By Matt Skoufalos
Many children imagine future careers in medicine, law enforcement, paleontology, even space exploration. Linnette Johnson grew up wanting to be a nun.
“My hero was Mother Theresa,” Johnson said. “She loved all people, no matter where they were in life. As a child, I recognized that she had so much compassion and so much love.
“The problem was I wanted about six kids,” she said.
When Johnson’s parents broke the news to her that Catholic nuns take a vow of celibacy, the devout six-year-old decided that she would be a nurse instead. Her reasoning: nurses “take care of God’s people, they love God’s people, and doctors are like priests,” she recalled.
Today Johnson can reflect on a career that has brought both of her priorities into focus: she is the Assistant Vice-President for Surgical Services at the 1,200-bed Florida Hospital Orlando as well as a mother of four. At the time she began her career, however, Johnson recalls the doctors alongside which she worked as emphasizing her latter qualifications over the former.
A native Ocalan, Johnson got her first nursing job in the late 1990s, when there was not the shortage of staff that has since emerged. Nurses were expected to pay their dues in convalescent care before graduating to a hospital setting, and it was a testament to her capability that she was hired into a 34-bed, post-operative surgical unit without having had to travel that route. By far the youngest nurse on the unit, Johnson recalls stepping into an environment of “very mixed emotions,” where nurses were expected to yield their seats to doctors, or to chase after them with charts if they needed something. Her first encounter with the hierarchies of the workplace involved being berated by a surgeon.
“We went into the room together, and he started screaming about the dressing on the patient’s arm,” Johnson said. “The patient was scared to death. I wasn’t that experienced with anything that was going on, and he wouldn’t stop yelling. So I ran out of the room, and lo and behold, the man follows me, screaming.”
One of her clearest memories of the moment is that “nobody came to my aid,” Johnson said.
“Everybody looked down quickly and then dispersed like ants.” she said.
The only thing Johnson could think to do was to lock herself in the hallway bathroom. The surgeon continued to pound on the door for several minutes. She waited until she didn’t hear anything outside, and went back to the nursing station to regroup. Her colleagues were familiar with that doctor’s temperament and had little encouragement to offer her. When the surgeon returned to apologize at the end of his shift, Johnson had collected herself enough to confront the situation.
“I said, ‘If I do something wrong, or if there is something I can learn from, I want to learn,’” Johnson said. “‘But I need you to communicate with me in a way that fosters our relationship, that makes me want to come to you, and that doesn’t delay patient care.’”
To this day, Johnson is still in contact with that surgeon, a talented doctor whose gifts she respects. Without the moment of communication they eventually shared, however, their relationship may have been irreparably breached. At the time, she said, the hospital had no mechanism for correcting the behavior she experienced.
“There’s a lot of this that happens,” Johnson said. “These are physicians who bring in a lot of revenue; hospitals making 25 to 35 percent on the cases they do. People look the other way. It’s a life-and-death environment; people are under stress.
“Truly, it’s the patient who suffers if nurses and physicians and administrators don’t have good relationships,” she said.
When her career took her to Florida Hospital Orlando, Johnson was invited to participate in a physician leadership development course begun by Mark Hertling, its Senior Vice President for Global Partnering, Leadership Development and Health Performance Strategies. Hertling, a retired U.S. Army general, founded the course based upon his 40-year military career and the principles of maintaining unit cohesion founded in it. Johnson said the training taught them all how much her coworkers in every role at the facility shared the same fears: losing authority in their areas of expertise, and failing to be acknowledged on a human level.
“When we got to it, we’re really the same,” she said. “Doctors fear that everything they used to have control over, now is dictated by the government, or the payers, or the hospital. By us not fitting with them—not getting that face time, not building that relationship—they fill in the gaps with not-nice things.
“Remember, the whole time we’ve got a patient at the center of it who’s the most important person of your life,” Johnson said. “This whole thing about segregating us by doctor class, or nurse class, or executive class…if we’re going to improve outcomes, we’ve got to do it together. Everybody’s got to buy into it, or it’s not going to work.”
Johnson said the program helped participants to value one another as people foremost, and to redefine their roles in the hospital cooperatively instead of adversarially. The workshop taught her, “If we want a seat at the table, we have to have table manners,” she said.
“I think it’s incredible, and it’s changed the way I work with nurses and physicians,” Johnson said. “My patients deserve that I have the moral courage to do what I think I have to do, that is my duty, that is what I’m supposed to do.”
Upon graduation, each class participant was given a challenge coin; a military tradition meant to strengthen morale among all members of the group, and to demonstrate that they are all part of the same unit. When graduates of the class encounter one another, they may challenge each other to produce their coins to demonstrate that they are keeping faith with the group. People who fail to produce their challenge coins are on the hook for a drink.
“This little coin has been a great sign of what the possibilities are,” Johnson said. “It works; it’s powerful.”
Nowadays, if she catches a surgeon on a bad day, or if she is concerned about having communicated insensitively with a colleague, Johnson says their leadership training has inspired everyone to take responsibility for making amends for the preservation of the integrity of the workplace. She and her co-workers have expressed their mutual efforts not to take one another for granted.