Flickering Gaslights

At my annual performance appraisal this year, my boss told me I struggle with change. I looked at her askance and received no elaboration before my reflex of justification kicked in. I was confused because that is one trait I’ve often been praised for in the past.

Over the intervening weeks, I’ve thought about where that comment came from and I narrowed it down to two things; either folks around here don’t understand me and are too quick to judge, or I’ve changed so much in four years that the me of 2016 wouldn’t recognize the me of today.

A rational person would say it’s a combination of both.

Since graduating college fifteen years ago, I haven’t lived in the same place for more than two years. The jobs I’ve worked have lasted less than that at a stretch. That’s the life of a seasonal employee.

I still take great pride in having lived a fiddle-footed life akin to the drifting cowhands of the late 1800s. Adapting to change is still one of my favorite traits about myself.

So why did my boss say that about me?

Lately, most of the people I’ve worked with are here for a night or two, then rotate through with ten other people. When you work 3 nights a week, that means you work with the same person less than a handful of times every two months. 

When three quarters of those people insist that I change how things are done or laid out in ER to suit them better, I resist that change since they are only going to be there for a couple months at the longest. I don’t see the point of re-engineering everything for short-timers.

It’s easy to see how so many of them have taken that as a sign that I don’t like change.

No one inherently likes change. Change is the arch enemy of survival. Failure to adapt to change leads to extinction. Few places or careers demonstrate this paradigm better than emergency medicine. 

Ongoing research in EMS leads to periodic changes in practice. These changes are studied and reviewed extensively before they are implemented, and there is good reason for that. 

Depending on the extent of the change the allowed margin of error created by the change is minor or extreme. This corresponds to the level of risk each change introduces into the system. Also, there is always a period of transition that further raises this risk.

One way we mitigate this is training on the new procedure or equipment over and over again until it is second nature, more muscle memory than conscious effort, though our conscious mind still has to know what our hands are doing. 

The more variables a person has to consciously remember in a time of stress, the higher that person climbs on the ladder of risk. The higher they climb, the probability of error increases.

This means that implementing random changes “just because” is, in fact, taking unnecessary risks. Things as minor as rearranging equipment without at least communicating these changes increases the risk of error.

In times of stress, such as critical patient care, when your brain isn’t working the best due to adrenaline, you default to your training. That is the model EMS, fire and law enforcement is based off of, and it grew out of the military, which most people would agree that combat is the epitome of operating under critical stress or “under the gun.” 

While I respect nurses, not all nurses are suited to EMS because unless they are critical care nurses, they don’t train with a crisis situation in mind.

The majority of nurses I work with are long-term care nurses and have been for most, if not all of their careers. 

That variety of care most often affords time to extensively analyze a situation. Most of their work involves helping patients through the daily activities of life. Unless a patient, or resident, suffers a stroke or heart attack, their shift isn’t much different from working at Walmart. I know because I’ve worked both.

Why I resist changing the layout of my workspace every month is the last thing I want to do when we receive a patient in full arrest is to waste time tracking down where all the equipment is because someone moved it since my last shift, and didn’t tell me which has happened far too many times in this place. The other reason is those who most want things moved don’t have the EMS mentality and want things put in places that don’t make sense.

If that means I’m resistant to change, fine. I’m doing my job. I’m mitigating what risks I can to make room for the risks I can’t, namely the fact that I work with an entirely new set of staff every week.

After I explained this, my boss’s response was basically that I needed to get along with the travel staff. I have nothing against traveling nurses in general. Some have been fantastic to work with and I’m grateful to them for expanding my understanding and knowledge. 

However, I’ve always taken issue with people who just want to see if they can make others jump through hoops. There have been a few of those too, most of which are permanent staff.

I’ve long known that I’m not a fit for long-term care culture, but that’s not the problem.

The problem is in their inability to accept what makes the two sides in our hospital different. Instead, the standard of long-term care is forced into the EMS setting along with nurses who don’t understand that doing a patient’s nails takes a back seat to getting them to a cath lab to remove a blood clot.

This hospital isn’t alone in that. Many rural hospitals are set up like this, and I’d be curious to know what the correlation is between the attrition rate of employees from the respective departments and management’s background and ability to accept that each type of care is a different animal. That disconnect reflects how I feel management views not just my profession but especially me as an employee.

That comment about my inability to adapt to change also made me question a fundamental part of my identity that I can’t substantiate any other way than as a misunderstanding, a repetitive theme of my time here along with poor communication. I don’t need that and my patients don’t need that. 

After years recovering from the last place that gaslighted me into an identity crisis, I’m finally able to rely on my training without second guessing my actions because someone might not approve and punish me for it. I refuse to let anyone push me that far again, and I know where my skills are needed and will be utilized.

I’ve cast the first die. Now it’s a waiting game, waiting to see what door opens and where it will lead me next.


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