Barbara Norris: Leading Change

in the General Surgery Unit

COMMUNICATION FOR
MANAGEMENT
PROFESSOR SHUBHDA ARORA

NAME: ADITI JAIN

ID: PGP35055
SECTION: B
DATE: 01.08.2019
 Letter of Transmittal

01 August, 2019

To: John Frappewell, Director of Nursing, EMU Hospital

From: Barbara Norris, Nurse Manager-General Surgery Unit
Subject: Report on the Problems and their Solutions for GSU

Sir,
I am submitting a report on the problems of low employee and patient satisfaction and high
turnover at the General Surgery Unit and my recommendations to deal with the same. The
report has been made keeping in mind the gravity of the situation and the constraints we face
in dealing with the same.

Please have a look and revert back with your comments and suggestions
Looking forward to your insights!

Regards,
Barbara Norris

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 CONTENTS

1. Executive Summary Page 4

2. Situation Analysis Page 4

3. Problem Statement Page 4

4. Options Page 5

5. Criteria for evaluations Page 5

6. Evaluation of options Page 6

7. Recommendations Page 6

8. Action plan Page 6

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 Executive Summary

The economic crisis in the economy has forced the initiation of a number of cost cutting
measures. This has resulted in a hiring freeze, which has aggravated the employee
dissatisfaction in the short staffed General Surgery Unit. The nurses have been complaining
of increased workload and stress which has resulted in high turnover. The report presents 4
options to increase employee satisfaction and reduce turnover. These 4 options have been
evaluated on their performance given the constraints of time and cost. A ​mentorship
programme where older nurses mentor younger nurses emerged as the best option to
promote a collaborative work environment and feedback.

{103 words}

Situational Analysis

Because of the recent downturn in the economy, the administration has initiated a number of
cost cutting measures. The unit was initially staffed with 25 registered nurses (RNs) and 8
patient care assistants (PCAs). But we have lost some employees since then. Due to the hiring
freeze, the unit cannot be adequately staffed and overtime is no longer being offered.
As a result, employee satisfaction in the unit is low and stress levels are high. It is also
plagued with high employee turnover. To cover for any nurse that was on leave, we have to
rely on RNs from the general float pool. These “floaters” are not familiar with the procedures
and protocols of the unit, and extra time has to be spent on training them. This often has an
additional negative effect on our staff dynamics and patient care quality.
The senior nurses are highly critical of the newer nurses. Instead of giving them any
feedback, the older nurses are complaining about them behind their backs. There exists a
culture of conflict and blaming in the unit. There is a lack of a collaborative environment and
team building is sorely needed. The general feeling amongst the older nurses is that they are
so overworked themselves, that mentoring the new RNs is an additional burden that nobody
wants to take. In addition, the review structure is not transparent and does not provide any
incentive for good performance. ​There are complaints of favouritism and partial behaviour by
the administration. ​Furthermore, no complete record of past performance reviews exist to
guide me in being an effective manager for the unit. The nurses feel disconnected from the
administration and they think that they are not valued for the job they are doing.

Problem Statement

The problem statement is to increase the employee and patient satisfaction and reducing
turnover in the unit.

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 Options

1. Periodical assessment, informal one-on-one and feedback sessions-

Currently the performance reviewal system did not give any incentive to the nurses to
improve their performance. We have to incorporate transparency and consistency in
the review system. There should be periodical assessment, informal one-on-one and
feedback sessions with the managers. Since cost cutting is important, we can also
initiate a non monetary incentive to motivate employees to perform better. Incentive
structure like announcement of monthly best nurse and patient care assistants, peer
appreciation system is important.

2​. Instate a mentorship programme by Senior nurses for Junior nurses

To foster a positive and collaborative work environment and to solve the problem of
lack of constructive feedback in the system, a mentorship programme should be
instituted where older nurses help the younger nurses learn. To help promote the
maximum interaction, mentees can be rotated after a set time period, say 1 month.

3. Offsite sessions, team building activities, regular meeting​s-

The relationship amongst the nursing staff is cold and resentful. The unit needs team
building activities to create a where no one is actually ready to help another
employee, to overcome this issue, the department should conduct regular meetings
and interactive sessions amongst the nurses so that they shall come closer to another.

4. Increasing staff and using job rotation to help nurses learn and grow
Some nurses were unhappy with the limited opportunities for growth. The unit could
together come up with a plan to have job rotation so that each RN gains experience in
all fields that they want to get acquainted with.

Evaluation Criteria

The criteria for judgement should be that the option selected should take the minimum
time and cost (human and monetary)

Time Cost Effect on Feasibility

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 Employee
Motivation

Feedback System High Low High High

Mentorship Low Low High High

Team Building Medium Medium Medium High

Job Rotation and Medium High High Low

Increasing Staff

Recommendation

As per the Evaluation Criteria, I propose that we go with Option 2. That is the initiation of the
Mentorship programme between older and younger nurses.

Action Plan

The following steps can be taken-

1. Separate Meetings with the older and younger nurses to understand their
objectives and problems, preparation of a feedback form for older nurses to fill
2. Deciding a time period for the first phase and creation of a schedule matching
making nurse pairs
3. Initiation of Phase 1 with monitoring and supervision
4. Separate meetings with older and younger nurses to gain review on the
exercise.
5. Improvise until objectives are met.