to hire for social media positions are entrusting these hires with their brands and giving them the power to alter how the public will perceive their organizations. What's needed is a competent individual who will be able to effectively communicate with the audience in a professional manner that provokes both engagement and interest.
And the hire must be able to react and respond professionally when an angry patient tweets something negative, when tough questions are asked publically, or in emerging situations such as weather- or crime-related crises.
"Social media is so fast-moving" says Manley. "Your social media manager will have to make judgment calls. To effectively do that, they have to understand your industry, its culture, and the political nuances involved, and that requires someone with more experience."
3. Find Motivated Self-Starters Twitter waits for no one. The Internet doesn't close at 5:00 PM on Friday and reopen Monday morning. Whoever you hire should be comfortable with having a job that isn't a traditional nine-to-fiver.
Due to the hours and level of responsibility required, Manley urges hiring managers to recognize the demands of this job require some level of flexibility. "This is a job that can definitely be done remotely—and it can be done from just about anywhere," she says. Ten-hour days suddenly seem less grueling when those hours can be worked from home with a long lunch to break them up.
But flexibility only works if the employee is ready to work and to exercise good judgment without constant direct supervision.
While there are certainly some very responsible recent grads and new workers out there, it might be a bit much to ask someone who is just getting the hang of the business world to manage themselves the majority of the time, work evenings and weekends, and use good judgment in all communications when there's no boss around to ask for pointers.
Those who are ready for that level of responsibility will flourish in an independent environment, says Manley. In other words: Tell your golf buddy you're sorry, but you need someone with several years of work experience to manage your organization's social media, not a Facebook addict.
Male nurses face lots of scrutiny about their career choice. To retain this growing segment of the workforce, challenge your assumptions about male nurses and make sure you're sending the right message.
For years, human resources departments have openly discussed the discrimination and judgment women often face when they step into a traditionally male role, like hospital finance or the C-suite. But what happens when a man takes on a traditionally female role?
That's a reality faced by male nurses—or, as they're colloquially called, murses—on a daily basis.
While most people have grown comfortable with women climbing the corporate ladder, healthcare still has a long way to go when it comes to accepting men who choose a role that is associated with women.
"If you ask kids to draw a nurse, they'll draw a picture of a woman in a skirt with a cap," says Bill Lecher, RN, MS, MBA, NE-BC, president of the American Assembly for Men in Nursing and senior clinical director at Cincinnati Children's Hospital Medical Center.
But in a medical system where cultural competency and diversity are becoming important elements of improved patient outcomes, this has to change. Here are four steps toward creating an environment where nurses of all ethnicities and both genders can flourish.
1. Don't make assumptions regarding career goals or failures
A common assumption about male nurses is that they had planned to be doctors but were unable to gain admission to medical school. While some nurses of both genders began their careers with aspirations of an MD, many simply saw greater appeal in being a nurse. Another stereotype male nurses must contend with is that that they are just looking for an "easy way" into leadership positions.
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As with all careers, the reasons why men go into nursing are diverse. "The reasons I became a nurse really aren't that surprising," says Lecher, who was a construction worker prior to becoming a nurse. "I wanted to work with and help other people."
Some men find their way into the civilian healthcare system after completing military service, where about one-third of all nurses are male. Also, an increasing number of men are drawn to nursing in the recessional economy, says Lecher.
"Healthcare has been more recession-resistant than many industries, and more men entered nursing schools as a result. Fourteen percent of nursing students now are male," he adds. "It's a popular second career."
2. Don't assume the women are playing nice
Nursing is already known as a profession with intense infighting, but some people wrongly assume that, while women bully each other, they'll leave men alone. Not so, says Christopher Kowal, a registered nurse at a New York-based hospital and adjunct nursing professor at American Sentinel University.
"If I [behaved this way], it would be seen as sexual discrimination, but by a female, it is not. … I don't think we address it equally," he says.
Lecher's experiences echo Kowal's. "It's subtle. ... In 2014, you can't say discriminatory remarks about ethnic minorities, but it's 'ok' in healthcare to make snide remarks about men, whether male nurses are in the room or not," Lecher says.
While both Lecher and Kowal are quick to say that most nurses, both male and female, are supportive colleagues, it's important to be aware that female bullying and harassment is often subtle. Many men might not feel they can go to HR or a manager about harassment under these circumstances, especially if they fear being perceived as weak.
"You might or might not say anything about it because you have to live in the environment," adds Lecher.
Bottom line: Bullying will squash your retention efforts and bring down morale among your staff. Don't be afraid to ask people of either gender what's going on.
3. Don't assume male nurses are 'muscle'
"Historically, male nurses were hired to work in higher risk areas, like [the psychiatric ward], critical care, or emergency. It was a purposeful bias—I'd rather have a staff of 20 men if I might have patients who will become aggressive," recounts Kowal, who has also noticed an expectation that male nurses take on manual labor before female nurses do, even when the women present are perfectly capable.
"I am not a large, tall, muscular gentleman. I could work with women who are more muscular than I am, and they could be sitting down at the desk, expecting me to do the heavy lifting."
Some people wonder if men are even compassionate and nurturing enough to be nurses, says Lecher. "Men are incredibly nurturing, but they do it differently," he says, adding that men are more likely to use humor than give someone a hug. For some patients, that might be just the right touch.
As men and women deal with many situations differently, including experiencing pain or losing a spouse, it makes sense to have nurses of both genders on staff. "When people seek healthcare, they want to see people like themselves at the hospital. We've seen that with cultural competency, we get improved patient outcomes. It's reasonable to assume we might see the same sort of thing with gender competency and more men in the nursing workforce," says Lecher.
Additionally, as a pediatric nurse, he's found that it's helpful to have someone on staff who can talk to boys about "boy stuff," and that fathers who come in with their kids sometimes communicate better with a male nurse.
4. Do make diversity a priority
Do your nurse recruiting efforts overlook men? When HR staffers and other representatives go to career fairs, make sure they give men copies of handouts. "Use a verbal invitation," advises Lecher. "Say, 'Hey, we're encouraging male candidates to apply, we're a diverse and inclusive workplace.'
"When hospitals design recruitment materials for nurses, almost all of them use ethnically and racially inclusive pictures. They should do the same for gender-inclusive images," he suggests, along with using gender-neutral language on communications from management and HR materials.
He also suggests creating mentorship programs for male nurses, pairing men with other nurses who have similar career goals, experiences, and interests.
Finally, take a critical look at the wards in your hospital. What is the gender mix like? Make sure that men who want an opportunity to work in a traditionally female-heavy ward, like pediatrics, have that opportunity—and don't allow tolerate sexual discrimination under any circumstances.
"Nursing is about being a caregiver," says Kowal. "It doesn't matter if you're a man or a woman. Nursing is for everybody."
Personality testing is a common tool used to predict a job candidate's potential within a given role—but there are some traits no test can adequately uncover.
It's "utterly meaningless," according to science reporter Joseph Stromberg, who wrote about the MBTI for Vox last month.
Many HR departments depend on personality tests, including the MBTI, to gauge a candidate's ability to sell, his openness to new experiences, leadership potential, or likelihood of fitting into an organization, among other things.
Nick Fabrizio, principal consultant with the Medical Group Management Association, prefers behavioral interviews to personality tests—but not all of his clients agree. "I have two for-profit healthcare system client that use personality testing," he says.
"They use the tests to make hiring decisions. Sometimes, they use them as a first cut, to screen out the first round of applicants after a first interview." He's seen both MBTI and the Big Five Personality Test used in these inventories.
As for what his clients are looking for, "It all depends on the job," he says. "If it's a physician who has to be more sales oriented, they assume introverts might not do as well in that field. But, if they're doing data analysis, that might be a fit."
But there are certain things that standardized personality assessments can't reveal.
1. A Candidate's Impact on Group Dynamics
Anticipating how well a candidate will fit in with a team and get along with coworkers is one of the main reasons for conducting a pre-hire personality test—but that's something these tests can't measure.
But, says Cheryl Oxley, a consultant with the corporate solutions team at Hogan Assessments, the test isn't going to tell you if your new guy is going to get on well with the team. "We do have a measure of social desirability," she says. Specifically, it "measures if someone is responding in a way the majority of the working adult population would."
Hogan offers a multiple-choice employee personality assessment which is used by 60% of Fortune 500 companies and about 20 healthcare systems to assess executives.
So, the test might be able to tell if a subject reacts in ways consistent with the norm, but not if he's going to get along with people.
Another thing these tests won't tell you: whether you're hiring a bully, a sociopath, psychopath, or a narcissist. "We don't get into the world of personality disorders," says Oxley, who adds that the tests also can't uncover propensities toward stealing, addiction, or personal integrity.
2. Whether the Subject Is Having A Bad Day
As if job interviews weren't stressful enough, taking any sort of multiple-choice test can summon unpleasant memories such as flashbacks to high school—especially if people feel they're being judged or "typed." Additionally, test results can be skewed if the subject is having personal problems which may change the way they might normally answer questions.
"When a subject is going through major life events like death, divorce, disease, there can be a dramatic shift in scores," admits Oxley.
Oxley suggests that if the test scores seem counter to what one would expect—especially if the candidate is well-known to the organization—the hiring manager or other person involved in the testing process may be able to discuss it with the candidate.
But a perfectly qualified candidate you've never met before who had an argument with a loved one the night before the test might answer questions such as, "I am a relaxed, easygoing person" or "I never worry about my past mistakes" differently after a stressful confrontation, than on a regular day.
3. The Candidate's Drive and Passion
No test can tell for certain how badly a candidate wants a job, or how badly he wants to succeed.
"The candidate [who received an undesirable score] might not be a poor fit all of the time—they'll just have a harder time getting up to speed or fitting into the company culture. They might experience greater challenges, depending on the organizational need. It doesn't mean they can't do the job… we're dealing with probabilities [of success], not possibilities," Oxley says.
MGMA's Fabrizio is less forgiving of the assessment's shortcomings. "I think a person's track record and their accomplishments are a better indication [of potential success within a role]." If a candidate got to the point where you are considering them, they got there for a reason, he adds—they don't need to take a personality test to show they are inclined to do the job.
These tests give a false sense of security that your incoming employees will fit in, do their jobs well, and be happy in their work. But, if you are properly conducting your interview process, you should already be fairly confident in your choices.
"I always ask organizations that are considering doing this, 'what do you hope to gain from it?' if you do a good job of screening a candidate, doing the reference checks, and using good, behavioral-based interviews, you'll already be way ahead of the game," recommends Fabrizio.
The Food and Drug Administration wants to mine social media for information on adverse reactions to medications, but "listening to random chatter on the Internet," isn't the answer, says one patient advocate.
After more than a decade of ambivalence toward social media, the U.S. Food and Drug Administration is wading into the deeper waters of online communication platforms. In June, the FDA distributed a draft of long-awaited guidelines for industry when using social media.
In late February, the agency quietly announced that it was looking for a contractor to take on the task of listening for adverse drug effects. It wanted to partner with an organization able to monitor social media sites, including Facebook, Twitter, LinkedIn, YouTube, Wikipedia for mentions of key words that would indicate negative side effects or other problems.
But depending on social media data mining for adverse event reports is a long shot, says Steven Nissen, MD, department chair of cardiovascular medicine and patient advocate with the Cleveland Clinic. He believes that monitoring consumer social media posts for adverse reactions will not bring the FDA any meaningful data.
"This is like listening to rumors," Nissen says, pointing out that a herd mentality often takes over online. "Someone tells you something, you tell someone else, it gets repeated as fact," he says, expressing concern that tweets about the negative side effects of a specific drug "bad" could cause widespread misinformation about it.
When the FDA submitted its 'sources sought' notice last February, it described social media as a new opportunity to interact with and educate the general public.
"The FDA is responsible for communicating about the risks and benefits inherent in all the products it regulates. The rise of social media on the Internet… has created new opportunities to interface with the public with respect to emerging hazard situations involving FDA-regulated products.
The increasing presence of social media promises new capabilities to monitor the effectiveness of FDA's ongoing risk communication efforts. FDA is in need of both historical and "real-time" monitoring and analyses of a representative sample of social media web sites."
One early indicators is not especially promising.
A 2013 study by social media monitoring firm Visible Technologies tracked mentions of 224 pharmaceutical brands across 257,000 posts during a 30-day period. In that time, it found that 0.3% of posts contained direct reference to an adverse event experience, and, on average during the reporting period, each pharmaceutical brand received a total of three posts that would meet the FDA's requirements for adverse event reporting.
The General Services Administration has been encouraging government agencies to begin employing social media monitoring and engagement with citizens via social media on a wide scale. Many private businesses have employed social media programs with great success, and some members of the government hope to see that success duplicated in the non-profit sphere.
The FDA, along with other government organizations, may be feeling the pressure to adopt cutting edge technologies.
Social media is trendy and no organization wants to get left out of it, says Nissen. "The FDA is [employing the social media monitoring strategy] just because it's very 'in' right now," he says. "I would never have recommended that the FDA use social media to monitor [adverse effects]."
Additionally, it would be virtually impossible for hospital leadership or medical professionals to participate in this program due to privacy regulations, says Nissen. "Doctors aren't going to be tweeting adverse effects, and the Twitter Generation doesn't take too many drugs yet."
While hospitals and health systems may have some success using social media monitoring technologies to keep up to date on patient concerns, the FDA likely will not find similar success, argues Nissen.
"I am not encouraged by this. Any information they get through these means will be very anecdotal and not very useful. If the FDA wants to get better data about adverse reactions, it will be through improving their current reporting systems, not by listening to random chatter on the Internet."
Given the current trend toward consolidation in healthcare, there's a good chance you'll face the aftermath of a merger or acquisition at some point. What are the best strategies for leading employees through the transition?
While mergers and acquisitions aren't easy for anyone involved, human resources leadership may bear the greatest brunt of all.
"There's a long list of things that healthcare HR departments have to deal with post-merger," says Steven Gelineau, senior vice president at the Camden Group, a healthcare management consulting firm that frequently advises on health system and hospital mergers and acquisitions.
In the chaos of integrating benefits, eliminating redundancies, and negotiating new employment contracts, a topic that is often overlooked is proactively addressing employee concerns rather than responding after the fact.
"Questions, concerns, and anxieties of employees will arise early on," says Gelineau. You will likely find yourself fielding questions about changes in management, job security, and company culture. As an HR leader, you set the tone for the organization. Management will be taking cues from you, and you can expect to answer lots of questions."
Human resources should be a key partner in helping to ease the human side of the transition, suggests Gelineau. "I think one of the realities of many mergers is that the HR aspects … are oftentimes considered far, far too late in the ramp-up to the affiliation."
Here are three top strategies for HR leadership during the post-merger transitional period—applicable to both acquiring and acquired organizations.
Be visible and accessible
"Be there for individual meetings, informal gatherings, expressions of concern, formal gatherings, at all times of the day, at all times of the week," says Gelineau. "Do that for an extended period of time, until the two organizations are fully merged."
Even if you usually work from nine to five on Monday through Friday, come in early or late and on the weekends talk to shift employees. Have coffee and donuts delivered to the overnight workers and ask them to join you for a break.
Many health systems have multiple facilities; be sure to visit each one in person. Let them know ahead of time you're coming—this isn't a surprise inspection or a pop quiz. Make sure everyone sees you and knows that you're there to address questions and concerns confidentially.
Don't let the rumor mill churn unchecked
After a merger, the rumors will fly like birds. While you must be realistic regarding management's ability to control gossip, it's also important to address rumors when they crop up.
Monitor employee intranets, bulletin boards, and online communities for rumors of layoffs, changes in policy, management shifts, and so on. Don't be afraid to address misinformation. "Put forth the real message … be engaged in these conversations, address employee questions and concerns," Gelineau says. Let employees you catch gossiping at the water cooler—real or virtual—know that you understand their concerns but that they can't trust information they hear through unofficial channels.
After a few days or weeks, you'll notice which rumors you hear most frequently. In response, Gelineau suggests making a list of frequently asked questions and either posting it on an employee social network or sending it to employees in an email.
Include social media in your campaign. "Any HR executive worth their salt today must be cognizant of the presence of social media and how these communications tools can support a strong rumor mill," warns Gelineau. "Ignoring social media is done at the peril of the organization. There has to be a very deliberate strategy."
On a related note, be aware that emails, instant messages, and memos are easily uploaded to social media and shared publicly. If you don't want something on the front page of your local paper, don't put it in writing.
Communicate proactively
Now is not the time to sit back and leave employees wondering about where they stand. "Don't speak in legalese," urges Gelineau. Explain tough topics like reasons for layoffs or changes in benefits and management in plain English.
Now is also a good time to let your top employees know they're valued.
"What all merging organizations need to guard against is the loss of their best people," cautions Gelineau. Instability is a daunting prospect and your most valuable players will likely find it easy to move to another organization if they are uncertain about their current employer.
"Have a sit-down with them and tell them, "We're growing a new organization and there's a place for you in within it. You are valued here. We want you to contribute to our growth going forward," Gelineau suggests.
The most important thing is that you listen closely to what employees are telling you. It doesn't matter if you hear it from a janitor or the CEO, if it's an anonymous tip left in a comment box or it was a question asked in a town-hall style meeting—all messages are important, Gelineau concludes. "Pay attention to all avenues and conduits of communication. Don't discount any of them."