Journal Logo

ER Goddess

ER Goddess

Women as a Force for Change for Women

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000554847.03164.ed
    conflict resolution
    conflict resolution:
    conflict resolution

    ‘I'm every woman!” was my college student government campaign slogan. The words from Whitney Houston's hit song were all over the radio and plastered all over Wake Forest University with my picture. I won. That was 1993 when the world to me was still a meritocracy. I was naïve enough to believe there was no such thing as a woman being too assertive. I thought the same things would be expected of me as of my male colleagues.

    Twenty-six years later, I know better. I took my “I'm every woman” mentality into my medical career and inadvertently violated gender-based expectations that I didn't even know existed. No one tells women that they'll be breaking the unspoken and largely unconscious rules that govern women's relationships with other women if they try to run their EDs using the masculine traits rewarded in EM residents.

    It's not enough for female EPs just to do our jobs well; to succeed, we must also meet these relational expectations of our mostly female nursing staff (91% female per the U.S. Census Bureau). Being too confident, too pushy, or asserting a position of authority can create problems with other women.

    I learned to temper my “I'm every woman” attitude with a humble dose of “I'm NOT every woman; I need and value each woman in this ED.” I still struggle sometimes to balance being a strong leader with avoiding conflict with female nurses, but I've figured out a few strategies that make it easier to lead ED teams without backlash: leveling, relational courage, and “role hats.”

    I'm Not Better than You

    Leveling is a way of using words, body language, and actions to convey that we don't see ourselves as better than another woman. Most women already do this innately. How many times have you foregone giving an order as “do x” and used linguistic tactics to soften the delivery? We use these with other women to sound less authoritarian: “please,” “thank you,” and “we” instead of “I.” Something as simple as using “help me understand” instead of “why?” can decrease defensiveness in another woman and open the door for communication without sounding accusatory.

    “I'm sorry” can also be used as a device to equalize power, not just an apology. “I'm sorry to interrupt you” communicates that her time is important. “I'm sorry you're sick” expresses empathy. Like it or not, as women we are more likely to communicate successfully if we use these linguistic tactics to sound less brusque.

    It's not just the words we choose but also our willingness to be relational with female staff that can neutralize perceived power differences. We can enhance relationships with other women by involving them in the discussion. Engaging in chit-chat can also improve dynamics with female coworkers because women value chatting and unconsciously expect it from other women. Nods, smiles, nonthreatening body posture, pleasant facial expressions, and tone of voice support relationships through nonverbal cues. Our actions speak volumes, so don't underestimate the value of doing something yourself instead of asking someone else (when you have time).

    All of these leveling strategies help us deal with the competing constructs of telling someone what to do while meeting relational expectations. You are likely already using some of these tactics reflexively. A caution—use leveling with sincerity; women sense when another woman's words or actions aren't from the heart. Keep in mind that one of the impossible double binds of being a female leader is that using language that is more palatable to other women may cause you to come across to men as unsure of yourself. Tailor to your audience.

    Unfortunately, no matter how much we try to maintain smooth sailing, the tumultuousness of the ED will repeatedly put us at odds with coworkers. When disagreements arise, healthy conflict resolution is essential for getting our jobs done without triggering “mean girls” behavior, that is, indirect aggression. Women are unfortunately more comfortable with indirect aggression due to our social conditioning. We must reteach ourselves how to resolve disputes with productive, direct communication so festering resentments don't explode later.

    All of us need to practice relational courage, which is the ability to stay engaged and have uncomfortable conversations. Often when a woman doesn't behave the way we expect, our reflex is to stop speaking to her or withdraw from the relationship rather than talk about what happened. It's often not easy, but relationships get stronger when we have the courage to clear up misunderstandings face-to-face.

    We're All Biased

    Women can use leveling to show humility and relational courage to brave our way through disagreements, but what if we just want to do our darn jobs without being encumbered by relational expectations? The truth is, even though I shouldn't be expected to be more nurturing and supportive because I'm female, I am. “There are differences between men and women in both their behavior and in the way their behavior is perceived by others,” Sheryl Sandberg wrote in Lean In. “All of us, myself included, are biased, whether we admit it or not. And thinking that we are objective can actually make this even worse, creating what social scientists call a ‘bias blind spot.’”

    Biased expectations for women mean we have to play by a difficult and more complicated set of rules if we want to succeed. You may be tempted, but I wouldn't recommend ignoring the relational expectations of women at work by adopting an “all-business” masculine style. Instead, use strategic boundary-setting to clarify when and why relational expectations will take a back seat. It can be confusing when you go from being friendly to having to be the person who says, “Get that done. Now.”

    Anne Litwin, the author of New Rules for Women, suggests using role hats to explain when you are speaking from a supervisor role versus a friendly just-one-of-the-girls role. Stating “I'm wearing my friend hat” when having a personal conversation or “I'm wearing my patient advocate hat” when giving orders is a great way to manage expectations. (Third Bridge Press, 2014.) Don't assume another woman knows where you are coming from when you suddenly start giving orders.

    Navigating the pitfalls of women's professional relationships is hard. We don't realize that internalized societal messages about how women are supposed to be are acting as filters for how we see our interactions, so we think the problem lies with us or our coworkers. We don't understand that masculine hierarchical workplace cultures set us up to be disappointed by each other because we aren't even aware of our unconscious expectation that women be egalitarian.

    The key to improving our relationships with each other is to try harder to see and talk about our own gender bias and how it affects our behaviors. If we are able to become aware of these larger forces at play, we can challenge ourselves and each other to resist destructive ways of relating and start being more supportive of women at all levels in the workplace. Let's turn our focus away from watching our backs with each other and toward banding together as a force for change.

    Share this article on Twitter and Facebook.

    Access the links in EMN by reading this on our website or in our free iPad app, both available at

    Comments? Write to us at [email protected].

    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

    Wolters Kluwer Health, Inc. All rights reserved.