4. If you were a staff nurse at this facility, how do you think you would have reacted to this change in administration?

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new vice president of nursing was brought in to replace the former one, who had retired after 30 years. Th e vice president addressed the staff members at the reception held to welcome her. “My philosophy is that you cannot manage anything that you haven ’ t measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more effi cient than ever.” Th e nursing staff members soon found out what the new vice president meant by her measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the “interruption” in his or her work.
No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel offi ce, overwhelming the sole benefi ts manager with their requests to “tell me how soon I can retire with full benefi ts.” Th e vice president of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area off ered few good job opportunities.