You are a nurse manager in an agency that is experiencing financial difficulties, and this problem affects more than just your agency. You are located in a county that is economically depressed, and unemployment is high. You have just received the budget for the next financial year and note that you have lost one full-time position, meaning you must lay off one of your full-time nurses. Because of a poor economic situation, it is not possible to transfer within the agency, and the layoff will most likely be a permanent one. Also, no other agencies in the area are hiring, although some jobs may be available through a staffing pool or on a contingency basis. You must decide which of the following three employees to lay off. This is a nonunion agency, each of the nurses has the same number of years of service with the hospital, and all three have had very similar performance evaluations for the past 3 years.
Nurse A: Nancy is 50 years old and entered nursing later in life after raising a family of four. She is married to the hospital’s chief of staff, and some of the younger nurses on the unit resent her “country club” attitude. They think she is not really serious about nursing and works only to escape being bored. Nancy does a good job, but she does have some difficulty working with other staff nurses. You personally like Nancy a great deal. She is closer to you in age and life experience than the other staff nurses, and you find yourself turning to her for advice and support. Nancy has confided in you that she really enjoys her newfound career. She says that for the first time in her life, she has an identity of her own instead of always being somebody’s daughter, spouse, or mother. Nancy has missed 4 days of work in the last 6 months: 2 days to take her mother to the doctor for evaluation of Alzheimer’s disease, 1 day because her husband unexpectedly told her that she had to accompany him to an important hospital social event, and 1 day for calling in sick.
Nurse B: John is 35 years old and the only male nurse on your unit. He has suffered a number of personal crises and losses in the past 2 years. His 2-year-old son has Down syndrome, and his 10-year-old son was killed in an automobile accident last year. About 6 months ago, his father died unexpectedly from a heart attack. John has confided in you that he is really struggling with these personal losses. He is especially having difficulty with losing his son because he says he will never be able to do all the “father and son things” with his 2-year-old son that would have been possible with the older son. John says he just doesn’t feel the same kind of bond with either his 2-year-old son or his 6-year-old daughter. John also states that he’s having difficulty with his wife. Their relationship is very strained and stressful. He’s not sure if the marriage will survive. He says that he has been very depressed over all of these crises and has sought professional counseling. He also tells you in confidence that the psychiatrist has him on antidepressants to help him cope. John has missed 4 days of work in the last 6 months. All of them have been on Mondays. He says that the depression at times has made it difficult for him to start another week.
Nurse C: Carrie is 33 years old and is very well liked by her peers. She is an informal leader in the group. You personally don’t like Carrie very much. She was working on the unit before you became manager, and she has constantly challenged you since you arrived. She is argumentative and resistant to change, but she always ends up doing what you ask her to do. You worry about the effect that she has on unit morale, yet none of the staff nurses has ever reported having difficulties working with her. About 9 months ago, Carrie seriously injured her back when a patient she was ambulating started to fall. Carrie saved the patient from injury, but she was on medical leave for 6 weeks because of the incident. Her recovery may have been hindered by the fact that she is 40 pounds overweight. Because of her back injuries, she often requests that she be assigned to charge (desk) duty. Other staff nurses have offered to give her their charge duty or volunteered to help her with patient care if she needs any assistance. Carrie has missed 4 days in the past 6 months: 2 days on two separate instances, both for complaints of back pain.
Which nurse will you lay off? List two reasons to terminate or retain each of the nurses.
Case Study 2
Susan, a new graduate nurse, is assigned to a general medical/surgical unit. After an extensive orientation, she is assigned to the night shift. She has worked hard and demonstrates considerable learning and an effective transition into her role as a nurse. She arrives at work one Saturday evening, receives her assignment, and begins her work. After rounds, she is in the nurses’ station and strikes up a conversation with the other, more experienced nurse. As she draws closer, she notices an unusual smell. It smells like beer. She watches the other nurse more closely and notices a slight unsteadiness in her hands and slower speech. Susan knows that this more experienced nurse is her only co-worker for the shift. Susan asks where the experienced nurse was before coming on shift. The nurse says she was with friends.
1. How should Susan proceed?
2. In spite of the reassurances, Susan is concerned about the nurse. What would the next steps be?
3. How might this action affect Susan’s reputation on the unit and her relationship with the experienced nurse?
Case Study 3
Carlos, a new professional nurse graduate, has been asked to participate in the hospital-wide initiative to go live with an electronic medical record (EMR). Carlos understands that nurses and physicians at his institution have long resisted technologic advances, and this conflict has taken 10 years to progress to the point of implementing the EMR with computerized physician order entry (CPOE). Some work has been completed by the committee to gain buy-in, in an attempt to reduce resistance and reluctance, and plans are now needed to effectively manage conflict after implementation.
1. What strategies can Carlos and the EMR implementation team employ to address conflict management before the go-live date?
2. What strategies can Carlos and the EMR implementation team use to address conflict management after implementation?
3. What conflict-handling techniques will be of particular importance during the implementation?
Case Study 4
Sandra recently began to question her decision to become a nurse and was considering leaving the profession after only 6 months of licensure. Orientation had left her in tears at least once per week, and she began to question her ability to be a safe and competent nurse. Sandra felt belittled by her preceptor and unsupported by her co-workers, who all seemed too busy to help her. She frequently observed her preceptor roll her eyes and sigh loudly when Sandra asked a question; she observed the same thing from the preceptors of the other two new graduates. Sandra understood that her preceptor was experiencing conflict in her own life because she commonly overheard her preceptor on the phone arguing with her husband.
1. What strategies can be implemented to reduce lateral violence on Sandra’s unit?
2. What can Sandra and the other new graduates do to improve the work environment?
