How Well has Barbara Norris Done in Her First Month as Nurse Manager

1. How well has Barbara Norris done in her first month as Nurse Manager of the GSU? Was she a good choice for the position?

Barbara Norris, who comes from a family with nursing professionals, is nominated as a nurse manager for the General Surgery Unit (GSU) at Eastern Massachusetts University Hospital (EMU). She is a local resident in western Massachusetts and a graduated master of Nursing and Health Care Administration Program. After raising her own family, Barbara comes back to work and challenges herself by accepting the offer as a nurse manager to turn over the well-known frustrating situation in GSU. At the time when Barbara becomes the nurse manager, the hospital is experiencing the decreasing revenue and rising expense during the economic recession. It leads to hiring freeze and staff shortage. Five registered nurses of GSU leave during the past seven months, and the limited overtime allowance brings the difficulty to refill the positions. Internal conflicts are getting worse between the nursing staff as well as the physicians at GSU.

In addition, the nurses felt that the unit turns its focus to administration rather than patient care. As the new nurse manager at GSU, Barbara is facing all of the existing problems and making her best effort to handle them. She gets to understand these unfavorable culture better after having one-to-one meeting and off-site with the majority of the unit’s staff. Barbara is a sophisticated professional nurse with decades of working experience at EMU. The nurse director places a great expectation on Barbara to “turn this unit around” when she accepts the job offer. She quickly identify the existing problems and hold an Off-Site meeting to welcome all staff’s opinions and suggestions to make practical changes to GSU. It is believed that Barbara is a good fit of the position as nurse manager, and all members at GSU are looking forward to her actions and changes to make the unit better.

2. What changes is she trying to make and why?Yipei’s part, using green color.

Firstly, the culture in GSU does not treat collaboration and teamwork as priorities. That is, members in GSU cannot rely on others when needing help. However, Barbara’s old organization, the trauma unit, was like a closely-knit group. Nurses were friends, ate lunch or dinner together and some also socialized outside of work. Babara experienced the culture-shock after accepting the job in GSU. For example, rather than helping and mentoring the newer nursing staff, the senior nurses were highly critical and complained about the newcomers behind their backs. In the off-site, the relatively new nurse Megan expressed the disappointment that she felt she did not belong to the team and often got indirectly negative messages and feedback from seniors. In this way, not only the morale of newcomers would be disastered, but opportunities would be lacking for new nurses to learn and grow.

As GSU was experiencing hiring freeze and staff shortage, Barbara should take the change of GSU culture into consideration, thus more experienced nurses can be cultivated and employee satisfaction as well as patience evaluation will be improved. Nurturing a helping culture within the unit is of great significance. As is connected to the class discussion of LucasVarity Vision, to develop and encourage the employees, giving them opportunity to grow to their fullest potential and maintaining rigorous standards of integrity and ethical behavior at the same time is the best application. Also, in the reading materials Grassroots Leadership, Commander D. Michael Abrashoff insisted that it must be a leader’s focus on cultivating and engaging a set of talented young folks. He devoted himself to build an interpersonal relationship with folks to improve the entire operation. Consequently, Benfold ship accomplished a great deal of contribution to the navy and gained the morale of team-building and the highest reputation outside.

In addition, staffs in GSU always feel that their efforts and contributions cannot be acknowledged and valued. Barbara also discovered that her predecessor had not kept complete and accurate records of the staff’s annual performance reviews so that the evaluation towards the internal members seems like a secret. Jennifer strongly expressed her need for feedbacks in the off-site forum which bear the function of helping her to be a better nurse and a better co-worker. Moreover, since Jennifer paid a lot of efforts in improving the technologies of herself, such as continuing education requirements to bring herself to speed on all new technologies, not receiving acknowledgement make her feel frustrated.

As for Barbara’s changing activities towards this problem, building a plan of reviewing the performance of staffs is indispensable. Although Barbara might not have any influence regarding making annual salary increases commensurate with a review outcome, she could submit the review outcome to her boss and make a suggestion that the salary increase of staffs should be formulated according to their performance. Also, other forms of acknowledgement she could employ apart from salary, such as operating training session, paid-holidays, constant communication, compliments and respect from supervisor, etc.

At last, the job in GSU is becoming more administration centered rather than patient centered. Louise, an experienced nurse who had been with EMU for 30 years and worked in GSU for 23 of those 30 years, complained in the off-site that she did not have enough time to do her own job because everyday she had to make difficult decisions and she spent more time tending to machines than tending to patients. As is related to the components above that new nurses lack opportunities to learn and grow, Barbara should try to make a trade-off between new nurses’ learning need and senior’s limited time. After all, GSU is set for saving more and more patients, which also need more experienced nurses.

3. What are three obstacles to bringing about change that Barbara should anticipate and how should she address them?

Obstacle 1: Establishing the determination to change inside the unit On the first few days Barbara become the nurse manager, 29 of the unit’s staff members went to talk to her. This shows a sense of urgency inside the unit. However, during the 0ff-site meeting, when barbara asking suggestions from them, the awkward silence occurred. This telling us that the staff members are getting used to complaining instead of offering solutions. This would be the first obstacle for Barbara.

The biggest problem in the whole case is in the human resources part, is the freezed hiring at EMU. Therefore, Barbara has to ask her director to put off from the hiring freeze and get more staff for the unit by establishing the sense of urgency. If, on the other hand, this did not working well, she can schedule the shifts of the existing nurses and in this way, they do not feel over worked or ensure that the ones who put good amount of effort are not left unacknowledged. This shows that she is a really seropus people when she is trying to get things right and alleviate some of the grievances on an urgent basis. Obstacle 2: The complaints towards performance review system In order to do so, Barbara can institute a transparent review process which can link the payment with performance. The questions is, she does not possess the authority to do so.

And what she could do now is to incorporate a system that rewards the good performers with non-monetary rewards, for example, some verbal acknowledgement or certificates of merit or regular meetings where performers are identified and thanked for their valuable contribution by their peers and bosses. Obstacle 3: the less cooperation and collaboration environment Just like any changes before, Barbara need to make her best effort to break the hostility and make a more powerful cooperation and collaboration environment. She could hold small meetings to solve the problems together. She could also institute a system wherein the nurses have to work as a team rather than working by themselves. This would create a friendly environment and make it easier for her to create a team of people who are ready to embrace change for the betterment of their unit.

4. Please outline the main components of an action plan for Barbara. Nancy’s part 🙂 Purple is such a pretty color!
action plan:  If the EMU is not going to call off hiring freeze, the action plan have to built based on the same situation. The “floaters” will be inevitable. The problem that the floaters are not familiar to the specific working units would be universal, which means every unit would facing the same problem as GSU are facing towards the floaters. Main components of the action plan:

1. Clarify the performance review system inside the unit, make sure that everyone knows how this system works. The complains towards performance review system are in two aspects. One is that the nurses think the system is mystery, another point of view is that the good performers are not getting the reward they suppose to get. Those two complaints can be tackled by making the performance review system transparent. Clarifying each standard in the system and setting up clear vision of what is a good performer would give the nurses a clear path towards the performance review system.

2. Distribute the assignment by random.
The favoritism is infamous in GSU. From the off-site meeting, this devil is exist at the assignment distribute system. The nurses are feeling that they have been given the assignments based on the relationship. However, after the assignments are assigned to the nurses by random choose, the favoritism will not exist.

3. Involve the nurses on decision making.
As how Barbara did at the end of off-site meeting, asking for everyone’s suggestion/ opinion towards decision making would built the sense of ownership inside the GSU. Just like the article Grassroot Leadership, how Commander Abrashoff believed, the leader should see the ship though the crew’s eyes.

4. Build a feedback system inside the GSU.
This system could be a feedback box that everyone could put the note in. Or it could be weekly off-site meetings.

5. Mentors for new comers.
This part could be optional, if the feedback system works well. However, signing mentors for new comers would help the new nurses to learn and blend in the GSU working environment more quick and smoother.