Nurse Janus Gets Restructured (Fired)

HIStalk correspondent Nurse Janus, new to the healthcare IT industry after a long career in ICU nursing, lost her job in a major software vendor's restructuring this week. You can contact her at nursejanus@hotmail.com.

This past Monday started like any other. I was on the 8:00 weekly conference call with my team, some of whom are in India, and we updated one another on our projects. My team leader and I were sitting in the conference room on our end, and he gave no indication that anything was amiss. Afterwards, as I clumped out of the room on my crutches (I had surgery a couple of weeks ago and have a cast on my leg), trying to hold the door open while precariously gripping my laptop, I saw my manager – we’ll call him Fred - standing outside a few feet away. I gave him my usual friendly hello and kept plodding. 

Since we have only spoken privately on one occasion since I started, I was somewhat surprised when he asked if I had a few minutes to talk. Like a kid waiting in line for confession, my mind immediately raced over my recent activities, trying to figure out what I had done wrong (I must admit that my prior HIStalk contribution popped into my head at some point.) But overall, I knew the quality of my work was highly regarded, I played well with my coworkers, and I’ve routinely worked 60-70 hour weeks since starting, so my conscience was clear.

Instead of turning towards his office, Fred kept muttering about finding a place to talk, and headed in a different direction, slowing only when he figured out I was struggling to keep up with him. (He never did offer to carry the laptop.) He turned a corner, and then, as if it had just occurred to him, said, “Let’s go in here”, motioning to the HR director’s office.

Did I suspect anything at that point? No. Although recent changes had generated rumors of possible layoffs over the past few months, I was the Pollyanna who reassured everyone that we were doing valuable work that the company needed. Since we were all working so hard, I assumed that this would protect us as well…after all, how can an EMR product be finalized without clinical review? 

Overall, the restructuring was still at such a high level (or so we were led to think) that I thought it would be months, at least, before anything would filter down our way. Besides, our new management team had held a series of “all-hands” meetings late last year and early this year to reassure us that our jobs would not be affected by the changes; the same opportunities would still be there – in fact there would probably be MORE of them! So as I entered the office, I truly was more puzzled than apprehensive. 

The only item on the HR manager’s desk was a large envelope, face down. Fred began to talk. “As you know, everything’s been pretty chaotic around here, and there have been a lot of meetings with upper management…” OK, I thought, but what does this have to do with me? He went on for several minutes in this vein, certainly holding my attention, without coming to the point, but suddenly, he started talking about staffing levels and I experienced “the moment”. I do remember feeling my jaw drop and my eyes widen, and I said to him, “You’re not firing me, are you?” to which he responded, “No, you’re not being fired…we are having to lay off some staff, and your position has been eliminated.” There must be a difference that I couldn’t quite grasp just then.

In my lifetime, I have received bad news on several occasions. Very bad news. But I don’t remember ever having the feeling I had sitting in that office, the one where you think it all has to be a bad dream. Unfortunately, I’m too much of a realist to be able to pull that one off. I sat in stunned silence as the HR manager outlined the termination provisions. On the payroll for four more weeks, then nothing. After she was done, they asked whether I had any questions. Ummmm, yeah I do. However, none of them were anything they were allowed to answer. All they would say is that others were being laid off as well (was that supposed to make me feel better? I’m not a schadenfreude kind of girl.), and that it wasn’t performance-related. 

The HR manager told me, kindly, that I didn’t have to return to work, and that I had until 5 p.m. Tuesday to turn in my badge, laptop, token, and corporate credit card. I slowly got up, gathered my laptop and my white envelope, and went back to my desk. On the way, I passed my team leader’s cube. “Hey, how are you doing?” he asked in a normal, jaunty tone. Unaware that he already knew, I replied, “Not too good. I just got laid off.” To which he replied, “Yeah, I heard about that last week.” Great. Thanks. 

I have always cried easily, something I really work on trying to control. I felt proud of myself for having sat so calmly through the meeting, and getting back to my desk OK. After calling my husband to give him the news, I picked up my purse and went out to my car. Then the flood started. It took me about an hour to get out of the parking lot, and another hour to drive the 7 miles home. I’d start crying, slap myself a little and say, “Stop it!” which worked for a minute, but then I’d start again. Worried I wasn’t safe to drive, particularly since I have to use my left leg due to the cast, I’d pull over in a parking lot or the side of the road until I could see again. I guess I hadn’t quite become suicidal. 

On top of that, my team leader called twice. The first time, he asked whether I was coming back that day, which actually made me laugh. Yes, I want people to see me with my eyes swollen to twice their usual size. I told him that since I was on crutches, I couldn’t see carrying my stuff out by myself, but I was planning to return later to pack it up. He must have picked up on my sadness, as he called back later to ask how I was doing. Wonderful, thanks for asking, sorry, gotta go.

Once I made it home, I knew I had to tell people about it, but really didn’t feel like talking to anyone. My three teenagers were home for spring break, so I had to face them as soon as I came in the door. I called my mom. Several of my (now) ex-coworkers called to express their shock. I tried to not sound angry. That was enough human contact for the day. Being an optimist at heart, I told myself things would get better.

After my eyes stopped leaking, I read over the material in the white envelope. There was a letter signed by Fred, stating in formal terms what had been told to me earlier. There was another one from our new engineering VP explaining why layoffs were needed now, and stating that all decisions were final. And there was a third letter, a generic letter of recommendation (one copy – do I haul this thing around to any interview I may get? Better get it laminated.) signed by some HR guy I had never heard of. This company could not have stated any more clearly that they did not want to hear from me any more, although there was more material about laid-off employees getting preferred status for any current openings, which we were encouraged to explore. It turns out that the openings for which I might be qualified were “placeholders” – no one would actually be hired for them. Yet another corporate term I had never heard of until now.

Later that evening, when I figured no one else would be around, I dragged my husband back to work to help me pack up my stuff. Does it tell you anything about how much OT I worked that the night security guard, whom I always chatted up for a bit, not only let me bring my husband in with me, but also let us take out three big boxes (mostly books) without opening them to check the contents? I took my laptop, to copy some things I had written. The problem with that was I then had to bring it back the next day, along with my badge, token, and corporate credit card. That part sort of felt like when they rip the guy’s epaulets off in the French Foreign Legion. There wasn’t any possibility of forgetting to return those things, though; my team leader had left four messages on my cell phone before 11 on Tuesday asking when I was going to bring them in, even though I had told him Monday they would be returned by 3.

So what hurts? It bothers me that after all that effort, neither my team leader nor my manager thanked me when I was leaving. In fact, my team leader sounded like he thought I was going to 1) come back with my Uzi, 2) steal my laptop and run up the corporate card, or 3) both. When I was working there, I never expected thanks, but once I was laid off, I thought it would have been the decent thing to do. One human to another. And I won’t hold my breath waiting for either of them to tell me how sorry they are that this had to be done.

I put in so much OT that my husband joked about my hourly rate going down to about 50 cents. Although it may sound odd, I didn’t mind it. Some of it was self-imposed. Although I had clearly and honestly stated my lack of engineering qualifications when I interviewed, I needed to learn Outlook, test and requirements tracking systems, risk management and evaluation, and a million other things I never even knew existed. Since I couldn’t find any online learning module titled “HIS for Dummies” (I get a royalty if anyone ever writes that book), a lot of it was hard. I remember at first feeling like I had been marooned in Latvia, for all the conversation I understood. But gradually, things came to me, and because I like to learn new things and knew I was broadening my skills, I kept at it.

To my coworkers, I was new and dumb with computers, and not afraid to say so. But if they had a clinical question, I could give as much information as they needed, most off the top of my head, which is what I was hired to do. I was the one who organized the engineers’ Christmas lunch, and cleaned up afterwards. I was the one who thought to create a support site on the intranet to help engineers learn more about what they were doing, as well as general health-related information they could use for themselves. I figured out how to create the site, did it, wrote fun quizzes to market it, and gave away prizes. I brought in a (never used) bedpan and used it as a candy dish. Oh, almost forgot – I was also the one with the office candy dish. I was the one who used the huge whiteboard in my area for the “Clinical Analyst Quote of the Day” (our motto: “No Quote Too Pithy”). I was the one who signed up for the volunteer activities. I was the one who changed the toner cartridges and added more paper (and you people who don’t, you know who you are). I had surgery at 1:30 on a Thursday and was back for an 8:30 conference call the next morning. In short, I tried. 

Despite being the class clown (which doesn’t seem to go over well in a big company – but I don’t know why a software company would take itself more seriously than an ICU), I met my deadlines and didn’t keep anyone else from meeting theirs. And the only criticism I ever got about my performance is that I was too customer-focused. I always thought that was a good thing. It was also noted that I think too far ahead, and tend to turn over ‘what-ifs’ in my head. As an ICU RN, it was important to ask yourself at the beginning of every shift, “what’s the worst thing that could happen to my patient(s)?”, and then prepare for it, because it does happen. Again, I viewed that as a valuable skill, but this company was very focused on a “need to know” approach to information sharing, which inhibited advance planning because no one seemed to know what would happen beyond the next few days. The result in my product area was not consistent for a company that advertises creativity and quality as two of its core values.

A while back, HIStalk featured an article or interview with someone from a smaller company regarding the cost of HIMSS exhibits. Using those figures as a guide, I estimate that my former employer spent slightly over $1 million (conservative estimate) for a four-day trade show exhibit. Would it have been too much to keep me a few more weeks so I wouldn’t have to slosh around in the snow on crutches going to interviews? Although I intend to look for another HIS position, my resume now makes me look like a job-hopper. I can always fall back on hospital nursing, one of the few truly layoff-proof positions in the U.S., but my cast is on for another 3-4 weeks, so it will be a tad more challenging to convince a hospital that I can physically perform the job.

The sadness I feel is partly due to wounded pride. There’s no closure here; I’ll never find out what happened, why I was singled out. But a lot of sadness comes from what I logically can see happening: If I was working all those hours, and I’m not there anymore, 1) my former colleagues will have to pick up the work I was doing; 2) the work will be done haphazardly or not at all; or 3) I was doing totally meaningless work all this time (let’s not go there.) None of these are attractive thoughts. Worse yet, either of the first two options have negative consequences for a group of people I worked with and was close to. It’s obvious what #1 means to the people left behind this week. The consequences of #2 include the possibility that less-than-perfect software will be installed at a customer site. I’m getting flashbacks now…’Trick Messin’…nooooooo….

With my departure, there is no one in acute care product engineering who has set foot in a hospital as a working clinician in the past eight years, other than one with a six-month internship. I’m being very generous; for most it’s been much longer, and at least one ‘medical reviewer’ (an MD) never did, after med school. Don’t misunderstand; the people with whom I worked are extremely smart, but everyone’s understanding of any given component always seemed to be slightly skewed. Although individual software engineers had about an ‘A’ (92-100%) comprehension of the concepts and workflow, the 1-8% they didn’t know (and in some cases, didn’t know they didn’t know) accumulated as various items and features were added. Small mistakes in one component added to those in another had an exponential effect. By the time something got through the development process, the bugs had multiplied, and much work involved going back and untangling the spaghetti to find out what small conceptual misunderstanding or wrong turn caused them. 

Someone has to know enough to spot a mistake (which may look fine to a non-clinical person) and say, “Hey, the fluids on the flowsheet should be displayed like this”, and then show the engineers where the wrong turn happened, how things should be, and explain why, to prevent recurrences in the future. And the final product should be in line with what a majority of hospitals use. My opinion was that this someone who finds our mistakes should ideally not be the customer. The company gave that concept lip service, but had no process in place to make sure it happened as little as possible. Fear not, though – I’m told the new comrades-in-arms added to our group will provide all the clinical review. We’ll see if the aggressive production schedule can be met, while keeping a modicum of clinical validity and utility for the bedside clinician. (Just kidding on that last part. We all know that doesn’t count.)

No doubt many of you have gone through similar experiences, so this may all sound very whiny (which it is). But to date, nothing in my life has involved this sudden involuntary closure, being cut off from work you enjoy and produce a lot of, and many people you enjoy and with whom you have been friends. I felt like a big part of me was sucked right out. Leaving the hospital (even voluntarily) produced the same sort of empty feeling for a while. But gradually I met people, learned things, and became productive, so most of the emptiness went away. In a similar fashion, I made it almost all day today without crying, and sent out resumes, so some progress is being made.

And I’m not unaccustomed to being deceived at work. Believe me, hospital administrators lie to staff too, but at least there you have your ‘homies’ to commiserate with. And most nurses are below the fray. We knew we were a fungible commodity. But we went along with management decisions because we had the consolation of job security, and each other, and we enjoyed our job and the feeling of accomplishment it provided. Truly, nurses are not in it for the money, the status, or the glamour. Most don’t aspire to be anything but a nurse. (I didn’t aspire to be anything but a good clinical analyst.) There isn’t a lot of “management” for nurses to move into. ICU nurses, with arguably the highest-level skills in the facility, must go through extra training every year. Some take a voluntary certification exam. Yet most hospitals don’t offer any more money for an ICU nurse than for one working in a unit that requires less outside time.

Ironically, over last weekend I started reading Barbara Ehrenreich’s new book, Bait and Switch. I was about halfway through when I put it down Sunday. Barbara (a PhD in real life) tries to land a white collar job with little or no qualifications, and describes the job-search process. An excellent read, but kind of ominous, considering the events that were about to take place. I’ll have to start evaluating book content more carefully.

For music…has anyone tried the Radiators? Good Cajun blues.

So, in closing, if anyone is looking for an older but wiser clinical analyst who lives near Chicago, loves to travel but can’t relocate for a few more years, and works her sweet potato off, please send that info to Mr. HIStalk, who has graciously agreed to pass that info on to me. And fear not – I have three or four notebooks full of goofy IT stuff waiting to be written, so as Ahhhhnold would say, “Ahhh’lll be baaaaack.”