Running head: Analyzing Manager 1

Analyzing a Manager Interview

William G. Russell
NURS 440





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Running head: Analyzing Manager
Introduction
Mary Smith, RN, BSN is the manager of the very busy Surgical Center at the large hospital
where we are both employed. The unit she manages processes about 70 surgical patients and
discharges approximately 50 surgical patients on a daily basis. The staffing for this unit
comprises registered nurses, unlicensed assistant personnel and unit secretaries. The number of
staff she manages is approximately 50. The hours of operation are from 0430 until the last
outpatient is discharged, which could be as late as 2400. The staff is responsible for assisting the
patients into surgical attire, taking vitals, administering pre-operative medications and, most
importantly, assuring all the proper orders and permits are charted and all information is correct.
The staff is also responsible for the safe discharge of all surgical outpatients. This is more
daunting of a task than it sounds. There is immense pressure to process the patients rapidly.
Patients do not like to arrive pre-surgery any sooner than they have too. The staff tries its best to
keep on top of the daily surgery schedule; this is sometimes easier said than done. Marys duties
include the supervision of all staff, their schedules and day-to-day operations of the unit. She is
also responsible for her staff coordinating patient information and establishing and maintaining
collaboration with the surgery department, the anesthesia department and the post-anesthesia
department. All of these areas depend on Mary and her staff to keep the surgery schedule on
time. She has very demanding job. One of the most difficult aspects of her job is that no other
unit in the hospital is like hers. She does not have the benefit of calling another nurse manager to
see how he or she might handle a difficult situation, including an ethical issue. She does an
amazing job. In our interview, she told me that she takes one day at a time and handles every
challenge on issue-by-issue basis. She also shared that she spends a great deal of time selecting
the best staff possible and works to keep them; staff retention is very important to her.
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Running head: Analyzing Manager
Ethical Issue
As mentioned earlier, the surgery schedule must run on time as much as possible. The most
frequent complaint from patients is that their surgery was not done at the scheduled time.
Patients are sent from Marys unit to surgery, then to the post-anesthesia care unit and then back
to Marys unit. When the system backs up, Marys unit has pressure to discharge patients quickly
in order to open beds for patients from the post-anesthesia care unit who are returning to Marys
unit. This, in theory, keeps the operating rooms running at their most efficient pace. This then
leads to more patients having surgery at the scheduled time. Keeping this flow moving is best for
the staff in each unit as well. Operating room personnel are scheduled based on the estimated
time surgeries are to be performed. Surgeons and anesthesia providers also want to be as
efficient as possible so they may tend to other inpatient and office patients. The entire
perioperative staff feels the pressure to keep on schedule and move things along. The ethical
issues identified in the interview are that Mary frequently feels she and her staff are put in the
position of deciding which patients will receive the most appropriate and complete care. They
sometimes are not sure who they are serving - the patients or the surgeons and anesthesia
providers.
When decision making on ethical dilemmas is properly executed, quality care will be
delivered and malpractice can be reduced. (Wang & Hung 2005) This is where Mary and her
staff struggle. The surgery schedule gets backed up on a regular basis. Mary told me that she
regularly calls the nursing process into play. She has and will continue to expedite care to
patients when appropriate. She feels that her staff makes good decisions on when to discharge
patients from her unit in order to make room for patients being transferred from the post-
anesthesia care unit. In a study by Wang & Hung that looks at nursing care in patients who were
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Running head: Analyzing Manager
dying, The most disturbing ethics and human rights issues experienced by nursing leaders are
staffing patterns that limit patient access to nursing care and prolong the dying process. While
the patients on Marys unit are not dying, she and her staff at times feel they need to hurry
patients out the door; theyre concerned they may be limiting the care patients deserve. As
mentioned earlier in this paper, Mary takes staff retention very seriously and knows that staff
members who feel they are unable to deliver necessary care may decide to leave her unit. Mary
knows she must do her best to keep the surgery schedule on time but also knows she has the
responsibility of maintaining quality care in her unit.
Nurses and physicians often have different perspectives on how to resolve ethical dilemmas.
Satisfactory resolution depends on overcoming conflict and achieving collaboration between
members of the health care team. (Wocial 2006). In our interview, Mary explained that in her
leadership role she finds it necessary to exhort her power and influence with her up-line and
those physician groups who may apply pressure to compromise care in the name of timeliness of
the surgical schedule. She was proud to tell me that this is important for me to learn, especially
while I am enrolled in a class about leadership.
Resolution
During the interview with Mary, she stressed that all decision-making and resolution must be
centered on the best interest of patients. Mary did impress upon me that other factors also come
in to play as well. Surgeons who are unhappy with efficiencies leave hospital systems. Hospitals
with too much inefficiency dont make money. Hospitals that dont make money go out of
business. The resolution of this conflict - assuring patients get the care they need while keeping
the business aspects in mind - is a difficult balance. For me, Marys best advice as a leader was
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to try to keep an open mind during ethical conflicts and try to discover the best solutions with the
interest of the patient at the forefront.





















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References
Redman, B.A., Fry, S.T. (2003) Ethics and human rights issues experienced by nurses in
leadership roles. Nursing Leadership Forum, 7(4):150-6
Wang, S.F., Hung, C.H. (2005) Ethical issues in nursing leadership. Hu Li Za Zhi, Oct; 52
(5):51-8
Wocial, L.D. (2006) Achieving collaboration in ethical decision making: strategies for nurses in
Clinical practice. Dimensions in Critical Care Nursing. May-June; 15(3):150-9