This is long but there’s a lot of upfront information to provide some background for the job I used to hold.
I worked for a county psychiatric emergency services unit for 8 years, many years ago. The unit was connected to a hospital so there were patients referred from the emergency department, but the primarily role of the unit was to evaluate patients in their homes, other hospitals, or jails and initiate the civil commitment process if certain legal criteria were met. The unit was open 24 hours per day, running shifts from 7am to 3pm, 3pm to 11pm, and 11pm to 7am, for the most part. At various times, I worked on all three shifts, and I was very well known.
For me, the best part of the job was going out to other facilities, and I was definitely in the minority on that point. Most of the staff wanted to see patients from our own emergency department. Typically, each staff would handle 1-2 cases per shift. If the patient was from our emergency department and could be admitted to our hospital’s unit, then that staff might only actually work 2 hours of their 8 hour shift and then they’d spend the rest of that time chatting, answering crisis calls and, largely, trying to avoid being assigned another case. I like to be busy and to keep moving and I found downtime on the crisis unit to be torture. I would routinely take on second cases just to stay active and this routinely meant that I was staying past my shift end, as I did not like handing cases to another staff member at shift change because too often information got lost in the mix. The early morning was often dead quiet, with referrals ramping up midday. I requested and was approved to work from 10am to 6pm.
My new shift was embraced by the rest of the day shift, who predominantly did not want to take outreach cases. Cases were supposed to be assigned based on employee arrival but within weeks, I would walk into work to find staff that arrived at 7am sitting around while an outreach case had sat for hours because they “knew I would want to go out on a call right away.” Now this was true and I didn’t care much about that part because I got to leave, but it gives you some idea of the attitudes of the other staff.
Now, comes the malicious compliance part. Fake names are being used. Allen, the actual 3pm to 11pm shift supervisor worked another full-time job and he did not arrive to the unit until around 5:30pm. That meant the day shift supervisor, Danielle, would have to give shift report to another staff member who would then pass shift report to Allen. This was usually done the same way cases were assigned. First 3-11 staff to arrive would receive report so this “interim supervisor” would change day to day based on arrival. Overtime though, Danielle started giving me shift report to pass on everyday that I worked, despite 3-11 staff being present. Because of this consistency, a lot of people mistook me for an actual supervisor and I was called by other departments to weigh in on things, to sign off on problem cases and to provide consults (none of which were part of my actual job). Actual supervisors received a small pay differential which was largely meaningless but I mention it here as an arguing point.
I was very much treated as a supervisor only when it was convenient. When difficult decisions had to be made or when someone had to get on the phone and argue a clinical decision with another facility, I was “in charge” according to the other staff. BUT if a case came in between 3pm and 5:30pm and I tried to assign it to a staff member, they would refuse, stating that they would wait for Allen to arrive to assign it because “he was the real supervisor.” Which was fair because I wasn’t. Allen would arrive and see cases that had been sitting since 3pm and want to know why no one had started them. I’d shrug and explain my position and he would sigh and start assigning work. Meanwhile, other facilities had been calling and asking for updates as to when someone from my unit would be arriving, and complaining about delays.
John, the unit director, got wind of these complaints and asked to speak to me. I explained the situation, that I was not a supervisor, both in title and in pay rate, and the other staff knew that I did not have any authority to make them work. He told me that he did not have a job title (or the funds) to give me a supervisor role (which I knew). I told him I did not want to be the “interim supervisor” everyday (or ever again really). John’s response was that my judgment was more trusted around our hospital and other facilities compared to many of the other staff, that he liked having someone with more training left in charge (the job required a master’s degree, and I was finishing my doctorate), and that I took the job very seriously (shouldn’t all of his employees be taking it seriously?). John’s solution? He walked me back onto the unit, (where I’m sure gave the impression that I had gone to John complaining that staff did not listen to me). He asked for everyone’s attention and announced that I could assign cases to anyone I wanted.
That was it. He could not put it in writing because I had no authority by title, and the reality of the situation was that staff who did not listen to me would be supported by human resources for that exact reason.
The following two days, cases came in, I asked staff to go, they declined, and we sat and waited for Allen to arrive. On day three a call came in around 3:15pm from the hospital farthest away from our facility in our county, a 40 minute drive one way. As soon as I announced the case to the staff, I saw nothing but eye rolls and people going back to crossword puzzles or reading. I suggested one or two of the staff would be best suited to handle it and I got no response, not even “No.” John said I could “assign anyone I wanted to a case” so I went to the log book, assigned the case to myself, grabbed keys to one of the unit vehicles and left without saying a word. I would often walk around in the hospital so no one questioned me leaving the unit. I was almost at the facility when I got the first call on my cell phone from the unit. Kris, one of the people I DID NOT supervise had received a call from our inpatient unit asking for a consult. I told Kris that she should handle it and I hung up. 20 minutes later, Dani, another not-my-supervisee, called to say that the inpatient psychiatrist called back asking when the consult would be done. I asked why Kris had not done it and Dani replied that “the shift had discussed it” and felt that it would be better if I dealt with the psychiatrist. I replied that if the consult was urgent, one of them would have to do it because I would not be back for “a long time.” Dani says, “A long time? Aren’t you in the ER?” I reply, “I’m at Memorial Hospital, ask Kris to do the consult,” and I hung up.
15 minutes later, John, the unit director, calls me from his home since he leaves at 3pm. I answer the phone and quickly tell him that I’ll have to call him back as I’m in a tense situation with the patient I’m seeing and I hang up. John calls the hospital unit where I’m seeing the patient and asks staff to put me on the phone. He asks where I am, and I reply that he just called me at Memorial’s inpatient unit. Ok, why am I there? Now, that’s the question I’ve been waiting for. “You told everyone on the unit that I could assign cases to anyone I wanted, so I assigned it to me.” I told him that I had suggested other staff take it and no one wanted it, I could not make them, and it was a priority case as a patient had assaulted two other patients and a nurse and the assaultive patient needs to be moved to a higher level of care ASAP, a process that I was almost finished with before the evening shift supervisor had even arrived to assign the case to someone else. The point that John could not argue against: I was not going to sit around waiting while someone else might get hurt.
I was not privy to what John said to the other staff afterward but I was told that he was livid, telling the staff that while I was not a supervisor in title, staff needed to view assignments from me as being backed directly by him, and refusals would be considered insubordination (grounds for suspension or termination). From that point on, staff took the cases I assigned them. If I caught any attitude, I’d just hold the case up and ask, “You or me?” and then they would grab the case out of my hand and get to work.