What's in a Culture?

For those of us who entered nursing before the late 1980s and early '90s, we thought of hospitals as service organizations. We cared for patients as set forth in the state practice acts. We received a 1-day, hospital-wide orientation and tried to follow their rules and regulations. Admittedly, we soon forgot many of them.

Back in the good old days, we followed the Golden Rule when we interacted with other disciplines. But treating others as we'd like to be treated wasn't always easy. Can you remember when physicians made care decisions after they'd seen the patient and checked lab results and other tests? Unfortunately, today it's often an HMO employee - sitting in a cubicle two time zones away - who has the power to approve or deny a request for an extra patient day. Today, these decisions aren't made so much by health need as determined by care providers, but by the utilization review bible. Back when medical dollars bought more, the only time we heard about cost containment was when we questioned why our raises weren't higher. Obviously, we can't go back to the good old days (and I don't think most of us would even want to), but something has to change. Corporate Culture Corporate culture isn't just for Fortune 500 companies. An organization's culture can and does directly impact every person who works in healthcare today. At ADVANCE's Job Fairs and CE Events, where I've talked to hundreds of nurses, I repeatedly stress the importance of learning about a hospital's culture as they apply and before they accept a job. Usually, I sense that most people don't have a firm grasp on this concept. Let me try to cover the main points. In the late '80s and early '90s, as technology and automation skyrocketed in almost all areas of business and industry in this country, people were laid off in large numbers - including nurses. This was when those disastrous hospital re-engineering projects emerged as a cost-cutting strategy. In fact, this short-sighted trend has been directly linked to the nursing shortage of today. Many nurses who were laid off back then decided to leave the profession and never returned. During the downsizing movement, an organization's culture frequently determined who kept their jobs and who didn't. Corporate culture is like an individual's "personality." Downsizing had an impact upon corporate culture: It changed companies' beliefs, values and goals. In many companies, employee loyalty and long-term goals and plans were replaced with employees who could implement short-term solutions quickly. Backbone of an Organization A good working definition of corporate culture is that it is the operating system of the organization. It guides how employees think, act and feel. Some aspects of culture are visible. These are called the artifacts and are often displayed in the company's dress code such as the IBM blue suit in past decades. These days even Big Blue's culture has made the leap to business casual. Besides the visible artifacts, a company's culture operates on a conscious and unconscious level. On the conscious level, the culture is what the CEO and management emphasize and model. On the unconscious level, it is often what isn't talked about or practiced. For example, if top managers prefer to avoid conflict, it's pretty clear that employees won't be rewarded if they view conflict as a positive behavior. Corporate culture is not intended to makeover all employees into one homo.genized brand. There is room for some cultural differentiation. However, in the fast-paced workplace of today, where employees come and go all the time, establishing a corporate brand is a stabilizing force. It's also an effective way of transmitting the organization's message and mission to the public. Ask Questions, Compare Notes Now let's apply this information to the hiring process. At job interviews with recruiters or managers, you should ask each person to describe their facility's culture. Take notes. Then, talk to people in the trenches at this organization - nurses who have similar positions to the one you are seeking. Ask them the following questions: What 10 words would you use to describe this hospital? Around here, what's really important? Who gets promoted? What behaviors get rewarded? Who fits in and who doesn't? Now, compare the information you received from management (your interviewers) and employees (other nurses). The similarities and differences will speak volumes about your potential employer. Is the data in sync between the two groups? How does it compare to the kind of atmosphere you'd like to work in? Go With Your Gut Assessing corporate culture is an important parameter when job seeking, but it's not everything. Don't dismiss your nurse intuition. The lure of the big-city medical center had wide appeal for me when I interviewed for my first nursing position. Then I visited a smaller hospital across town, where the esteemed director of nursing found time to take me on a personalized tour of the facility. She knew everyone's name - from the medical director to the cleaning man. After that interaction, it was a no-brainer where I wanted to start my nursing career. And I've never regretted my decision. Kay Bensing is senior staff nurse consultant at ADVANCE.