When Johnny Met Rosie--Women in EMS Part 4: God Save the Queen

"To find out a girl's faults, praise her to her girlfriends." --Benjamin Franklin

A few months after my promotion to a training assignment, I took a per diem line position at another MICU (couldn't stay off the truck). Like any new job, it had its good and bad points. I had to learn a new system that had a completely different dynamic than I was used to. At the core, however, was where I found peace of mind, because no matter where you work, the job is essentially the same. Instead of the deluge of concerns and daily forest fires I have to contend with at my primary job, when I go to the other place my function is simple: "You just want me to go out there and take care of sick people? Heck, I can do THAT." And that's what I do. I am not there to make waves, storm any castles or otherwise hit the proverbial radar if it can be avoided.

Yet, in short order, I had four separate complaints about me from BLS providers. Different agencies, different incidents, I had a different partner each time. The complaints were specifically about me and my behavior or attitude.

Now if you know me as a provider, this is unusual. Nobody gets along with everyone, ever. However, I have always had a good working relationship with the BLS providers I've practiced alongside. I am just not known for being "bad" to BLS. If I am irritated, it is usually isolated to patient care issues and will be addressed in due course.

I had only been off the road for about three months, so it's not like I experienced any radical changes in experience or practice. All I did was put on a new patch and go back on a truck; my personal ethics and clinical practice had not changed. Yet, now I was accused of being "rude" and "cold" and "mean." I had a "snobby attitude" and "blew off the BLS."

Listening to what was being said, I went back and dissected every single call and could not think of one single thing that was out of place each time. There were no icy comments, dagger-filled glares or snide comments. None of the patients were critically ill, where there might have been a dispute over a care issue. I had thanked the responding crew after each assignment, yet I was apparently this icy bitch on wheels. What the heck was going on? In venting to one of my partners, he said something that gave me pause: "She just didn't like you calling the shots."

There it was--SHE. In almost every instance, the source of the complaint was a woman, usually the only woman on a regular crew, or at least the woman in authority (crew chief, captain, whatever). Unlike my main job, where I have established presence, for the first time in a long time *I* was the new kid on the block. I was the new face, the unknown, the wild card...and a GIRL. It did not matter that it was part of my designated role as the paramedic to direct patient care. It did not matter that in some instances I was the only one on scene capable of doing a particular skill as part of my job and not my gender.

What mattered was that I had stepped into the sandbox without even a "by your leave" and usurped what was a unique position. I had ticked off the alpha female in the room. Just to be fair, I piss off guys, too (but that's a different article).

In a career ground that we all acknowledge is male-dominated, an arena where to succeed we often have to work harder, longer and with a different approach just to attain the equivalent respect, why is it that women are harder on each other than anyone else usually is? Why is it that when you put two unknown women providers in the vicinity of one another you run the risk of the ambulance turning into this subtle version of Thunderdome (two women enter, one woman leaves)? Well, since nobody will say it out loud, I guess I will.

We like having the playing field all to ourselves. We worked for it, we earned it and we're not about to let just any pretty young thing come in and supplant us without proving she can cut it.

I like to pride myself on my level of professionalism, but when I think about it, I know for an absolute fact that I judge women faster and harsher in the field than I do the men. I instinctively look for all the tell-tale signs that she's a girl and not a provider, and if she displays one sign, the scales inside my head automatically tip. We're talking an interaction of a minute or less.

When I discussed this topic with other female providers of all levels and experience, with a single exception they all agreed with me without hesitation: Yes, they are harder on women. What are we looking at?

Hair and make-up perfect? Honey, if you're sporting lip gloss on a highway at 3 a.m., it isn't a bandage you're looking to wrap.

Are you window dressing? Hanging back and not touching anything unless forced? Hands in the pockets, not even picking up equipment unless directed? Décolletage ramped up and spilling over your neckline? Are you wearing open shoes that display your pretty manicure or, if it's summer...shorts? It's not safety or patient care that you're thinking about.

Dragon-length acrylics clamped firmly to a sturdy clipboard, hugging it like a life preserver in the event of a water landing? A number of the women I interviewed universally agreed that the "clipboard-hugger" was the kiss of death. One of them told me, "Every scene you go on, there's always one girl on the squad hugging a clipboard for dear life, who won't touch or lift anything. As soon as I see that, I think, ‘Well, you're of no use to me.' So I move on to the patient and often forget she's there."

For most of my articles, I interview women of all types in the field, friends and co-workers, and people I happen to see in my various travels at work. I also usually throw out a survey on Facebook, because it consists of field providers from across the country, who can be a wonderful cross-section that is rich with individual experiences you will not get anywhere else. So this past month, I put it out there: "What do you hate about women in EMS?" What is it that ticks you off that is usually tied to the female provider? While the answers themselves did not surprise me, two things about them did.

First was the concentration of responses. The top two things that piss women off about other women in EMS are:

• Inability to lift/do the physical aspects of this job. The first time someone says she can't do something because she is weak or a girl, other women want nothing to do with her.
• Sluts. I thought about softening the term, but that is exactly the word used by women of all levels and all services. It refers to those who are openly sexually active, behave in a promiscuous manner or give the impression they are happy to barter with the skills they have on hand. That was the behavior many think give us one of the worst images.

The second thing that surprised me was the venom. Holy cow, ladies, I'm going to wear a flak jacket and helmet next time I put that question out there. Women absolutely hate other women they perceive are giving us a bad rap on the whole. You could see it not only in the language used, but in the quick, sharp, angry responses--much more demonstrative than keeping the question general about providers as a whole. We piss each other off, sometimes without even trying.

Why? Why do we do this when we know, at least on some level, there's a very good chance that these women might be intimidated, or they are just looking for direction and some help? That with a little investment they might open up and flourish as providers.

Is it because we never got it? Because many of us had to struggle through shift after shift of mistakes and self-doubt, hiding our tears in our cars on the way home and wondering why in the hell we bother to do this at all? Is it tough love? A demonstration of what she should be on a scene, of our own hard-won place, the lioness yawn that turns into a roar just to prove a point?

Is it because all of us were one of those women when we first started out?

Nobody comes out of the gate with her feet under her, comfortable in both her role as a provider and as a woman navigating a unique environment. It takes time, mileage, successes and failures to help fill that mold with some confidence on any level. It's very hard to balance our femininity without having it be misconstrued for intent, or even a crutch. I think it would be a lie to say you've never once in your career been mercenary enough to use your uterine privileges to get out of a less than desirable task. Chivalry isn't dead; it can even be your friend when wielded appropriately.

We approach the danger zone, though, when we use gender as an excuse, and I wonder if that isn't the deep-seated fear for all of us. We usually enter EMS knowing that it will be an uphill battle regardless of gender. We don't want to be seen by any of the traditional female stereotypes, but it doesn't change the fact that we are women and that shouldn't just be ignored or hidden. When we personally hit our stride and have our established circle of respect, we don't want to have to fight that fight all over again. So we're naturally hypersensitive and automatically see in other women what we've worked to overcome, as if their actions somehow reflect on us.

If you're taking offense to any of these descriptions, remember that I am generalizing. Women partners often go one of two ways: they click and it's like that first day back at high school after summer vacation, with happy squeals and chatty girl talk, music on the radio and delicious gossip. You might take some patients to the hospital, but that's incidental to the fun you're having. Or, the partners are polite, friendly, and maneuver quietly around each other while working out each other's abilities and deciding who will play what role that shift. Oh, we'll be supportive alright, as soon as you acknowledge that we were there first.

Of all the emergency services, women have made huge in-roads into EMS compared with either police or fire. So even though we're still the minority, there will usually be at least some women in every service you encounter. Because of the working dynamic, it sometimes seems like EMS in many regions maintains an almost matriarchal society--tours, teams, crews or agencies operating under the guidance or influence of these "mother" figures. These ladies' backgrounds or skills aren't necessarily in question; they've worked hard to get where they are, and it's a fragile place to be in.

In the business world these women would be known as the "Queen Bees." According to studies done on female managers, Queen Bees are far less likely to promote or advance women than they are men, and it's not a one-way street. One might think we'd support a sisterhood, but it turns out we don't like being told what to do by "Mom" now anymore than we did as kids. Approximately 70% of women said they preferred having a male boss, and the men were more accepting of a female manager, saying it didn't matter to them either way providing she was competent.

The nursing profession has battled this fight for decades, in what they call "lateral bullying" or "horizontal hostility." In a profession whose hallmark is compassion, it can be rife with jealousy, sabotage, hypercriticism and downright cattiness. In one paper, the nursing field was referred to as a "pink ghetto," which I thought was an awesome turn of phrase to help describe the complexity of women working together.

One woman I interviewed broke down the dynamic to simple supply and demand. There are plenty of good providers out there, but ones with strong skills are in high demand. Statistically speaking, only a portion of these folks are women, making them a limited resource. By ensuring you have no competition for your niche, you keep the supply low and the demand high, which results in personal security. If another female provider comes on the scene, you will think you have to continue proving yourself (even if all of this is in your head). Increasing the supply has devalued your position.

In some ways, it is one of our generalizations that work against us. Boys are usually raised to be openly competitive and more assertive, while girls are told to "be nice." I would imagine that is partly why we are not usually the first to openly confront someone. Women rarely get in each other's faces, at least in the absence of a precipitating event. You are more likely to get the cold shoulder and then hear about it later on.

Sugar and spice and everything not-so-nice, a study by the Workplace Bullying Institute (yes there really is one) says in addition to targeting female coworkers 71% of the time, female bullies use different tactics than their male counterparts. Men tend to favor more outright forms of bullying, such as verbal abuse, while women prefer more under-the-radar techniques, including sabotage and abuse of authority.

This is an awful lot of sociology! And I thought all we're doing is taking care of sick people. If I'd known there was going to be a quiz on complex human dynamics, I would've studied.

So with all this in mind, can anything be done to mitigate the situation and perhaps foster a more supportive environment for those women who will come after us? Can we build a culture based on respect and not competition? It's a tall order, considering all of the factors that come into play. Regardless of what role we're playing, we can certainly try to get along.

Remember that body language and expression make up more than half of all nonverbal communication. Making eye contact, having a confident body posture and just smiling in response can often make a big difference. Your approach and non-verbal reactions can easily dictate the progress and tone of an entire relationship, from something as brief as patient care to a long-term partnership.

For the new girls on the block, hang in there. There's a lot to be learned every day out there. For heaven's sake, don't be afraid to get your hands dirty. You are going to make mistakes, both personal and professional. Do you know how we know? Because, no matter what we might say to the contrary, we made them too.

Disclaimer: My former partner Charlene would like to point out that this article should in NO way bias anyone against lip gloss. That a little color now and then is good for the soul.

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact her at taloscar@gmail.com.

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Recommended Reading

• Tripping the Prom Queen: The Truth about Women and Rivalry by Susan Shapiro Barash, 2006.
• In the Company of Women: Indirect Aggression among Women by Pat Heim, PhD, Susan Murphy and Susan K. Golant, 2003.
• Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other by Kathleen Bartholomew, RN, MN, 2006.
• workplacebullying.org