4. What factors might have contributed to the negative behaviors exhibited by Tina, Lynn, and Sheila?

Shawna Jeff erson, a new staff member, has been working from 7 a.m. to 3 p.m. on an infectious disease unit since obtaining her registered nurse (RN) license 6 months ago. Most of the staff members with whom she works have been there since the unit opened 5 years ago. On a typical day, the nursing staff includes a nurse manager, two RNs, a licensed practical nurse (LPN), and two technicians for approximately 40 patients. Most patients are HIV-positive with multisystem failure. Many are severely debilitated and need help with their activities of daily living. Although staff members encourage family members and loved ones to help, most of them are unavailable because they work during the day. Several days a week, the nursing students from Shawna ’ s community college program are assigned to the fl oor.
Tina Brown, the nurse manager, does not participate in any direct patient care, saying that she is “too busy at the desk.” Laverne Sayed, the other RN, says the unit depresses her and that she has requested a transfer to pediatrics. Lynn Alvarez, the LPN, wants to “give meds” because she is “sick of the patients’ constant whining,” and Sheila, one of the technicians, is “just plain exhausted.”
Lately, Shawna has noticed that the other staff members seem to avoid the nursing students and reply to their questions with short answers in an annoyed tone. Shawna feels isolated and overwhelmed. She goes home at night worrying about the patients; she believes they need more care than they are receiving. She is afraid to tell Tina because she does not want to be considered a complainer. When she confi ded in Lynn about her concerns, Lynn replied, “Get real—no one here cares about the patients or us. All they care about is the bottom line! Why did a smart girl like you choose nursing anyway?”