Sheryl Sandberg is the chief operating officer of Facebook, and her book Lean In: Women, Work, and the Will to Lead (Knopf, 2013) has become a manifesto of sorts for women who want to succeed in business. It may be hard to imagine what this book by a wealthy business executive has to do with nursing. But nursing is a predominantly female profession, and it's well known that nurses aren't always supportive of each other. Lean In gives some insight into why that is, and how we might reverse it.
The book's dedications reveal much about the kind of environment Sandberg believes will enable people to succeed. She thanks her parents “for raising me to believe that anything was possible” and her husband “for making everything possible,” thus suggesting that unconditional support is crucial to achieving one's dreams. And Sandberg's parents and her husband weren't the only ones who believed in her. Throughout the book, she elaborates on the importance of professional support by describing her experiences with various business mentors who helped her advance.
My own clinical experience suggests, sadly, that unconditional support and true mentoring are rare in nursing. Granted, nursing is a hard job—12-hour shifts, lives on the line, the constant need to expect the unexpected—but nurses are also often very hard on one another. Sandberg says that such behavior is all too typical among women in the workplace: “Men need to support women and, I wish it went without saying, women need to support women too…. As obvious as this sounds, women have not always worked together in the past. In fact, there are many discouraging examples where women have actually done the opposite.”
Why do women tend to work against each other? I've heard more than one nurse manager say, “That's just women,” as if a tendency toward mutual conflict was a sex-linked genetic trait; but Lean In posits a more complex answer by exploring external and internal barriers to women's success.
External institutional barriers include the proverbial glass ceiling, the lack of flexibility in work schedules, and the fact that women are still being paid less than men for doing the same job (a disparity that recent studies show exists even in nursing). Internalized cultural barriers are subtler, more personal. Sandberg argues that women have been conditioned to limit their own potential: “We hold ourselves back in ways both big and small, by lacking self-confidence, by not raising our hands, and by pulling back when we should be leaning in. We internalize the negative messages we get throughout our lives—the messages that say it's wrong to be outspoken, aggressive, more powerful than men. We lower our own expectations of what we can achieve.” She uses “lean in” to refer to counteracting such barriers, advocating for women “being ambitious in any pursuit” and supporting each other in so doing.
I imagine that every nurse in America has a story about being confident and speaking up, only to be dismissed and perhaps even mocked by the physician she (or he) was trying to have a collegial conversation with. Such interactions teach nurses that it's wrong to be outspoken and assertive, because speaking up as a nurse transgresses the supposedly natural order under which only MDs, who historically have nearly all been men, may speak authoritatively.
Such interactions also teach nurses that being hard on others, particularly the most vulnerable members of any group, is a way to have power over them. That's how we've ended up with stories of nurses famous for “eating their young.” Leaning in has the potential to stop this cycle of bullying and retribution. If each of us—male or female—remembers that we're all in this together, if we learn to treat each other as allies instead of adversaries, even as we pursue our ambitions, both our profession and health care overall will benefit.
A nurse friend once said to me, “There's 3 million of us. What could we accomplish if we put our minds to it?” It's a delicious question. Of course, Sandberg is a very rich woman with many resources available to her, while many nurses struggle just to balance work and family while working 12-hour shifts. But the simplicity of her idea is what makes it so appealing, maybe even easy: support each other. Don't roll your eyes at another nurse behind his back, don't attack a new nurse who's struggling to learn her job, don't criticize nurses who speak up. Solidarity among nurses might just make anything—or everything—possible.