With vastly different ideas about career, two generations are trying to make it work at Swedish Medical Center
Swedish Medical Center CEO Rod Hochman looks every bit the old-fashioned head honcho in his dark suit and tie, clipped hair and air of authority as he stands in a nursing station, stares into a digital camera and launches into a lesson on the importance of hand washing.
It’s the 21st-century version of the memo to staff, and Hochman has cheekily nicknamed the podcast sessions “Rodcasts.”
Hochman’s daughter, who helped inspire his interests in multimedia, may roll her eyes at the pun, but for Hochman, head of a company with 7,000 employees, this is more than a baby boomer’s grasp for Gen Y cool.
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A professional changing of the guard is happening in this country as more than 75 million baby boomers, a third of the nation’s workforce, get ready to retire by the end of the decade. Millions of young workers will be needed to take over the reins.
But here’s the rub for Swedish, and anyone who gets sick.
While the nation reels from job losses in fields from construction to banking, other businesses — notably hospitals, clinics and doctors offices — are struggling with a labor shortage. And the problem is only going to get worse.
One recent survey showed that half of America’s nurses intend to retire between 2011 and 2020. But not enough young people are choosing to learn nursing, a job often afflicted with inadequate staffing and high stress. The news is no better for family doctors, the foundation of the medical profession. Lured by higher pay in specialized fields and worried about paying massive college debts, a whopping 98 percent of graduating medical students recently surveyed by the University of California at San Francisco said they did not plan to go into the less-lucrative primary-care field.
Given that troubling backdrop, it’s easy to see why Hochman and managers on down the line are doing whatever it takes to make sure new graduates and early-career professionals feel comfortable enough to join and stay at an organization dominated by people twice their age. Avoiding generational tension as junior employees join the ranks is more than just a water-cooler issue. Honoring the values and demands that so-called Generation X and Y workers bring to this 24/7 operation, where life-and-death matters are at stake every second, is now a pressing challenge.
“It’s gone from ‘Show me the money’ to ‘Show me my future,’ ” says Joanne Suffis, vice president for human resources at Swedish.
Sitting in an office with Meg Steele, director of recruiting and mobility at Swedish’s First Hill campus, the two opened up about the seismic shift in values playing out among baby-boomer staff and workers in their 20s and 30s.
Here’s the paradox as they see it: While new grads seem eager to plunge into the world of work, they come to job interviews and their jobs with sometimes contradictory demands.
Steele hears them firsthand from prospective Gen X and Y employees: “What’s going to be my career path?” When they’re told about job responsibilities, the response often is, “I can accept that, but . . .”
And this one really tickles Steele: “Can I get back to you Monday? I have to call my mom.”
Long gone are the days when a younger employee places loyalty to company above other considerations. “They bristle at all that,” says Suffis. “It’s, ‘I’m gonna work very hard, but what are you going to give me for it?’ “
Even hiring bonuses, commonplace during the boom times of the late 1990s, don’t guarantee the young will come. They want much more — and that’s forcing Swedish to rethink not just recruitment but effective ways to retain staff.
Younger employees, raised to value instant gratification and anything that boosts self-esteem, need constant feedback on how they’re doing and pats on the back for work well done, Steele explains. And they want it “immediately.”
Steele flashes a huge, self-implicating grin.
“It’s not wrong,” she says. “It’s the way they were raised by us! The generation that raised them doesn’t want them to feel bad about themselves.”
“We give them all sorts of awards,” she adds.
The unwritten mantra is: “No hurt feelings.”
Suffis notes that while baby boomers may be the most successful generation in history, in terms of glass-ceiling-shattering, material accomplishment, Generation X and Y workers, who watched their boomer parents struggle to reach the top at all costs, may be the most challenged, with the achievement bar set remarkably high.
“For this generation,” Suffis says, “it’s going to be tough to top the baby boomers.”
At 35, Heidi Aylsworth can rightly call herself a success story at Swedish. She is chief of operations for its new $140 million Orthopedic Institute on First Hill, a job that involves every aspect of managing this high-tech facility.
Ever since she started at Swedish seven years ago as an entry-level business analyst, she says the company has been throwing opportunities her way. She made a habit of spending time with top executives. “They were feeding me, and I was learning like crazy and providing good value,” she says of her bosses. “I totally feel like I’m being groomed. They sense that’s what I want, so it’s definitely a give-and-take.”
Odd thing is, Aylsworth never intended to become a company woman at Swedish: “When I got here, I was a typical Gen Xer and thought, ‘I’m not going to be here more than three years.’ I get bored easily.”
But she’s come to see the opportunities as her superiors, most of whom are in their late 40s and 50s, reach the final stages of their careers. “I’m at a point now where I say, ‘OK, I can actually be here for my whole career, which is kind of new for me.”
At the same time, Aylsworth is her parents’ daughter still. In the beginning, she says, “I was on the phone with my dad every night . . . my dad mentored me through the first four years of my career. They still know everything I’m doing.”
Suffis, head of human resources, tries to sound diplomatic about this muddle of attitudes and priorities, this charming, even admirable insistence on achieving a life/work balance, this need to have an impact at work, be catered to and rise quickly.
“It’s an exchange” between the hospital’s needs and new workers’ desires, Suffis says, “a partnership.”
After all, when you teach kids they can have everything, you shouldn’t be surprised when they start demanding just that.
Steele is more blunt: “They’re lucky to have a job, but we’re lucky to have someone in those jobs.”
Kris Schroeder, director of nutrition, environmental and food services at Swedish, agrees the company’s willingness to accommodate workers fresh out of school is more a necessity than a choice. “But one of the things we’ve seen with some of the younger folks coming in is everything is just as important as work,” she says. “They look at their lives (or appear to because I don’t know — I’m a boomer!) in a holistic way: ‘My work schedule needs to be compatible with my yoga and whatever things I do that are important to that well-rounded life.’ There’s an expectation of flexibility.”
Offers of flexibility extend to young doctors as well. The focus at Swedish’s Cherry Hill campus in the Central District is training family doctors, an area of medicine that is hard to recruit for, especially when you can make $500,000 a year as a cardiologist and upward of $1 million a year as a neurosurgeon.
The average medical student leaves school with $200,000 debt, so the $140,000-a-year average salary for a family doctor doesn’t sound so sweet by comparison.
Swedish runs one of the largest family-medicine programs in the country, which its leaders hope will pull in young doctors hesitant about going that route.
Reacting to the need of young doctors to have time for life outside work, Dr. Sam Cullison, director of Swedish’s residency program for new doctors, recently approved a job-share arrangement for a young clinic doctor who was a new mom, a move that has been replicated.
Dr. Mia Wise shares duties at Swedish’s Queen Anne clinic with fellow young doctor Sarah Babineau. By working only a few days a week, Wise can spend more time with her kids, a 2-year-old and a 4-year-old.
“I don’t care if this is the last thing I do” as a career, Wise says.
The Cherry Hill campus serves mostly low-income families and patients with substance-abuse problems. A spirit of altruism is always important in family medicine, but crucial in this place.
Among young doctors here, making a difference is given equal weight with career advancement and lifestyle. So Cullison has to think about ways he can offer younger residents the best of all worlds.
This summer, 28-year-old Dr. Krisanna Deppen was finishing a fellowship as a medical resident before moving back home to Ohio, where she had persuaded her first employer to give her time to start an outreach clinic to serve low-income moms.
“It’s not always rainbows and butterflies,” she said of working at Cherry Hill. “But it’s incredibly rewarding. I’m young and idealistic, and I want to change the world.”
Deppen says the last thing she wants in her career is “to be pushed around, getting pulled to do things you’re not passionate about.”
That’s a pretty standard attitude for Generation Y workers, in particular.
Dr. Christine Nguyen, also a resident at the Cherry Hill campus, grew up in Seattle’s working-class White Center neighborhood, the kind of so-called “underserved community” she wants to work with as a family doctor.
“That’s the population that I’m comfortable with,” Nguyen says. “And it really does help.”
If there is any place at Swedish that best illustrates the new workplace, it’s in the nursing department.
Director of nursing June Alteras uses terms like “oppression theory” and “horizontal aggression” to explain the way older nurses have traditionally treated their younger, greener peers.
Think of Zach Braff’s Dr. John “J.D.” Dorian character in the TV sitcom “Scrubs,” who’s constantly being pushed around by superiors in the tough-love environment of the show’s fictional hospital.
Traditionally in nursing, older nurses would deal with their own feelings of oppression by oppressing people below them in rank. It was one vicious cycle of integration through brutal initiation, played out in the seemingly nurturing climate of hospital wards.
“It’s like, ‘I had to jump through those hoops, so you’re going to jump through hoops,” Alteras says.
Alteras is 50, a boomer. She watched her parents, who were reared during the Great Depression, spend their whole careers devoted to their employers, happy for the chance to work and move up in the world. “All they wanted” in return, Alteras says, “was the gold watch at the end of their careers.”
But the old dynamic of loyalty to company in exchange for, well, not being fired, doesn’t hold up so much with workers who are young enough to be Alteras’ children. If they don’t like a job, they are far more inclined to quit and find another.
Swedish can’t afford to turn a deaf ear to their concerns. That applies not only to flexible hours but also to how authority is distributed.
“They don’t want decisions made at the senior level for work being done at the bedside,” Alteras says. Swedish, therefore, is looking for ways to move from horizontal aggression to horizontal cooperation, including freshman nurses and doctors in committees and discussion forums.
This sounds all well and good, but an emotional transformation needs to happen, too, especially among senior staff at Swedish who came up the ranks under very different circumstances.
For some, like Karen Sprague, a senior intensive-care-unit nurse at Swedish, the shifts have caused nothing short of an awakening.
Sprague doesn’t mince words about the kind of nurse she was trained to be. She describes herself with a grin as “an ex-whipper of nurses.”
Working as a nurse in the ICU is not a job for slackers, in any case. The patients who wind up in this ward are fresh out of surgery or suffering from acute illnesses that need meticulous attention. It’s a high-pressure, high-stakes world. ICU nurses are known as pretty tough customers who will call someone out for incompetence.
Sprague had always thought it important to instill a sense of urgency in younger nurses by being hard on them. “Nurses traditionally have eaten their young,” she says. More generously, she puts it another way: “It was just like a mother to a child — I’m gonna teach my young.”
Recently Sprague, who’s been a nurse for 29 years, attended a seminar on workplace mentoring that completely changed her view. She learned that when companies mentored younger workers, they were more likely to feel good about themselves and their jobs and be more successful. And they were less likely to quit.
In recent years at Swedish, more younger nurses have been hired into an ICU that was once the exclusive domain of more seasoned nurses, yet another major shift resulting from the nursing shortage.
It dawned on Sprague that she, and Swedish, needed a healthier approach to retaining nurses in a competitive climate where they could be snatched up by another hospital at any moment. She instigated a mentoring program for ICU nurses that encourages veterans to instill their expertise in a less adversarial way.
Mentors and mentees meet for an hour each month, but also hold less formal discussions at other times.
Today, you’re more likely to find nurses of different generations hanging out away from work, joining each other for barbecues and cocktails.
Younger nurses, who tend to be more comfortable with technology, are being used to acquaint older workers, who are accustomed to writing by hand on paper charts, with advancements like Swedish’s electronic EPIC medical-records program.
“One of the reasons that nurses leave within the first year is they don’t feel like they fit in,” Sprague says. “We have such an intense job and have to take control of situations. Sometimes that risks pushing people apart. But we can be retaught.”
Boomers can at least feel gratified that they’ve paved the way for Generation X and Y workers to focus on what matters most to them — doing good work and career advancement for some, life balance for others.
It means that when 25-year-old ICU nurse Talina Silbernagel comes to work at 7 p.m. for a 12-hour shift three nights a week, she has lots of duties but also a support network to keep her from slipping through the cracks or feeling helpless when things get rough.
For her, “What do you need?” is about the best question her bosses can ask. Silbernagel’s guiding Gen Y principle is: “I don’t live to work, I work to live.”
Her mom, a nurse, had encouraged her to avoid the profession because it is exhausting work. But the arrangement at Swedish — the three-day workweek, the mentoring, the plunge into ICU care at the onset of her career — is a far cry from what her mom endured.
When Swedish started implementing its EICU system — in which patient monitoring devices and video cameras relay information to a control room staffed 24/7 with a doctor and a nurse — it took some staffers awhile to get used to a second set of eyes looking over their shoulders all the time.
But Silbernagel, used to technology in everyday life, likes the system. If she has a question or something goes wrong, she can speak live to someone in the control room. It sets her mind at ease.
One night on the ICU, she walks into a room to call on an elderly patient, checking for pain in his IVs and tingling in his ankles.
“All done,” Silbernagel tells the man when she’s finished checking his blood pressure.
Happy for the brief social interaction, he gazes up at her, smiles and taps her hand ever so softly. She taps his back, then slides a thermometer in his mouth.
“Ninety-eight — perfect,” she tells him.
“You need a warm blanket?” she asks. He nods yes.
“I think that’s every patient’s favorite thing in the world — a warm blanket,” Silbernagel says outside in the hall.
Silbernagel doesn’t need a video feed or a mentor to figure that out.
Some things in health care never change.
Tyrone Beason is a Pacific Northwest magazine staff writer. Chris Joseph Taylor is a Seattle Times staff photographer.