I was talking to a friend of mine, who is an ED consultant in London (@wgbrook– follow him!) the other day about his ED induction programme for the new F2s joining the department in April. He said he was going to talk about “aiming to be a zero” to them. This concept came from Cmdr Chris Hadfield’s excellent book “An Astronaut’s Guide to Life on Earth”. If you’re about to start in a new job, department, hospital, office etc, then this post may help you! Now if I told you “just aim to be a zero and you’ll be fine”, then you’d probably think I’m bonkers (unless you are a supermodel….)

“Over the years, I’ve realised that in any new situation, whether it involves an elevator or a rocket ship, you will almost certainly be viewed in one of three ways. As a minus one: actively harmful, someone who creates problems. Or as a zero: your impact is neutral and doesn’t tip the balance one way or the other. Or you’ll be seen as a plus one: someone who actively adds value.”

Human nature dictates that we don’t want to be a -1 or a 0. Most of us want to be a +1 and add some value to the team we are joining. This seems pretty reasonable. However can a +1 individual have a negative effect on the team….

Let’s say you are the ED reg and have just seen a drowsy and  hypotensive patient in resus. He is being  attached to the monitor which shows ventricular tachycardia (VT). You step out of the cubicle to just to get some help from your consultant. When you get back, you see one of the new F2 doctors standing over the patient performing CPR……

The patient had gone into ventricular fibrillation  (VF), so the F2 “shocked” the patient and commenced  CPR. The patient has a return of spontaneous circulation (ROSC) and is taken for a cardiac angiogram. You congratulate your F2 and nursing team for their quick recognition and management of a life-threatening condition. The F2 says he had just passed his ALS course the other day which gave him the confidence to manage a cardiac arrest. You seem very impressed by him. After the patient leaves resus, the ED nurse who was looking after the patient, comes to chat to you alone.

“I didn’t want to say this to you in front of the new doctor, but as you went to call the consultant, he came into the cubicle and saw the patient was in VT. He didn’t call anyone but proceeded to shock the patient…..”

“Ok”, you reply, “So whats the problem?”

“The patient had a pulse and he gave an unsynchronised shock, putting the patient into VF!”

Think about this scenario. There is a new F2, who has just passed his ALS course and started in the ED recently. He’s eager to impress and sees a patient in VT. He is probably feeling stressed internally being in a new environment and dealing with a sick patient. He makes a snap decision and shocks the patient. He wants to demonstrate his leadership skills and knowledge to his new colleagues. He thinks he’s being a +1. He thinks that he’s done a positive thing, being a leader and making things better.He thinks he had all the facts about the patient before making that decision to shock. He didn’t realise the nurses feeling uncomfortable about his decision making or that the patient had a pulse prior to giving that shock. In fact he is being a -1 and has a negative impact on the team.

This is an extreme example. Cmdr Hadfield writes: “If you are convinced that what you are doing is right, you’re coming in and leading and making decisions to make things better, you swear you are positive, a +1. But, in fact, because you haven’t given it enough time, and I’ve seen this before in the air force and at NASA, because you haven’t gotten the lay of the land, haven’t allowed yourself to be a good enough listener and a good enough follower, you are actually a -1, you are actually doing damage. You may be physically messing something up or you are just not in tune to all of the situation or the people and you’re definitely the opposite of the leader you thought you were being.”

Relating this to what is sometimes a chaotic and stressful environment (like the ED for example), Curium for change writes:

“In unfamiliar or stressful situations, striving to be a ‘plus one’ may cause problems. In such situations, we may not be well equipped (in terms of knowledge and information to hand), experienced, or energetic enough to be a ‘plus one’. Entering a new environment intent on exploding out the gate will only result in a risk of wreaking havoc.

The pursuit to achieve a ‘plus one’ status will cause us to become a ‘minus one’, someone who causes problems instead of contributing. It is here that we over estimate our abilities and experience, misunderstand our role or the task in hand, and add negative ingredients into the mix such as stress and false confidence. Shaking off that tag then becomes very difficult and the consequences may last longer than you would like.”

No matter what medical or nursing speciality you work in, or what company you work for, we have come across this. A new team member (or even yourself )wanting to show their leadership skills from the outset and making snap decisions. They may be messing things up and just not aware of the situation or have the emotional intelligence to recognise how others feel. They are being the opposite of a leader. They don’t spend enough time getting the lay of the land and being a good listener and follower. In effect being a 0. 

My advice, spend some time being a Zero before becoming a +1. Try telling this concept to  your new team members, doctors or nurses and see what happens. Hope this was useful!

KR

N