Barbara Norris: Leading Change in the General Surgery Unit.

Sayantan Das, Batch-18.

Condition of GSU:

The General Surgery Unit at Eastern Massachusetts University Hospital has an average
patient satisfactory rate, and that has been declining over the past few years. To make things
worse at the hospital, there had been additional cost cutting, which resulted in hiring freeze,
and no over-time allowance for the nurses. This made the unit short-staffed, low employee
morale, and highly stressful.
Also, due to the lack of proper leadership, there was a culture of confrontation, blaming, and
favoritism within the department. Such conditions made the nurses over-worked and agitated;
so much that the senior nurses had stopped mentoring the junior nurses, and instead negative
criticism was being done.
It is also observed that the systematic review system of the nurses was not taken seriously,
which made hardworking nurses feel unappreciated and undervalued.

The following are the some of the problems that were being faced by the Nurses:

Lack of motivation and teamwork.

Interpersonal and intergroup conflicts.
Faulty performance review procedures.
Short-staffed and No over-time allowance.
High stress environment.

Likely Solution:

The Off-Site meeting facilitated pointing out the problems that were being faced by all
the nurses, and some serious underlying issues came to her attention, like, the lack of support
for junior nurses by the seniors, underappreciation for working hard and keeping up with the
latest technology to provide a better care to the patients.
A mentor program is required for the juniors to make them as competent as the seniors. This
should also help in building interpersonal relationships between them as well. This should be
scheduled at least once every month.
Set up a proper and effective review system for the nurses so that they are motivated to learn
and perform better. The appreciation should reflect in both, verbally and monetarily.
Questions:

Q1. Could she talk to her director of nurses and seek a reprieve from the hiring freeze and get
more staff for GSU?

Ans: Yes, it is appropriate as she is responsible for thirty-three nurses of which twenty-five are
Registered Nurses (RN), and eight are Patient Assistants (PA). They are highly distressed and
non-functional. It is necessary for her to address their issues to higher management so that
some compensation is made either in the form of monetary for over-time or by hiring a few
more nurses.

Q2. Would regular unit meetings build community and a healthier culture on the unit?

Ans: Yes, since the first off-site meeting uncovered a lot of problems being faced by the nurses
both, interpersonal and intergroup, more such meetings would render the nurses to open up and
discuss similar issues and collectively work it out. It is of utmost importance that the junior
nurses are encouraged and mentored properly, such meetings can facilitate that as well.

Q3. She knew she could institute a fair and transparent review process, but she might not have
any influence regarding making annual salary increases commensurate with a review outcome.
Perhaps there were other forms of acknowledgement she could employ?

Ans: Yes, as she suggested the hiring of a secretarial assistant, which would relieve the nurses
of the time-consuming paper work. This would help nurses to provide better care to the patients.
She can also start a mentor-mentee program so that the junior nurses can learn under the
guidance of the seniors. She can also ask the management to formally appreciate the
hardworking nurses on the monthly basis. These actions, if implemented properly, should
motivate the nurses to work effectively and happily.

Q4. What should she tell her boss who was awaiting a status report?

Ans: She should forward all the problems that her department is facing on the regular basis,
and implore the management to compensate the over-worked nurses, and if not that then at
least, lift the hiring freeze and employ a few nurses. She should also address to the management
that the Doctors treat the nurses as order takers and not care givers. By putting forward the
issues, the management may be able to better the lowest employee satisfaction scores, and
reduce the high employee turnout rate.