Meet Mark.

Mark is excited to begin training as an emergency department nurse. On his first day, the nurse training him makes multiple negative remarks about the physician on duty. "Don't ever make a suggestion, or she'll ream you out. You have to walk on eggshells around her." Later, another nurse is showing Mark where the supplies are kept. She tells him, "If you can't find things, don't call Central Supply because they'll get on your back about wasting resources. It's better to keep a few key things like IV start kits hidden so you can grab them when you need them."

Toward the end of his shift, a nurse assistant tells Mark a patient is vomiting violently in one of the examination rooms. However, Mark walks in to find the patient sitting up smiling and only a small amount of emesis in the basin. He hears muffled laughter coming from the hallway. Later in the shift, the nurse who is training Mark comments, "Hope you don't mind a little kidding around. This job can get to you, and it's good to laugh when we can."

The remainder of his training is free of other incidents and, overall, goes well.

Case Study Questions

1. What kind of culture best describes this department based on the scenario? Support your reasoning.
2. What appears to be the implicit rules of the emergency department of this organization?
3. Mark used respectful communication to optimize his relationships with the Central Supply staff, the nurse assistants, and the nurse training him. What barriers might exist in building respectful dialogue?
4. In what ways are you like Mark? In what ways are you different?