Many years ago I attended a workshop at The Menninger Clinic in Topeka, Kansas. The topic was about when a clinician enters the administration work field. I don’t remember much of the workshop except this: “middle managers are like Oreo cookies”. Let me explain.

First and foremost clinicians are people pleasers. We do our work because it makes us feel good to get positive responses from others. Now to the Oreo cookie. It has two chocolate cookies with a white yummy filling in the center. Middle management is the yummy center. The staff they are responsible for one side of the cookie, supervisors, the other side. Middle managers are in the middle, stuck between trying to please their staff and their superiors. It is a no win situation because administration goals and clinicians needs are often at opposition to each other. A middle manager can’t really please either to everyone’s satisfaction AND it is a middle manager’s personality to try to please everyone.

I was giving a presentation the other day and used that illustration. I watched heads nod in recognition. Now I’m going to take this idea a bit further. I see a “ladder” of Oreo cookies. Not just administration, middle managers and staff but how about this, the patient and family with the clinician the “yummy center”? We as clinicians are very often the “go between” for the patient and family. Sometimes it is challenging to please both. The patient/family unit and their physician often finds the nurse in the center trying to advocate for the patient while wanting the physician to be pleased with the agency and give more referrals.

"Being in the middle" continues with the nurse/social worker/chaplain being the connection to the hospice/palliative unit or hospital and the patient/family. Then up the chain of command from staff to supervisors to department heads, to executive offices to CEO. All caught in the middle of trying to please those below and above them in the chain of command. Stress, stress, stress for everyone.

Okay, now go home. At home we have kids and school, kids and partner. We have immediate family and extended family. We have personal life and the community. We are the go between activity on one side and the other. We are often in the center of opposing wants and needs, ideas and ideologies. Yes, life is indeed a stress inducing Oreo cookie.

I’ve reread this blog and see that I have outlined a problem but not offered a solution. How about this as a starting point: on the airplane, before the flight takes off, flight attendants explaining the safety procedures tell us to put our oxygen mask on first before helping others. I think we need to take care of ourselves first in order to have the energy to help others.

Something more about Hospice Middle Management & Oreo Cookies: In my new film, Care For The Caregiver, I reference times when I was the "creamy white middle" of the cookie and the ways I found to take care of myself before caring for others. This film is especially for end of life caregivers and their teams.