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Gender Issues in Management

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operation room nurses

One of the ways to start taking back power, is to assert yourself. If power is the potential to get someone to do something they don't want to do, assertiveness is the ability to get things done with respect for others and yourself. We all have power; what is crucial for our survival is learning how to use it properly. 

When you use power to threaten, abuse, and push people around, you are being aggressive and you've just become a bully. That's not to say there aren't times when you need to be aggressive, but it's not a good way to be all the time, it's no way to behave as a manager, and besides, most people do not respond well to bullying.   person carrying bomb
When you don't use your power, people walk all over you. There are times when it's okay to bow to someone else's needs or forego your own needs for the greater good of a larger group or purpose, but if you do it all the time, you're being a doormat and you'll hate yourself, and so will most people around you.  marionette with strings
Somewhere in the middle is assertiveness. You use the power you have to get done what needs to be done, with respect for those around you where you can, and with your own boundaries intact.  winner wearing a ribbon

Beware, however, that they don't start calling you "abrasive"! In this article sent to me by former student Julie Bergevin, we discover that women are called abrasive all the time in job reviews but the word is almost never used for men. Read the article here

And here's an exercise that unfortunately is still not yet out of date:
(from Phelps, Stanlee and Nancy Austin (1987) The Assertive Woman: A New Look. San Luis Obispo, California: Impact Publishers).

In a downtown Toronto office, the boss, Mr. Hugo, asks his assistant, 
man wearing pin that says the boss

"On your lunch hour today, would you please return this watch? I bought it for my spouse's birthday but it doesn't suit. And get back early, please; Campbell is coming at two to go over his account, and I have some calculations that have to be done first." 

Three different assistants will respond in three different ways.  
Doris Dormat, in an apologetic voice:
woman cowering behind desk

"Oh, I'm sorry, but I was going to have lunch with a friend I haven't seen in years who's in town just for the day. But I guess I could call her and cancel our plans. Yes, I guess I'll do that. Sure, it's no problem. Where do you want me to go?" 
Agatha Aggressive, in a voice near a shriek: 
woman steaming angry

"You want me to do WHAT? Listen, buddy, you can take that blouse and shove it. That kind of attitude went out with the Seventies, but I guess someone as block-headed and insensitive as you wouldn't have noticed. As far as getting back early, union rules say I'm entitled to an hour for lunch and I'm taking it. Campbell can wait if you're not ready!" 

April Assertive, in a calm, cool voice: 
calm pleasant business woman
"I have made plans with a good friend I haven't seen in years. She's only in town this one day. I know you're worried about being ready for Campbell but I assure you, I'll do the calculations as soon as I return and we will be ready. Returning the blouse is different. I'm not comfortable running your personal errands and I must refuse, but you can always count on me to pitch in with office business." 

waving hand Exercise
Mr. Hugo
Think of an example of when you might have been more assertive in answering a work-related request that should not have been made of you and describe which of these three female employees best represents the way you generally respond to an unfair requests. How could a good manager help Mr. Hugo?
Post your answer in the Moodle  Discussion Group.

An Example of the Use of Assertiveness

Let's say you are a recently appointed VP, the only woman VP in your firm, and you have just found that you are the only VP who does not have an elegant beautifully furnished office.

1. Carry yourself in a manner that indicates you mean business but are not aggressive or emotional
Standing or sitting up straight but not stiff, hands relaxed and quiet rather than fidgeting or pointing, head still rather than bobbing or ducking or staring angrily, a pleasant look on your face rather than an inane smile or angry scowl

2. State exactly and concisely what you want
I want an office equivalent to those of the other Vice Presidents.

3. Where possible, state your request in two equal ways that it can be accomplished
I can either take over the office vacated by Mr. Smith and have it decorated to my style, or we can find me another suitable office on this floor.

4. Stick to the point and keep repeating what you want while showing understanding of the other person's argument (assume here that your supervisor keeps trying to argue why it will be difficult to get you an office):  
"Yes, I understand that it will be difficult to do this by the March meeting, but I want an office equivalent to those of the other Vice Presidents."

"I realize that the budget is always problematic, but I want an office equivalent to those of the other Vice Presidents." 

"I understand that none of the other female employees has an office personally decorated, but I want an office equivalent to those of the other Vice Presidents who have such offices."

5. Get it in writing, in one way or another. If you don't obtain a written agreement right then, write a memo saying something like, 
"My understanding of our discussion today is that I will be moving into the corner office #153, with a budget of $7,000 for redecorating and that the decorators will be here by the first of next month. Unless I hear otherwise from you, I will assume that I will be in my new office before the March Board meeting."

And before you say this is trivial worrying about the office you will work in, read about Lessons From the Military about the importance of trappings of authority.

Another technique that works well to assert your authority is to learn how to "take up more room." Men do it almost by nature. Women usually have to be taught to do it. If as a woman you are not sure (or even if as a man you are not sure) of how this is done, take some time and watch people on the subway, in cafeterias, in classrooms.

waving hand Exercise
Taking Up Room
Describe ways that one actually goes about "taking up more room" and why may it be difficult for some women to do. As a manager, what can you do about people who take up too much room?
Post your answer in the Moodle  Discussion Group.

Some Techniques to remember to increase the authority of anything you say anywhere to anyone:

What you actually have to say
Looking the person directly in the eye
How you stand or sit
Distance from person to whom you are speaking
Gestures and facial expressions
Tone and fluency of your voice - calm, assured, confident
Your timing - know when to speak and when to shut up
Your willingness to listen to them

It's not accidental that the first item in that list is first; if you don't come across as being sure of what you say, it won't much matter what you say. 

waving hand Exercise
Relate an experience when you used one or more of these techniques effectively in a work-related situation or describe an imaginary workplace situation in which a manager would use one.
Post your answer in the Moodle  Discussion Group.

Power issues are a major source of concern in the nursing profession, in the traditional but outmoded model of the "omnipotent surgeon and the subservient nurse" Nurses have long known that asserting yourself often works far better than direct confrontation or aggressive behaviour. Two excerpts from recent articles in nursing journals explore this issue. 

Most Perioperative Nurses Verbally Abused by Physicians
Excerpted from a review of a study on verbal abuse of nurses:
Cook, J, et al., “Exploring the Impact of Physician Verbal Abuse on Perioperative Nurses,” AORN Journal, September 2001, 74 (3): 317-330. Paul McLaughlin (From Canadian Business Magazine)

[The authors] describe the most common types of physician verbal abuse experienced by perioperative nurses, typical responses by nurses, and the importance of hospital policy to help nurses deal with verbal abuse. The study found that 91 percent of the 78 perioperative nurses surveyed had experienced some type of physician verbal abuse…across the past year.

…Some experts link the incidence of verbal abuse with changes in the health care industry, such as mergers, downsizing and reduced staffing levels, which have affected the demand for quality, cost-effective care.
The five most common forms of physician verbal abuse … are abusive anger, condescension, abuse disguised as jokes, ignoring, and blocking and diverting. 
…Many nurses are skilled in using adaptive coping behaviors and problem-focused skills to deal with the abuse, which the authors linked to “the fact that more than 60 percent of the sample reported they received formal communication training, and 43 percent reported they received formal assertiveness training.”

…Nurses found it most effective to put the situation into perspective, ask for assistance or support, try to clarify any misunderstanding, or talk to themselves in a positive way…. nurses most frequently responded to the verbal abuse with the understanding that they were not to blame for the verbally abusive behavior. The nurses indicated that following the incident, they felt that they did not “deserve to be treated” that way, they could “deal with” the situation, and the verbally abusive physician had no right to verbally abuse them (Cook, Green, Topp, AORN Journal, September 2001).

The nurses surveyed said there were long-term negative effects that resulted from an incident or incidents of verbal abuse… primarily centered on the nurse's relationship with the offending physician, job satisfaction, and sense of well-being in the workplace.

Education regarding verbal abuse and the best methods for handling the stress that accompanies it is critical at health care facilities. “Nurses need to know that verbal abuse should not be tolerated and that they have a right to be treated with respect,” the authors write.   book on assertiveness training

The authors urge the adoption of hospital policies that include zero tolerance of verbal abuse, allow for support of the nurse, make the department head responsible for decision making, and require follow-up consultations with both the physician and the nurse. But policies are not enough: “It is important for nurses to realize that they must deal effectively with verbal abuse at the time it occurs.”

waving hand Exercise
Abuse of Nurses
The authors state that it is important to deal effectively with verbal abuse as soon as it happens. How is this also be important for managers in handling a situation involving verbal abuse?   
Post your answer in the Moodle  Discussion Group.  

Cook, J, et al., “Exploring the Impact of Physician Verbal Abuse on Perioperative Nurses,” AORN Journal, September 2001, 74 (3): 317-330.

Examples of Verbal Abuse in Operating Rooms, and Nurses’ Responses

Excerpted from from Espin, Sherry and Lorelei A. Lingard (2001) “Time as a Catalyst for Tension in Nurse-Surgeon Communication,” AORN Journal November (Vol 74, No. 5): 672-79.

Effective communication is critical to the smooth functioning of a multidisciplinary surgical team. The team is a complex system comprising representatives from nursing, surgery, and anaesthesiology – all disciplines with different health care models. An implicit hierarchy governs the team, fuelled in part by stereotypes of the “omnipotent physician” and “subservient nurse.” Team roles are not always articulated clearly or agreed on by team members, making effective communication in the [operating room] a challenge that potentially affects social, administrative, educational, and clinical outcomes.  

male surgeon female nurse

When surgeons and nurses are discussing issues of time … forms of discourse… include stereotypical communications, such as commands (e.g.: “Send for the next patient, please”) and rebukes (e.g.: “This room isn’t turned over yet.”). Non-confirming of stereotypical notions are findings that nurses were more likely than surgeons to use commands… and nurses were almost as likely as surgeons to use rebukes. Other discourse forms included:

Jokes "I think all the patients should be sent for at 8:30 a.m., and then I wouldn’t be kept waiting."
Stories "Last week, my team was really slow, and none of my patients were sent for on time."
Non-Verbal Circulating nurse nods head and picks up the telephone to send for a patient
Silence Although the nurse has heard request, does not acknowledge by verbal or nonverbal response

Interestingly, 47% of nurses regularly use statements (e.g.: “We are closing, so we will need the next patient in 20 minutes”) in communications with surgeons about time. This form of discourse is a rhetorical strategy in team communications. The statement is a useful response for nurses because its neutrality allows the deflection of questions that could potentially cause nurse-surgeon tension surrounding issues of time and domain control:  

Surgeon “Did I hear you say the next patient is cancelled?”
Circulating Nurse “She’s not prepped.”
Surgeon “What if we are out in five minutes?”
Circulating Nurse “I still think she is cancelled. We wouldn’t get to her.” 
Surgeon (angrily) “Well, I don’t know when we’ll be finished. I don’t have control.” 

The nurse’s statement “She’s not prepped” only indirectly answers the attending surgeon’s question, deflecting his inevitable frustration from her role as the individual who sends for patients or cancels procedures. Instead, the issue of patient prepping… is offered as a substitute target for the surgeon’s anger at falling behind schedule. Similarly, the statement “We wouldn’t get to her” followed by the telephone call to the front desk provides a strategic response to the surgeon’s persistent questioning. This neutral statement and use of the term we distributes responsibility for the cancellation fairly. Furthermore, the statement and the telephone call allow the nurse to implicitly make a point that might cause conflict if made explicitly. Her point is that the decision to cancel is based on more than the surgeon’s desire to complete all the scheduled procedures. 

Nurses also were observed employing the strategy of deflection during exchanges with surgeons about another tension-causing issue – temperature control. Here are four examples:

Surgeon “God, it’s hot!”
Nurse “It’s at 55 – that’s as low as it will go.” 
Surgeon “I’m dying in here – can we get the heat turned down please?”
Nurse “I’ll call plant engineering.”
Surgeon “Am I the only one who’s hot? Is this a menopausal thing – you don’t feel it?”
Nurse (soft laughter with no verbal response). 
Surgeon “Well, if we can’t turn it down… I mean, I can’t operate like this.”
Nurse “Maybe a quick break would help.”

Deflection in these instances directs attention away from the budding conflict between surgeon and nurse…This technique, in which the nurse deflects and minimizes the looming conflict often is accompanied by posing alternative solutions. For example, calling plant engineering serves a number of strategic purposes. It can imply a faulty thermostat or other circumstances beyond the nurse’s control and possibly create another target for the surgeon’s ire.

…Nurse responses often directed attention to discursive techniques such as deflecting and suggesting alternative – techniques that maintain a careful balance between supplicant and rebel and between the surgeon’s goals and perceptions and the nurse’s goals and perceptions.  Such techniques are the “nuts and bolts” of constructive conflict management.

A great story of assertiveness, posted by a member of an Internet course I taught: 

Just a Mother ...

A woman named Emily renewing her driver's license at the County Clerk's office was asked by the woman recorder to state her occupation. She hesitated, uncertain how to classify herself. "What I mean is," explained the recorder, "do you have a job, or are you just a .....? "Of course I have a job," snapped Emily. "I'm a mother." "We don't list 'mother' as an occupation... 'housewife' covers it," said the recorder emphatically. 

I forgot all about her story until one day I found myself in the same situation, this time at our own Town Hall. The Clerk was obviously a career woman, poised, efficient, and possessed of a high sounding title like, "Official Interrogator" or "Town Registrar." "What is your occupation?"! he probed. What made me say it, I do not know... The words simply popped out. "I'm a Research Associate in the field of Child Development and Human Relations." The clerk paused, ball-point pen frozen in midair, and looked up as though she had not heard right. I repeated the title slowly, emphasizing the most significant words. Then I stared with wonder as my pronouncement was written in bold, black ink on the official questionnaire. 

"Might I ask," said the clerk with new interest, "just what you do in your field?" Coolly, without any trace of fluster in my voice, I heard myself reply, "I have a continuing program of research, (what mother doesn't), in the laboratory and in the field, (normally I would have said indoors and out). I'm working for my Masters, (the whole darned family), and already have four credits, (all daughters). Of course, the job is one of the most demanding in the humanities, (any mother care to disagree?) and I often work 14 hours a day, (24 is more like it). But the job is more challenging than most run-of- the-mill careers and the rewards are more of a satisfaction rather than just money." There was an increasing note of respect in the clerk's voice as she completed the form, stood up, and personally ushered me to the door. 

As I drove into our driveway, buoyed up by my glamorous new career, I was greeted by my lab assistants - ages 13, 7, and 3. Upstairs I could hear our new experimental model, (a 6 month old baby), in the child- development program, testing out a new vocal pattern. I felt triumphant! I had scored a beat on bureaucracy! And I had gone on the official records as someone more distinguished and indispensable to mankind than "just another mother." Motherhood.....What a glorious career! Especially when there's a title on the door. Does this make grandmothers "Senior Research Associates in the field of Child Development and Human Relations" and great grandmothers Executive Senior Research Associates"? I think so!!! I also think it makes aunts "Associate Research Assistants".

waving hand Exercise
Mothering is one of the toughest management jobs there is, and definitely one that calls for assertiveness. Everyone knows a mother, even if it's not your own or you. Go find one, have a cup of tea, and talk to a mother about the part of her job that involves management. Report back to the group.
Post your answer in the Moodle  Discussion Group.

Finding Your Career Waldo (from Karen Salmansohn)

Assertiveness is based in large part in knowing what you really want out of life. In her wonderful little book that is now out of print, How to Survive in Business Without a Penis, Karen Salmansohn, who used to be an advertising executive putting in 90 hour weeks on Madison Avenue in New York City, tells the story of being at work on a Saturday to get a presentation ready and joking with her colleague there with her that the company's slogan ought to be, "If you can't come in on a Saturday, don't bother coming in on Sunday."

She eventually decided that working 90 hours a week for someone else was not what she really wanted to do, and she encourages others to find out what their real goal is in their professional life. She calls it finding your "Career Waldo" named for the popular puzzles where you have to find the little character Waldo in an incredibly detailed scene. Here, adapted from that book, are some questions to ponder. In each case, you are asked to think of 25 things. This is because it's easy to think of 3 or 5 or 10, but thinking of 25 gets deep down inside you and pulls out things that maybe aren't obvious to you at first thought. 

1. What would you do if you had limited time? If you only had six months left to live, what would you go out and do DIFFERENTLY from what you are doing now? List 25 things.
2. Along the same lines, if you had only limited time left on earth, list 25 things that you would continue to do the same as you are doing now; that is: things you would NOT change
3. What would you do if you had unlimited time? If we had lifetimes of hundreds of years, list 25 things you would do differently from what you are doing now.
4. List 25 things you do for which, when you are doing them, time seems to fly.
5. What would you do if you had unlimited money? List 25 things.
6. What would you do if you were much much braver than you figure you are now? What would you do that would, in your mind, really take more courage than you've felt you've had so far? List 25 things.
7. What would you do if you could have any career in the world? List 25 jobs you would like to have, without worrying about whether you have the qualifications or the time to learn them.

Now go through those lists; set them aside for a day or so, then return to read them again, looking for common threads, for old old themes in your life, for new ideas and things that surprise you.  Look particularly in the last 5 or 6 entries on each list, when you're scraping the bottom of the idea barrel. 

waving hand Exercise
Career Waldo
Report back on some of the things you learned about your work-self while answering the "Finding Career Waldo" questions. One thing I discovered is that given how much I really do want to live by the ocean I realized how much I really do love my job at York University or surely I would have moved to the East Coast long ago. Another thing I found out is that if I had all the time and all the money in the world, I would go back to school again, which makes it make sense that I work in education.
Post your answer in the Moodle  Discussion Group.

Sheryl Sandberg's Book Lean In

waving hand Exercise
Sandberg Assertiveness
How does Sheryl Sandbert's book Lean In help you further understand the topic of this unit?
Post your answer in the Moodle  Discussion Group.


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AP/ADMS/WMST3120 3.0 Gender Issues in Management
York University, Toronto
© M Louise Ripley, M.B.A., Ph.D.