When the Megaphone Is Bigger Than the Message: A Leadership Lesson From UNC Healthcare
A leadership lesson is unfolding around UNC Hospitals that extends far beyond one staffing initiative, one nursing executive, or even one health system.
It is about messaging.
UNC has officially announced that Chief Nursing Officer Jacci Jacobs will retire October 31 after 28 years with the organization. A career that long deserves to be viewed in its entirety, and no public evidence shows that the recent controversy surrounding UNC's shift-bidding initiative caused her departure.
Still, one has to wonder about the timing.
Twenty-eight years is just shy of the symbolic thirty-year mark, and the retirement announcement follows what became a significant messaging problem surrounding the shift-bidding initiative. That does not establish causation. But leadership decisions do not occur in a vacuum, and neither does public perception.
Whatever UNC intended to accomplish, the phrase "bid for shift" created an enormous communication vulnerability.
Social media supplied its own interpretation. Nursing commentators described the concept as the "Hunger Games of nursing." Others went much further, portraying UNC as the villain in a story that became less about staffing mechanics and more about nurses competing against one another for work.
Once that narrative took hold, UNC faced a problem no communications department could overcome.
UNC has a megaphone. The internet has millions of them.
No hospital system—not UNC, Duke, Atrium, Novant, ECU Health, or almost anyone else—can compete with the combined reach of Facebook, Instagram, TikTok, Reddit, nursing groups, podcasts, influencers, screenshots, reposts, and thousands of nurses talking to one another.
That is why communication can no longer be treated as something leadership addresses after the operational decision has already been made. The message is the decision.
These staffing decisions are complicated. UNC competes for nurses in the same regional labor market as Duke, Atrium, Novant, and other systems. Every organization is balancing recruitment, retention, vacancies, overtime, incentive pay, agency costs, scheduling preferences, difficult-to-fill shifts, and financial sustainability.
UNC was trying to solve a legitimate operational problem.
But a defensible operational strategy can become almost indefensible when the workforce hears something different from what leadership intended.
Intent does not dampen the outcry from misinterpretation.
Healthcare should understand this better than almost any other industry. If a patient misunderstands discharge instructions, we do not insist the instructions were technically correct. We clarify. We use teach-back. We reconsider how we communicated.
Leadership communication deserves the same discipline. When many employees interpret a message differently than leadership intended, the first question should not be: Why did they misunderstand us?
It should be:
Why were we so easy to misunderstand?
That question matters even more in nursing because nursing is already a difficult profession.
There is workplace violence, moral distress, staffing pressure, difficult patient populations, demanding families, regulatory requirements, documentation burdens, and the emotional weight of caring for people during some of the worst moments of their lives.
Healthcare is also public-facing work, and public-facing work can be unforgiving. Every delay, every interaction, and every operational decision has a human face attached.
Sometimes, nursing culture believes compensation can solve all of this.
Pay me more. Increase the differential. Add another bonus. Increase staffing.
Compensation matters. Staffing matters. Just like all non-nursing support roles (i.e., housekeeping, unit clerk, etc.), so do transportation staff and others who support patient care. All aspects of nursing practice occur within a larger healthcare environment. The absence of these support personnel either due to lack of funding to hire replacements or hiring freezes will result in increased responsibilities for the bedside nurse, increased frustration among the bedside nurse and the perception that the entire healthcare delivery system has failed.
Nurses should be paid in ways that reflect their skill, responsibility, experience, specialty, scarcity, and market conditions. But money does not solve all your problems.
Money can not stop you from being assaulted at work. Money will not make a dangerous job assignment safe. Money cannot replace bad leaders, a toxic culture, lack of support, or trauma to one's conscience (moral injury).
Compensation depends on the labor market. In other words, what a Medical-Surgical Nurse, Intensive Care Unit (ICU) Nurse, Emergency Department (ED) Nurse, and Perioperative Nurse are paid depends on what similar employers in the same area pay.
UNC watches Duke.
Duke watches UNC.
Atrium watches Novant.
Novant watches Atrium.
Everyone watches everyone.
That is not unique to nursing. That is how labor markets work.
At the same time, nursing offers something unusual among professional careers. Many bedside nurses can consolidate full-time employment into three twelve-hour shifts each week. Those shifts can be exhausting, but that schedule can also create opportunities for overtime, education, per diem work, consulting, advanced practice education, entrepreneurship, writing, content creation, or another business. That brings me to what I believe is one of nursing's greatest vulnerabilities.
We too often approach our profession from a position of weakness when we should be approaching it from a position of power.
Nurses are not powerless. Hospitals cannot function without nurses. Emergency departments cannot function without nurses. Neither can operating rooms, intensive care units, inpatient units, procedural areas, ambulatory practices, home-health programs, infusion centers, and much of the rest of healthcare.
That is enormous leverage.
Yet nursing does not always use that leverage. Too often our conversations begin with what administration did to us.
What did they take away?
Why aren't they paying us more?
Why aren't they listening?
Sometimes those questions are justified. But defining ourselves as the weaker party can become a limitation in itself.
Power is more than anger.
Power is understanding your professional value.
Power is organization.
Power is credibility.
Power is mobility.
Power is understanding staffing, reimbursement, economics, operations, and the pressure points that change systems.
Nurses are a powerful force inside a complex healthcare system. We should learn to use that leverage with the same sophistication that healthcare organizations use when making decisions about labor.
And that brings the discussion back to UNC.
Whatever the underlying reasoning behind shift bidding, UNC was communicating with one of the most important constituencies in its organization.
Nurses are not names populating scheduling software. They are a professional workforce with mobility, networks, options, collective influence, and an enormous social-media presence.
That audience required extraordinary care in how UNC introduced the initiative.
Once "bid for shift" became "the Hunger Games of nursing," a complicated operational explanation competed with a phrase anyone could understand in three seconds.
The phrase won.
Then came the retirement announcement. Again, there is no basis to say the controversy caused Jacobs' retirement. But the sequence illustrates another reality of leadership communication: once an organization loses control of the narrative, people interpret subsequent events through it.
A retirement becomes part of the story. A policy revision looks like capitulation. Silence becomes evidence. Clarification becomes damage control. That may be the most consequential lesson here.
Jacci Jacobs spent 28 years building a career at UNC. Twenty-eight years of nursing, operations, leadership, staffing problems, organizational change, crises, accomplishments, and difficult decisions.
The internet can build a competing narrative in days. That does not mean the internet is correct. It means leaders have to respect its power.
Leadership once controlled organizational communication. An executive issued a memo. Managers discussed it in meetings. Human resources prepared talking points. Communications released an FAQ.
That world is gone.
Today, one nurse captures a screenshot. Then another shares that image. The same nurse comments on the post. A Facebook group begins debating the issue. Users dissect the topic on Reddit. Influencers create an infographic from the photo and post it to Instagram. On TikTok, they turn that controversy into a 30-second video clip.
Those who use their microphones also carry a burden of responsibility. Because influencers like Nurse Erica can reach thousands (maybe millions) of people, they can also influence those audiences. While rage-baiting may drive engagement, it can cause harm if it sparks panic about morality, economics, and society before defining the problem.
When outrage is the product, nuance is lost. The message is reduced. What is left after the headline is what will provide the greatest value.
By the following morning, employees may know the social-media interpretation better than they know the original policy.
If the reward system encourages anger and fear, the conversation and the solutions that follow can shift toward views, clicks, engagement, and monetization rather than helping nurses understand the issue, recognize their power and leverage, and identify ways to create positive change.
Once outrage is the item being sold and attention is the commodity, discussions will no longer center on nursing; instead, they will focus on attention, engagement/views, and monetization.
Author: R.E. Hengsterman, MSN, MA, M.E., RN
Registered nurse, night-shift administrator, and author of The Shift Worker’s Paradox
For educational purposes only. Not medical advice.
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