Newspeak to Nurspeak : LEADERSHIP IS COMPLIANCE !

Orwell’s literary masterpiece, 1984, has apparently been flying off the shelves since our southern neighbors’ recent election of a icterical president. Since I’m a sucker for fads, I decided to re-read this book that had made such an impression on me in high school. Interestingly, it isn’t the oddly coloured president that came to mind while reading. What struck me most was the concept of Newspeak, and how Orwell masterfully played with words to imagine a version where they are devoid of any profound meaning. In this, I’m afraid to say, I recognized certain aspects of nursing education and of the public discourse of nursing organizations.

The purpose of Newspeak was not only to provide a medium of expression for the world-view and mental habits proper to the devotees of Ingsoc, but to make all other modes of thought impossible.” (George Orwell, Nineteen Eighty-Four, 1949)

The language of nursing, let’s call it Nurspeak, is impressed upon students very early on, and later reinforced in the workplace. Although there are many terms in Nurspeak that do not hold the same meaning when you leave the nursing realm, I will focus here on the concept of leadership.

The Oxford dictionary defines leadership simply as being: “the action of leading a group of people or an organisation” “The state or position of being a leader” or “The leaders of an organization, country, etc.”. They then describe the verb ‘lead’ as “be in charge or command of”, or “organize and direct”. Seems fairly straightforward.

Recently, I came across a Power Point presentation made to undergraduate students by a nurse leader that described abnegation as an important lesson in leadership.

There were other terms and concepts, but this one caught my attention. Abnegation, the act of self denial. Not a word usually associated with leadership. These students were in their second leadership course, they have three in all. Fun fact: nurses are the only health sciences students with ‘leadership’ courses. Other fun fact: nurses are the most underrepresented health profession in leadership positions.

What is the definition of leadership taught to nursing students? In Quebec, students learn a slightly modified version of the LEADS model of leadership. The model was the brain child of the Royal Roads University, a school with strong ties to the Canadian military and the private sector, and the Canadian College of Health Leaders, an enterprise of public and private sector executives. The LEADS framework is simple; everyone can be a leader, you don’t need to be in charge to be a leader. All you need to do is be responsible for your own actions, and align yourself with the values and mission of the organization you work for. As you can see, we are moving away from the traditional English definition.

In the Canadian context, with the massive cutbacks in health and the attempts at imposing the Lean management model developed by Toyota, this type of ‘leadership’ is a godsend. Nurses are basically taught that ‘leadership’ is championing management prerogatives, whether you agree with them or not. If you do disagree, you are not to voice your opinion unless you can bring positive solutions to the problems you see. So basically, if you don’t know how to bring about peace on earth, don’t criticize war. Let the leaders… I mean the OTHER leaders (because we’re all leaders), do their jobs.

In this model, nurses who do not hold management positions are basically told they are leaders if they support and promote ‘change’, as dictated by their superiors. “Compliance is leadership” is eerily reminiscent of the MiniTru’s slogans in 1984: “slavery is freedom” or “2+2=5”. When leadership means compliance, critique becomes resistance. More fun facts: resistance to change has become a popular theme in nursing management research.

For those nurses who are able to articulate their critiques and propose different modes of functioning, there are two ways to get rid of them. You can send them on a never-ending quest to change things ‘from the inside’. For example, get her to write a letter that you will send (or not) to a committee of some sort, then watch as nothing happens. If she’s not convinced, invite her to do a little presentation at a board meeting, she’ll get a pat on the back for being ‘such a good nurse’ and again, watch as thankfully, nothing happens. For the others who grow tired and exasperated with the inefficiency of the ‘proper channels’ to voice their concerns, there is always the option of slapping them with disciplinary measures. If you catch them critiquing their employer on Facebook or suggesting there are serious problems with healthcare, the regulatory bodies of nursing (reminiscent of MiniLuv) will support you if need be, by imposing fines or even stripping these unruly girls of their licenses, so there is no need to get your own hands dirty. Although we’re still civilised enough to not have a room 101 in the buildings of nursing regulatory bodies, there are courtrooms and disciplinary officers that will ensure loyalty is enforced.

At the end of the process, your administration remain snow white and benevolent, and most importantly, NOTHING HAPPENS. You may continue imposing drastic cutbacks endangering the safety of nurses and their patients as you deem fit. Leadership remains a term empty of meaning or nuance, and you may continue telling nurses that they are all leaders in this Brave New World of health care. (Look for Aldous Huxley in my next post).