Unfortunately, as soon as the complexities of our evolving health care delivery system mix with human relationships, even the best-intentioned supervisors can find the management side of their jobs deteriorating into chaos. Today's health care providers face expanding workloads, fewer resources, greater patient expectations, increasing threats (e.g., malpractice lawsuits), and closer scrutiny, especially from third-party providers. The art of healing is being transformed into a business. And like it or not nurse practitioners and physician assistants often find themselves in middle-management roles, with tremendous responsibility and little real authority. Job performance is reflected more in the bottom line than in the quality of patient care. Why, in this environment, do some managers thrive while others burn out? The answers lie in each manager's ability to inspire trust, loyalty, commitment, and collegiality among team members. The same techniques that work elsewhere in business can bring success in nursing and medicine - whether you're working in clinical practice, administration, or academia. More often than not, though, the task can be accomplished only by replacing learned behaviors with newer, more effective models.

The example set by past generations has led to huge numbers of autocratic managers today. Some lead this way because they honestly, and consciously, believe it is the best management style. For most, however, it is how they were treated throughout their careers (particularly at a first job). The cycle works very much like child abuse, where the abused child grows up to be an abusive adult. If you were managed by an autocrat, it is very likely that your most natural, comfortable method of management reflects that of a previous supervisor, especially your first.

Physician assistants and NPs find themselves particularly vulnerable to this cycle of abuse. Both professions faced great hostility from the moment of their inception. Today's NP or PA leaders spent years struggling to prove their professions' full worth, overcoming the mentality that nonphysician providers were hired to answer telephones and empty bedpans. Frighteningly, today's senior PAs and NPs are the product of that mentality.

WHY CHANGE?
While fear as a management style can accomplish impressive short-term results, the long term consequences can be devastating. With demand high and supply short for NPs and PAs, no manager can afford to alienate other clinicians. Similarly, efficient support staff are also becoming harder to recruit and train, as the technology of the workplace speeds along at a blinding pace. Disgruntled employees may vent their frustrations by being rude to patients, performing poorly, quitting, or complaining to upper management; some supervisors may even face lawsuits for treating subordinates unfairly.

An autocratic management style feeds high staff turnover and low employee morale. Low morale, in turn, causes a decline in productivity and in the quality of service provided to your patients. And while many autocratic managers still populate the American health care system, reform demanding higher efficiency and productivity will eventually squeeze such managers out of the marketplace. In short, motivational management produces better results; those who focus on positive reinforcement rather than fear and intimidation will be the successful managers in the next millennium.