Question

Case Summary

The case opens with Barbara Norris struggling through another 18-hour day as Nurse Manager of the troubled General Surgery Unit at Eastern Massachusetts University Hospital. Norris assumed the position of Nurse Manager just one month prior but has worked for over 20 years as a RN at EMU in

both full-time and part-time capacities (the latter for several vears while her children were voung)

She recently completed her Masters in Nursing and Health Care Administration and this is her first managerial role. She is coming from the Trauma Unit at EMU where a helping and effective team culture prevailed.

In GSU, Norris has inherited a 33-person unit with the lowest employee satisfaction scores and

highest emplovee turnover rate among all or the departments at EMU. Furthermore, the unit is infamous for its culture of confrontation, blaming and favoritism. It is also short-staffed, having lost five RNs in recent months, and the staff that has remained is dissatisfied, unmotivated and not functioning as a team to deliver patient care. In fact, GSU's patient satisfaction scores, although average, have been declining steadily over the past few years.

In addition to the manifold problems within the unit, the hospital is also experiencing significant challenges as a result of a national economic crisis. EMU's administration has been forced to implement deep cost-cutting measures throughout the organization including a treeze on hiring and

overtime pay.

Within this context, Norris has been asked by EMU's Director of Nursing to turn the unit around and to do so quickly. Norris welcomes the challenge but wonders where to begin. There are multiple

interpersonal and intergroup conflicts on the unit. For example, tensions exist between the older and younger RNs, between the RNs and PCAs and between the RNs and the unit's attending physicians.

In addition, even though the unit is under staffed, Norris cannot hire any new staff or offer overtime

to her current roster due to the hospital-wide budget cuts. Also, she has discovered that the performance review svstem is in disarrav and there are not complete and accurate records of the staffs previous annual performance reviews.

In an eftort to move the unit towards more open communication and transparency. Norris decides to hold an off-site to begin the dialogue and open the lines of communication. Three of her staff speak at the meeting giving first-person representation and voice to the different generations and level of experience present on the unit and an accounting of the numerous problems manitest in GU including lack of cooperation and support between the statt; lack of acknowledgment for positive contributions; feeling pressured to make difficult patient care decisions because of staff shortages; lack of transparency in review and reward processes; lack of input on scheduling; and too few opportunities for growth and continuing education.

Norris knew she had many challenges ahead of her but the feedback she received at the off-site was even more negative than she anticipated. The case closes with Norris making a list of items that most trustrated or de-motivated her stat and pondering the best way to move forward.



Questions:

As the Director of Institutional Development at that hospital, how would vou assess Ms. Norris' handling of the problem?

Answer 1

Ms. Norris has correctly identified and taken initial steps to address critical issues within the General Surgery Unit. Organizing an off-site meeting for open communication was a positive starting point although her approach will need to be followed by systematic changes and the development of a supportive culture within the unit.

Step-by-step explanation:

As the Director of Institutional Development at the hospital in question, assessing Ms. Norris' handling of the problem in the General Surgery Unit (GSU) involves analyzing her actions given the complex and challenging circumstances. Ms. Norris demonstrated an initial actionable response to the unit's issues by organizing an off-site meeting aimed at improving communication and transparency. Although faced with a deeply troubled unit characterized by low employee satisfaction, high turnover rates, and staff conflicts, Norris made strides toward opening dialogue among her staff, an essential step in resolving interpersonal and team dynamics. despite the constraints of budget cuts and staffing freezes, Norris has identified key issues such as the lack of cooperation the need for recognition of staff contributions, and the staffing shortages that contribute to difficult patient care decisions. Moreover the current performance review system's disarray is a critical area that requires attention to ensure a fair and systematic approach to employee development and recognition.

Barbara Norris' approach aligns with management best practices that prioritize open lines of communication and employee engagement as a foundation for change. While the impact of her strategies is not yet realized her recognition of the problems and her initial efforts to address them are important precursors to any substantive improvements. Future steps should include implementing systematic changes to address the identified concerns and developing a supportive culture that values the contributions of all staff members.