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"I did not know who was the leader" power move

#1 · June 14, 2023, 11:53 am

Quote from John Freeman on June 14, 2023, 11:53 am
Hello,
the same nurse (Sarah) after we had this emergent situation at the hospital where I was the leader said during the debrief:
Her: I did not know who was the leader
Here she was directly pointing at me as I was the leader in the first place. After I did the initial evaluation and workup (my job) I informed my superior of the situation, which I did. These are situations she must be informed of. And I'm not familiar with this specific one, especially as a leader, so I need her supervision, guidance and her confirming my decisions.
In short in this situation there were 3 leaders: me, my boss and the anaesthesiologist. The latter gave a counter-order to ours, that is he gave an order contradicting ours. The nurse went with his but it was the wrong move which my boss had to correct quickly or the child could have worsen real quick. So life-threatening counter-order. So this is the origin of her confusion and when subordinate feel confused they feel insecure. She has low self-esteem/shame issue (probably coming from an inferiority complex: she has a squint and is probably not ok with it, my analysis). She also felt inadequate as she's not used to emergent situations. So she basically lashed out on the lowest leader on the totem pole she could attack: me.
That was a wrong move as I answered truthfully:
Me: for me as soon as I ask help from the upper echelon, they are the official leader in charge.
That was true. In this situation I redirected her remark to my boss. It was not shifting blame. It was because when my boss came into play I was confirming every order with her (which my resident did not with me). Which is what she did, she was criticising my boss indirectly blaming me instead of having the balls to blame my boss. Also, my boss was in the room with the patient 90% of the time of the situation. So there was a doctor in the room at all times.
Where she was right is that leadership was not totally clear (the resident was also giving orders). However, instead of giving specific feed-back: "when this person told me to do this, it was not clear if this person was in charge or not". This is fair as when there are several doctors, nurses are supposed to follow their orders. Now what happens when their orders are contradictory? Yes. A mess. And that's what happened, hence the debriefing.
However, she chose to blame generally the leaders, creating an "us vs them" frame: executants vs order-givers. The old "nurses vs doctors" frame, which I despise.
My lesson learned: Tell the resident to confirm every order with me in emergent situation so I can confirm with my boss and we have only one leader and respect the chain of command.
Her power move below is also a common one in hospital in emergent situation (teamwork, high stake, fast paced, lots of things happening so prone to confusion)to power move and blame the leader: meaning "you were not doing your job/doing a bad job". It's a tough one to defend from as sometimes it is a good criticism.
Her: I did not know who was the leader
There's another classical one in the hospitals when there's a conflict between two healthcare workers as another example of classical hospital power moves.
Person: what matters the most is the patient
When two people are having a conflict, the first one to pull this one wins. As they go higher and take the "eagle card" so they won by definition as they frame: "I'm not concerned with this petty discussion, for me all along was the higher interest of the patient". Even if they were petty or being a power player in the first place.
I'm happy to read your comments on this.
PS: I now put these power moves in posts so we can discuss them rather in my journal where they will be probably lost. These are common occurrences and worth discussing I believe.

Hello,

the same nurse (Sarah) after we had this emergent situation at the hospital where I was the leader said during the debrief:

Her: I did not know who was the leader

Here she was directly pointing at me as I was the leader in the first place. After I did the initial evaluation and workup (my job) I informed my superior of the situation, which I did. These are situations she must be informed of. And I'm not familiar with this specific one, especially as a leader, so I need her supervision, guidance and her confirming my decisions.

In short in this situation there were 3 leaders: me, my boss and the anaesthesiologist. The latter gave a counter-order to ours, that is he gave an order contradicting ours. The nurse went with his but it was the wrong move which my boss had to correct quickly or the child could have worsen real quick. So life-threatening counter-order. So this is the origin of her confusion and when subordinate feel confused they feel insecure. She has low self-esteem/shame issue (probably coming from an inferiority complex: she has a squint and is probably not ok with it, my analysis). She also felt inadequate as she's not used to emergent situations. So she basically lashed out on the lowest leader on the totem pole she could attack: me.

That was a wrong move as I answered truthfully:

Me: for me as soon as I ask help from the upper echelon, they are the official leader in charge.

That was true. In this situation I redirected her remark to my boss. It was not shifting blame. It was because when my boss came into play I was confirming every order with her (which my resident did not with me). Which is what she did, she was criticising my boss indirectly blaming me instead of having the balls to blame my boss. Also, my boss was in the room with the patient 90% of the time of the situation. So there was a doctor in the room at all times.

Where she was right is that leadership was not totally clear (the resident was also giving orders). However, instead of giving specific feed-back: "when this person told me to do this, it was not clear if this person was in charge or not". This is fair as when there are several doctors, nurses are supposed to follow their orders. Now what happens when their orders are contradictory? Yes. A mess. And that's what happened, hence the debriefing.

However, she chose to blame generally the leaders, creating an "us vs them" frame: executants vs order-givers. The old "nurses vs doctors" frame, which I despise.

My lesson learned: Tell the resident to confirm every order with me in emergent situation so I can confirm with my boss and we have only one leader and respect the chain of command.

Her power move below is also a common one in hospital in emergent situation (teamwork, high stake, fast paced, lots of things happening so prone to confusion)to power move and blame the leader: meaning "you were not doing your job/doing a bad job". It's a tough one to defend from as sometimes it is a good criticism.

Her: I did not know who was the leader

There's another classical one in the hospitals when there's a conflict between two healthcare workers as another example of classical hospital power moves.

Person: what matters the most is the patient

When two people are having a conflict, the first one to pull this one wins. As they go higher and take the "eagle card" so they won by definition as they frame: "I'm not concerned with this petty discussion, for me all along was the higher interest of the patient". Even if they were petty or being a power player in the first place.

I'm happy to read your comments on this.

PS: I now put these power moves in posts so we can discuss them rather in my journal where they will be probably lost. These are common occurrences and worth discussing I believe.