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Emotional responses to unplanned voyage

by Penelope Chase
Psychiatric Consultation Liaison
Many of us are experiencing different feelings and energy levels as we gradually hear announcements and rumors of changes throughout the university and the Medical Center.

Money is tight. Federal cutbacks in Medicare reimbursement are affecting all hospitals nationwide, especially teaching hospitals who traditionally have provided treatment of the elderly and under-insured or uninsured. Federal subsidies for medical education have shrunk. Budget-trimming is par for the course.  JCAHO is coming.  The change to being a State Authority is here. The equilibrium of the status quo has been shaken or lost.

For some, the only noticeable difference is on paper. The paperwork for days-off is different. Our paycheck is a little different, but otherwise things may be pretty much going on as before in our day to day performance on the job.

For others, colleagues or programs are gone, perhaps voluntarily, perhaps not - perhaps a mixture of both. Things feel different, and uncertainty may persist. This wasn’t expected. We are full of emotions, or perhaps avoiding feeling at all. We have lost something we took for granted and valued.

“When people choose to work for an organization, they frequently have unconscious expectations from unspoken psychological contracts which involve such expectations as being supported, protected, gratified, and/or having a secure job. When organizations change, employees feel violated, even though such contracts never, in reality, existed,” wrote Harry Levinson 15 years ago. He was discussing the emotional reactions of employees of a large regional telephone company which was going through significant change and reconfiguration.

When we signed on at MUSC we all had expectations, spoken and unspoken. Many of these were assumptions, not promises, and were not reality-based. The present changes are like an unplanned voyage for us. We weren’t prepared for the current changes or this particular journey, even if we may have heard rumblings about losing disproportionate share, etc.

We were prepared—since this is the beginning of a new academic training year as well as a new fiscal one—for some new faces and names this time of year. 

Last year’s fourth-year medical students have become first-year residents, and the new third- and fourth-year students appear in the clinical areas or the labs.  Soon first-year students will move onto the campus and into the library, Wellness Center, cafeterias, and parking lots as they have done every August for a good many years.

Many of us remember the day we first arrived at the Medical University, the hospital, the College of Nursing, Allied Health Professions, or Dental School.  Most of us had some idea of what to expect and took whatever came in our stride, either as faculty, students, or new employees—anticipating a whole new world of academic or work “adventure.” Of course there was a frisson of fear, “what if’s,”  “will I be able to handle it?” But we had planned.  We were ready for the trip.

Dottie Perlman and George Takacs outlined 10 predictable emotional phases associated with organizational change in their 1990 article in Nursing Management called “The 10 Stages of Change: The Emotional Voyage of the Change Process.”  Based on Kuebler-Ross’s Loss and Grief Model, each phase tends to build on the experiencing and working-through of the previous one. 

Perlman and Takacs describe characteristics of a person’s energy associated with each phase, and offer suggestions for getting beyond each stage. 

But, depending on the extent and timing of each particular change, one can also move back and forth among phases as one adapts to loss or change in general or to sequential changes.