28 January 2011

Evaluation season

Job performance evaluations are a normal part of a practitioner’s life. The norm is to be evaluated on our medical work, of course, but this skews a bit when working as a U.S. Foreign Service nurse practitioner. In the Foreign Service, the evaluation season theoretically begins on 15 April and ends a month later, when all evaluations are to be in Washington for processing and review. This year, the already-complex system has been “electronically enhanced” to make the procedure run in a more linear, proficient manner, so, of course, we have to start much earlier. To this end, a human-resources expert came to post to teach us the new system.

Each employee, regardless of her or his actual job, has a rater and a reviewer, selected on the basis of organizational hierarchy. I am the chief of my section—medical—so my rater is the management officer, who is responsible for the embassy’s administrative function. His boss, the deputy chief of mission, who is ultimately responsible for the function of all departments of the embassy, is my reviewer. It should be noted that neither of these great guys has any idea what I do medically.

It is incumbent upon the employee to provide the rater and reviewer with a list of accomplishments that can be highlighted in the evaluation. Most of my nonmedical colleagues can speak in specifics, but I must speak in generalities or risk treading on patient confidentiality. I can offer vague statistics that are medically related or, if something is widely known, such as when the bombing happened in Islamabad, I can offer my rater more specific details. But, usually, my evaluations barely touch on the practice of medicine and I am rated more on administrative issues. There is an exception. Once, during each assignment, a regional medical officer or regional medical manager must submit a supplementary evaluation, which does address medical practice and skill.

On the surface, it might appear that there’s a lack of accountability, but that’s not really true. In Foreign Service lingo, it is called “corridor reputation,” which provides the real scoop on how an employee handles his or her responsibilities, and it has a very real effect on that person’s career. If there are problems, it will be known.

So, back to the training provided by the human-resource specialist. To illustrate how far the Foreign Service has come in performance evaluation, she handed out the single-sheet form used in 1949 for all employees. There were 16 areas of evaluation, each containing only four phrases. The rater was asked to underline the one phrase that was most descriptive and cross out the line regarded as least descriptive. Some of my favorite choices are:

  • He talks too much.
  • He lacks breadth of view.
  • He is careless in his personal habits.
  • He is too much of an individualist.
  • He lacks aggressiveness.
  • He is ingratiating.
And my personal favorite:
  • He does not wear well as one knows him better!
I’m grateful to say that the evaluation process has progressed light years from this type of appraisal. One other thing: Note that all the phrases begin with he. In 1949, women did not serve in the U.S. Foreign Service. That change might be the greatest advancement of all!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

14 January 2011

If you're from Georgia, I'm from Mississippi!

I haven’t lived in the United States for almost 12 years. I can’t count the number of times a week I am asked, “Where are you from?” or some derivative of that question. I always hesitate before I answer, a habit I dislike, but it is a question that does not have a simple answer, and I’m forced to think before I reply. I have to think about the actual information the asker wants, which can vary quite a bit, depending on circumstances. I realize Americans are, more and more, a mobile society, but the question, “Where do you live?” or “Where are you from?” asked by one American to another has a limited connotation. Not so for the expat.

I spent the first 20 years of my life in Texas, followed by 17 in Tennessee and 10-plus in Mississippi, before I joined the U.S. Foreign Service. Today, I live in the Czech Republic, my legal residence is Tennessee, and I own a house in Mississippi. If I am relatively sure the intent of the question is what part of the United States I call home, and the asker is foreign, I answer “From the South” Most non-Americans have as little understanding of the geography of the United States as Americans do of other countries. I learned early on that most foreigners know New York, Chicago and Los Angeles. Any place else is just a mystery and answering “From the South” seems to satisfy them. In fact, I once spent about 10 minutes on an overseas flight trying to explain to someone that I was going to Mississippi, the state, not Mississippi, the river. He never did get it.

If I am asked the question when I begin work at a new embassy posting, I know they want to know the location of my last post. If I am traveling away from my post and someone asks the question, I always answer with the city of my current residence. About 50 percent of the time, that solves the issue. Sometimes I can have great fun with this, like the time I was in Thailand and answered the question with Pakistan. The young lady behind the counter repeated it twice with a look of amazement on her face but, since the address I had put on the registration form was indeed a Pakistan address, she didn’t argue.

If I meet people from Texas, I always tell them I am, too. I still think of myself as a Texan, even though I have spent two-thirds of my life outside of Texas. I cannot remember ever meeting someone from Mississippi overseas, but if I am introduced to a person from Alabama, Georgia or another southern state, I will counter that I am from Mississippi. And, if some stranger is pushing me about my nationality, and I am uncomfortable with giving the information, I say I am from Nova Scotia. No one knows where it is, how they talk or anything about it—shuts them right up!

Is it any wonder I’m confused?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

03 January 2011

A Red Square New Year's

A new year is upon us. Years seem to turn over much faster now than when I was a child. How I spend my New Year’s Eve directly reflects my stage in life, as I suspect it does for most people.

When I was a young adult, it was all about the big party, dressing up and celebrating with a large, sometimes raucous, crowd. As a young mother, my New Years’ Eves were spent in the company of couple-friends, eating and playing the latest parlor-game sensation. The TV was on in the background, just to make sure we didn’t miss the stroke of midnight. When that magic moment arrived, we quickly passed hugs and “Happy New Year” greetings, and then it was back to the game. As my children entered high school, New Year’s suddenly became about them—
what they were doing, who they were with, and their safety—while I watched celebratory events around the world on TV and waited for them to return home.

For the past 15 years or so, New Year’s Eve usually concludes, for me, somewhere around 10 p.m. My mother used to say, “Whatever you do on January 1st, you will do all year long!” I use that as an excuse to beg off attending any late parties on New Year’s Eve, because I need to be well and rested on January 1, so I can enjoy the same throughout the year (wink).

An exception was December 31 of 2005. I was in Moscow and it was cold, with lots of snow on the ground. Two medical-unit colleagues and I decided we would walk down to Red Square to people-watch. The Kremlin was holding a huge outdoor party in the Square but it was by invitation only, and we were not invited. We arrived at the Okhotny Ryad shopping center, which is a large underground mall just outside the entrance gates to Red Square. The street crowd was massive—many thousands, just milling around, drinking and singing. At the ground-level entrance to the mall, a park and recreation area, soldiers stood in a semi-circle, shoulder to shoulder. One of us decided we should try to get in, so we made our way to the front and flashed our diplomatic badges. VoilĂ ! The guard let us pass.

We were feeling pretty cocky until we realized that, behind the barrier of guards, was another barrier in front of the gate to Red Square. We boldly marched forward and got in the line, but when we made it to the front, our diplomatic badges didn’t pass muster and we were denied access. Darn!

We found a vantage point to watch the activity but, as we were still outside the walls of Red Square, we had no inkling of what was happening on the Square. Then we noticed an opening in the wall, off to the side from the main entrance. A few people, walking on a path that led to the opening, disappeared into the Square. There appeared to be no guards at all. Well, you just know we had to give it a try and, once we made our way to that path and through the portal in the wall, there we were inside Red Square on New Year’s Eve!

The rest of the evening was truly magical. President Putin addressed the crowd on a big screen set up to the side of a stage, where entertainers sang and danced. Fireworks burst over Saint Basil’s Cathedral, probably loud enough to disturb poor old Lenin, who was laid out in his glass box across the way. I have no idea how the invited guests were chosen, but the variety of languages spoken was like a mini Tower of Babel. People sang and danced and generally had a great time, my friends and I among them, considering our selves very fortunate to be enjoying the party rather than experiencing the disgrace of having been caught gate-crashing!

Happy New Year!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.