In this case, a top nursing executive in a public teaching hospital grows concerned when she encounters employees holding negative attitudes toward the establishments underprivileged patient population. Elizabeth Murphy, Director of Nursing at Oakridge University Hospital,cannot wait to get off of her feet for her lunch break. It has been a verybusy morning, she is hungry, and she desperately is in need of a momentto catch her breath. On her way to the cafeteria, she navigates aroundand through several construction areas placed throughout the massive 525-bed public teaching hospital, located in Hamilton, a city of 1,328,984situated in the East South Central region of the United States. The minor inconveniences associated with the construction are relativelynew to her and her fellow Oakridge University Hospital employees,resulting from the hospitals efforts to upgrade a number of patient waitingareas, repaintseveralmain corridors, and make a number of other functionaland aestheticenhancements. Ultimately, through these upgrades,the establishment hopes to improve patient access and comfort at OakridgeUniversity Hospital. As she ma kes her way into the hospitals cafeteria and purchases hermeal, Elizabeth spots two very familiar faces who invite her to join themfor lunch. They are Sherry Graham, a Respiratory Therapist, and BruceFaulkner, an Assistant Manager in the hospitals central supply department.Joining them at their table, she eagerly awaits the latest newsand thetopic of the day pertained to the hospitals construction. While each ofElizabeths two lunch mates were pleased with the construction, notingthat it would make for a better working environment for staff members,their comments regarding the benefits to Oakridge University Hospitalspatients were less sincere, something Elizabeth found to be very troubling. Bruce questioned using hospital resources to improve patient waitingareas. He remarked that since the hospital is always full, why should moneybe spent to improve convenience and comfort for patients. He continuedon, noting that the hospital certainly does not have to worry about customertraffic, especially as it is the healthcare provider of last resortformost patients who are too poor to goanywhere else. Sherry agreed withBruce, adding that the hospital had no reason to fear competitorsStealingOakridge University Hospitals patient population. She expressed thatbecause most of Oakridge University Hospitals patients, as Medicaid orcharity cases, were not paying for their care anyway, they were not trulydeserving of the enhancements being made by the new construction projects.Sherry simply could not understand the rationale for doing more forOakridge University Hospitals patient population. Elizabeth, a 30-year veteran of the hospital, was dumbfounded by theviews expressed by Bruce and Sherry. Arguing that all patients should betreated with respect and dignity, she responded that one of the centralreasonsfor Oakridge University Hospitals existence is to treat patientswithout sufficient financial resources and noted that this obligation is clearly expressed in its mission statement. As a mission mandate, Elizabeth conveyed that Oakridge University Hospital and its employees have an obligation to these patients, making them important and deserving of the best health care that can possibly be offered. Elizabeth was particularly quick to correct Sherry regarding her belief that Oakridge University Hospitals patients are nonpayers. Sure, they may not have the means to open their wallets and pay for healthcare services, she expressed, but government programs provide funding on their behalf that the hospital would not receive otherwise. Technically, they are paying customers, the money just does not come from their pocketbooks. Finishing up what turned out to be an unpleasant lunch experience,Elizabeth noted that even if Oakridge University Hospital never received a single penny from any source to pay for the healthcare costs of its clients, the patients of Oakridge University Hospital still deserve the best of care and attention. Finishing off her comments, she questioned the two, asking why they would even wish to work at Oakridge University Hospital if they did not see the value of both its mission and the rewards of serving the needy. Returning to her office, Elizabeth reflected on her lunch experience. While she was concerned that both Bruce and Sherry embraced such views, she was particularly troubled that Sherry would do so, because she is involved in the direct delivery of care to patients. If she harbored feelings in her heart and mind that Oakridge University Hospitals patients did not deserve the comfort and convenience of enhanced patient waiting areas, how might this impact the quality of the care that she provided? But what Elizabeth perhaps viewed to be most troubling did not pertain to Bruce or Sherry specifically, but instead dealt with the fact that she had heard time and time again the same thing from many of Oakridge University Hospitals employees. In prior years, she had even spoken with Oakridge University Hospitals top administrators about the matter, seeking guidance in how she should handle what at best is an uncaring attitude regarding patients, and at worst could lead to the inappropriate treatment of patients and even death. Sadly, though, the top officials did not have much guidance to offer, noting public sector bureaucracy and complexities associated with disciplining employees, especially in cases where there are no tangible infractions. Elizabeth found this to be very frustrating. While Elizabeth always tried to educate and enlighten employeesholding negative beliefs about Oakridge University Hospitals patientpopulation, she knew that her success at converting them was at bestvery limited. Thankfully, she did not view the mindset held by Bruce,Sherry, and others to be epidemic,but did view it to be prominentenough to warrant concern. And there was at least a degree of comfortin knowing that the problem was not limited to Oakridge UniversityHospital, as, through her network of professional contacts, she cameto realize that the mindset was rather commonplace at public hospitalsserving the underprivileged. In trying to craft a theory on the origins of such a negative and unproductivemindset, Elizabeths best guess was that it simply was an artifactofthe institutions culture and characteristics. She well knew that OakridgeUniversity Hospital did not possess a marketing culture; that its employeesdid not view themselves to be customer service agents or ambassadors onbehalf of the institution. And she well knew that a constant and unendingflow of patients who possessed few if any other options for medicalcare certainly could instill a mindset of complacency in employeesandthe institutions in which they served. Further, she knew that the size ofOakridge University Hospital did not help matters, as the employee basewas so large that massive bureaucracy was a given, making even seasonedemployees feel more like a number than an individual person. Elizabethreasoned that all of this and more set the stage for negative mindsets atOakridge University Hospital. Regardless, Elizabeth could not understand why employees wouldcare to work for an institution that embraced a mission that theypersonallydeemed to be unacceptable. She wondered why theywould not desire working elsewhere; somewhere that supported a missionthey personally viewed to be acceptable. Their motives defiedcomprehension. Elizabeth cared very much for Oakridge University Hospitals patientsand, given her longtime experience at the hospital, she was committedto improvement on every front. Hearing Bruce and Sherrys perspectivesbrought back countless memories of other employees expressing similarviews. She wondered what more she could do to improve the customerservice and marketing orientations of Oakridge University Hospitalsemployees. 1. This case presents a very negative mindset harbored by at least someemployees at Oakridge University Hospital. What are the possibleramifications for patients at Oakridge University Hospital or anyother facility who encounter employees possessing the mindset heldby Bruce and Sherry? Do you believe that such a negative employeemindset can result in tangible patient harm, or is the mindset simplya personal expression that would not be extended to the careand treatment of patients? Please justify your responses. 2. Assume that you are Sherrys supervisor and you receive a telephonecall from Elizabeth who conveys the perspectives that were echoed bySherry over lunch. Would you bring the matter up with Sherry? Whyor why not? If you did indeed address Sherry, what approachWouldyou take and what would you expect to gain by your actions? 3. Elizabeth attributes the negative perspectives of the patient populationheld by Bruce, Sherry, and some others at Oakridge UniversityHospital to be the product of culture, a burgeoning supply of Patientswith few alternatives, and bureaucracy. Assuming that sheis correct, how might you go about stemming negative sentiment? 4. Elizabeth noted that she had approached the top executives atOakridge University Hospital and asked for guidance as to howshe should address employees when hearing negative perspectives Regardingthe hospitals patient base. Much to her dismay, she didnot receive any particularly beneficial advice. What does this sayabout the executives she consulted? 5. This case presents an account by a nursing executive who encountereda negative mindset held by at least some of Oakridge UniversityHospitals employees. Suppose that Elizabeth had been accompaniedby a marketing manager during her lunch meeting with Bruceand Sherry. Would you anticipate the marketing managers perspectiveson the matter to be similar to Elizabeths, less intense, or moreintense? Please justify your response. read and answer the questions