Cases for Analysis Wk $3$

Case $23$

The New Supervisor

This action took placo on the general surgery floor of a small hospital in western Now York State. For several months, the bospital trustees had debated the feasibility of building an addition that would movo all critical$-$care facilities into a modern, fully equipped building. However, just last month, the decision was made not to oxpand but to modernize the present facilities. During this period of docision making, the administrative organization of the bospital changed markedly. A now administrator from a large city hospital took over and brought in a new nursing head and several new nursing supervisors.

The general surgery floor on this particular shift $(3$ to $11$ P$.$M$.)$ was staffed by eight longtime registered nurses, three licensed practical murses, and two nucses' aides. Molly P$.,$ the new nursing supervisor for this shift, reported for the first time on Saturday aight. She obscrved during the shift that there were several infractions of sterilo procodures, that on two occasions practical nuryes adminisicred ixjections $($which$,$ by law, must be handled by the registerod nurses$),$ and that the nurbes tended to congregate at the aursing station for long periods. The first thing Molly did when sho weat on shift Tuesday night was to call the entre staff together. She said that they shouid know that she expected all of them to adbere strictly to sterile procadures, that there must be no abrogation of R$.$N$.$ responsibifities; and that "coffee klatching" at the nursing station must be kept to a minimum. It appeared that things improved on Wednesday and Thursday nights, but by the middle of the following week, Molly sensed a return to the general lemness that was evident when she first took over.

Molly waited until the next Monday. That night, she met with staff mexnbers individually in a quiet room: With each one, she reiterated her determination to $"$rsn a tight sbip, medically," and then asked for cooperation. From most of the staff mombers, stie got no meaningfil replies. However, one of the older R$.$N$.$s looked her in the eye and said, "We've handled this floor in our own way for a nuraber of ycars, and we've had no problems. Our record is as good as any in the fospital. We don't need your big$-$city ways here. And since the new addition won't be built, the chances are that you won't be here for long, anyway."

Analysis

If you were Molly, what would you do$?$ Five appooaches are listed below. Rank them on a scale from $1$ to $5$ in the order in which they appeal to you $(1,$ most attractive; $5,$ leest ettractive$).$ You may add another altemative if you wish. Be prepared to justify your ranking.

a$.$ Continue to insist on a high level of performanco while taking steps to weed out those staff members who don't or won't measure up$.$

b$.$ Make changes after the staff is better unified under your leadership.

c$.$ Relax the rule about "coffee klatching," but stick to the letter of the procedures for sterile practices and R$.$N$.$ responsibilities.

d$.$ Hold fast to your demands for a medically tight ship, but work with each person to find a way to convince him or her of the value of operating this way.

Get together with the other nursing supervisors to make certain that the procedures set down are uniform from floor to floor.