Nobody Handed Me the Playbook

5 A Note on These Stories This book draws from two leadership transitions: first from staff nurse to Service Line Coordinator, and later from Service Line Coordinator to OR manager. Each role brought new responsibilities I hadn’t been prepared for. The chapters move between those transitions as I describe what I learned. Some follow a single occasion; others bring together patterns I recognized later. They aren’t a day-by-day account of one appointment. Names and identifying details have been changed. Some people and events are composites, and dialogue reflects the substance of conversations rather than a word-for-word record. I’ve made those changes to protect people while staying true to what I experienced and learned. Patient details have been kept to a minimum and altered to protect privacy. The stories are about my experience of leadership, not a record of anyone else’s care or employment. No person, employer, or facility is intended to be identifiable. These examples come from the settings where I worked. Responsibilities and decision-making authority differ between organizations. The stories don’t replace clinical judgment, professional advice, or your organization’s policies and requirements. I have tried to preserve what those transitions felt like, including the things I missed and the decisions I would now make differently.

6 The Page That Wasn’t There When I accepted the manager position, I expected to have a director to learn from. Then the director who hired me left. I received emails and some stacks of paper. There was information about payroll, scheduling, requesting positions, and Wednesday huddles. There were instructions for parking, badge requests, and codes. Those things mattered. I needed to know how to do them. But the information was brief. It didn’t prepare me to lead the department. I was responsible for about eighty employees while still doing the service-line work I’d been responsible for before the promotion. For five months, we had no director. Learning as I went became the normal way of doing the job. The information explained parts of how to work there. It barely touched how to lead there. Over time, I put together a binder of information I needed. I still had to learn how to handle the situations those instructions didn’t cover. I needed help with questions the instructions did not answer. What should I do when someone I had eaten lunch with for years started arriving late? How would I explain to a family that a long-awaited procedure would not happen that morning? How would I read the financial reports I would be expected to explain? And what should I say when people I had worked beside stopped talking, looked at me, and waited? I knew where I was allowed to park. I was less certain what I was now expected to decide. I’d accepted the position because I wanted the opportunity. I was willing to work and learn. What I didn’t have was a clear way to learn the responsibilities I’d just taken on. The practical information was useful. I also needed someone to help me understand the work behind it: what I could decide, when to ask for help, and how to work through a problem I hadn’t handled before. Clinical skill had helped me earn the position. Leading a department required knowledge I didn’t yet have, and I wasn’t sure where to turn for it. I had been a good student. Give me the material and I would learn it. This time, I was learning what I needed to know as people came to me with problems. I couldn’t always tell which question I should have asked before they arrived. A form could tell me which box to complete. It couldn’t explain why I hesitated when the name belonged to someone I knew.

The Page That Wasn’t There 7 I was proud of the promotion. I wanted the responsibility, and being chosen meant something to me. I had worked hard to earn that opportunity. I assumed I would know how to handle more of it than I did. This is the story of what I had to learn after I accepted the position. I needed to hear from someone who had struggled at the beginning without being made to feel they didn’t belong in the job. Friendships were changing. Requests went unanswered. Decisions followed me home. Instructions alone couldn’t explain that part of the work. For a long time, I thought struggling meant I had been the wrong choice. Some of the difficulty came from not being prepared. Some came from decisions I needed to take responsibility for. I had trouble telling the two apart. Later, other leaders described experiences I recognized. Often the conversation ended with the same admission: I thought it was just me. I had thought so too.

8 Two Promotions It was around noon, and I was standing at the desk when the director asked me to come into her office. The manager position had become available. She said she thought I would be a good fit and had spoken with a few of the department’s current leaders. There wasn’t much time between hearing about the opening and deciding. I said yes. I would step into the interim position as OR manager. Saying it out loud sounded more certain than I felt. I was hesitant. The position was outside my comfort zone, and I didn’t feel prepared. I also thought the transition would be easier than the first one. I was already a Service Line Coordinator. I was already in leadership. I knew the department, the surgeons, the rooms, and the people. I thought I was accepting a larger version of work I already understood. That assumption lasted until the first day. As a Service Line Coordinator, I knew what a good day required: the service prepared, the rooms ready, the schedule moving without avoidable delays. I usually knew what needed my attention and what I could do about it. As a manager, I wasn’t always sure where to begin. On day one, people came to me with department problems and expected me to solve them. There were staff conflicts, payroll discrepancies, scheduling questions, and surgeon concerns. Some of that work was new to me, and I didn’t feel qualified to handle all of it. I moved from an office shared with other leaders to one of my own, with two screens and a big desk. It took much longer to feel comfortable in the position than it did to move into the office. Knowing the department made it easy to underestimate how much I still had to learn. I knew the rooms and the daily routine. Payroll, performance concerns, and decisions affecting the whole department were different responsibilities. The role was interim. The problems were not. The appointment was temporary, but the person in my doorway with a payroll problem needed an answer that day. The schedule still had to work. I had accepted the responsibility before I understood how much of it would begin immediately. How much should I change when I didn’t know how long I would be there? Moving quickly could leave people living with a decision I barely understood. Waiting could leave them with a problem I had already agreed to handle. I could tell myself I was being cautious for only so long before I had to explain what I was waiting for.

Two Promotions 9 I needed to understand what I could decide and who I should consult. Instead, I often acted as though I already knew. That spared me an awkward conversation at first, but made it harder for anyone to see where I needed help. I didn’t ask for help often at first because I thought the person in that office should have answers. As a coordinator, I usually did. Competence had meant knowing my area well enough to keep the day moving. When something went wrong, I acted. That approach had made me reliable. As a manager, the same instinct kept me running in circles. Problems came up all day, and I treated each one as something I should fix myself. A smooth day no longer meant getting one surgeon through the schedule without delay. Some days it meant reaching the end without another scheduling conflict or payroll discrepancy to work out. The relationships changed too. People stopped by with problems or ideas, and I was eager to help with both. The coordinators seemed comfortable with the transition. With surgeons, I felt I still had to show that I could help with the broader issues they now brought to me. That took time. The earlier promotion, from staff nurse to Service Line Coordinator, had already changed my relationships. A question from me carried more weight. So did overlooking a problem because the person involved had been a peer. The second promotion changed how much work followed me home. I had to understand productivity targets, staffing decisions, employee concerns, and financial reports. I also had to find out why a problem kept returning and who could help change it. Being unprepared didn’t change the fact that people were depending on me. My decisions still affected them. I needed help learning the work, and I needed to take responsibility for how I handled it. The stories that follow move between those two transitions. Some lessons returned when my responsibilities grew. I didn’t learn them in the tidy order I would have preferred.