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Many of the questions asked by newly promoted managers reflect their concerns about managing friends and acquaintances who, until only recently, were organizational equals. This is always a concern when the new manager comes from within the work group, and in the health care setting, the new manager frequently comes from within the work group.


A certain amount of withdrawal from the group will occur naturally over time. The manager should not be overly concerned about how it will happen but simply accept the fact that it will happen. However, there are some aspects of the manager's relationship with former peers that require conscious monitoring and close attention by the manager.


The work group is also a social group or, more accurately, a collection of overlapping social groups of varying size and closeness of membership. The manager, who was formerly a normally integrated member of the group, had a number of relationships that coincided with or perhaps extended beyond the relationships required in the performance of work. The manager's peers were not simply coworkers; some were friends and others were at least acquaintances. The manager was undoubtedly closer to some than to others and probably did not care for some as much as for others.


When one member is appointed manager, the structure of the group is altered and the new manager's membership in the group changes. Therefore, some amount of withdrawal begins almost at once without the manager making a conscious effort to establish distance. Structural changes and the changes in one person's status are enough to cause some group members to begin pulling away from the management appointee. The appointee is now "the boss," and whether or not all the former peers accept that reality, most will recognize that the appointee now has some authority that was not previously there and that the use of this authority could affect them and their jobs.


Should you experience promotion from the ranks, your former peers, now your employees, may begin to pull away from you for a number of reasons, including the following:


* As manager, you are now an authority figure.


* To those few employees who will always regard management with suspicion, you are now on "the other side."


* Some who considered you their friend may deliberately back away from you to avoid creating the appearance of trying to trade on your friendship.



To a number of employees, however, it is likely to be business as usual regardless of your new role as manager. With some of these employees, it may be necessary to take deliberate steps to limit the extent of personal relationships. It is easy for the appearance of favoritism to develop from your relationship with a few employees. Although you may be able to maintain such relationships and at the same time scrupulously avoid playing favorites, it is often the simple appearance of favoritism-although no actual favoritism may exist-that does the damage.


Your withdrawal from coworkers will be reinforced by the effects of structural changes in the way you work. You will spend less time on the job with former peers and less time doing the hands-on work of the department. Instead, you will spend a certain amount of time with other managers, including your superior, and will be involved in management activities such as planning, scheduling, and budgeting. These kinds of activities tend to either keep you from contact with individual employees or channel necessary employee contacts along fairly specific lines. In short, as manager, you must go your way while your employees continue to go their way. Although your way and their way coincide much of the time, because you have many common tasks and objectives, you nevertheless now have things to do that take you away from the group's immediate interests much of the time.


Management has been described as a lonely calling. This is true to some extent even at the level of first-line manager. A new manager no longer enjoys full-fledged membership in the social groups that overlay the work group. Certain formerly close relationships are bound to be affected, and the manager cannot help but experience a sense of loss. Although becoming a manager supposedly opens the door to other relationships and membership in other groups, the gain is ordinarily not sufficient to cover the loss. The departmental work group encourages close, long-term relationships because members spend much time together in pursuit of common goals. However, the organization's managerial "group" is a different matter. Managers, scattered throughout the organization, are each concerned with their own departments, so relationships among managers are often necessarily looser and less active than relationships among nonmanagers. Thus, the new manager may experience lonely or isolated feelings. He/She can no longer be as close as previously to former peers, and the opportunities for forming new, close ties are limited.


The manager promoted from the ranks probably has a few more advantages than does a manager recruited from outside. The insider knows the organization and how its parts work together, knows the department and its tasks, and knows the people in the group. However, a major disadvantage faced is the tendency of many of the employees to remember him/her as "just one of the gang." How well an employee's entry into management is accepted by other employees will depend a great deal on how well the person was regarded in the work group before the promotion. Someone who was reasonably well liked and respected as a member of the group will likely be given a chance to win the respect of the group as their manager.


Being liked is important to almost everyone; surely, most people would rather be liked than disliked. However, in their desire to get along with everyone, some managers make the mistake of putting the desire to be liked ahead of other considerations. Far better for the manager is to be respected-respected for job knowledge, integrity, fairness, and such-rather than simply to be liked. The manager whose actions convince employees that each is an individual worthy of respect and special attention is well on the way to earning the respect of his/her employees.


To properly withdraw as a working peer after being promoted to a management position, consider the following:


* Play fair. Go out of the way to guarantee that each employee receives equal consideration in all matters.


* Recognize that you can do nothing to guarantee that you will be liked by all employees at all times.


* Through your actions, strive to earn the respect of the employees. Never assume that the limited respect that may be given your position is automatically owed to you as a person.


* Do not get carried away with the symbols of status and position, the so-called perks of management.


* Recognize that your status as a group member has changed.


* Make certain that you are simply stepping back a short distance, rather than turning around. You need to remain visible and available to your employees. Your employees do not work for you, they work with you, and your primary function is to help them do their jobs as efficiently as possible.



For your additional consideration, this issue of The Health Care Manager (Issue 27:3, July-September 2008) offers the following:


"Responding to a Bioterrorism Attack-One Scenario: Part 1" outlines a simulation conducted as part of a federal grant award, simulating an attack of anthrax into the Central Florida region and highlighting the spread, effects, and eventual control of the disease entity.


"Acute Myocardial Infarction and Race, Sex, and Insurance Types: Unequal Processes of Care" reports on an investigation following up on earlier studies suggesting that whites and African Americans do not receive the same processes of care for a first episode of acute myocardial infarction, one of many cardiovascular disease pathologies.


"Inappropriate Selection of First-Line Managers Can Be Hazardous to the Health of Organization" examines the possible perceptions of employees concerning new, relatively ineffective first-line managers and cautions against some common hazards of placing new managers without full consideration of their qualifications.


The Case in Health Care Management, "The Turnaround Challenge," asks the reader to offer suggestions for turning around an underproducing department the employees of which have long been accustomed to a lax and undemanding management style.


"Strategic Analysis in Nursing Schools: Attracting, Educating, and Graduating More Nursing Students: Part I-Strengths, Weaknesses, Opportunities, and Threats Analysis" is the first segment of a 2-part article reporting on research undertaken to identify strengths, weaknesses, opportunities, and threats facing schools of nursing in their efforts to increase enrollments.


"Employee Satisfaction and Employee Retention: Catalysts for Patient Satisfaction" suggests an indirect approach to patient satisfaction in that greater emphasis on issues of employee satisfaction and on improving means of employee retention will likely yield improved patient satisfaction.


"Serving Billions: A Pilot Study on Clinician-Perceived Efficacy of Rehabilitative Services in China" reports on a study that addressed rehabilitative services in China, identified the most common treatments modalities and average patient charges, and addressed the extent of the use of Western medicine in Chinese rehabilitative services.


"Sex Differences in Health Care: The Compensation Experience of Registered Dieticians" presents the results of a study undertaken to follow up on a 2002 survey of gender differences in compensation, suggesting that there has been only minor positive change in recent years and that health care in general continues to experience gender-based compensation differences.


"Helping At-Risk Students Succeed on the National Council Licensure Examination-Registered Nurse" suggests the means by which the members of an increasingly diverse nursing student population may be prepared for success on the National Council Licensing Examination-Registered Nurse.


"The Health Care Professional as Manager: Balancing Two Important Roles" explores the problems often encountered by professional employees who move into management and suggests how to successfully balance the 2 roles of functional specialist (working professional) and manager.