General Surgery Case Study
Background: Barbara Norris grew up in a small town in western Massachusetts. She developed a fond respect and admiration for the nursing profession due to her mother and grandmother both being nurses. She knew that nursing was the career she wanted to peruse. She obtained her nursing degree from Eastern Massachusetts University, and began to work at EMU in the emergency room. She was an ER nurse for four years then transferred to the trauma unit for a year until she became pregnant with her first child. Barbara then worked part-time for the next several years and had her second child. Barbara returned to full time work in the trauma unit while her children were in elementary school. While her kids were in high school, Barbara began her coursework for a Master’s degree of Nursing and Health Care Administration, with the encouragement of Betty Nolan, Barbara’s friend and mentor. Not long after Barbara’s graduation from the program, Betty (nurse manager of EMU’s general Surgery unit) announced her retirement. Barbara applied to the open position, with the knowledge of the GSU’s high turnover rates and low retention rates. Barbara was also warned by Betty Nolan to not take the job; Betty stated that “GSU was a lost cause. Spare yourself the grief and aggravation.” Barbara believed that she was up for the challenge of the GSU and wanted to try to turn the unit around. When Barbara accepted the job she was congratulated by the nursing director John Frappewell, who said “you’re doing the right thing, Barb. I’m counting on you to turn this unit around and do it fast.” Until this point she was confident in her decision but now started to think that she may have taken on more than she could handle. Barb had yet to consider the factors working against her that she couldn’t really control, for example: the downward turn the economy had just taken which led to difficult decisions made by the hospital. The hospital’s revenue sharply decreased while the costs increased. This led to hiring freezes, stopped over-time allowances and decreased shift differentials. GSU Nurse Manager: As nurse manager, Barbara was responsible for managing the staff, scheduling and budgeting for the unit (33 person staff consisting of 25 RN’s and 8 patient care assistants). In the first month as nurse manager of the GSU, Barbara lost 2 RN’s plus the 3 that left just prior to her joining the unit. She was unable to replace some of these positions because of the hospitals hiring freeze. This led the unit to be short staffed. Because of being short staffed, the unit’s morale was low and the stress levels were high. The GSU had the lowest employee satisfaction rates and highest employee turnover rates of all of the departments at EMU, as well as declining patient satisfaction scores. The GSU also had a culture of favoritism, confrontation and blaming. Unlike the trauma unit where Barb use to work (where the nurses were a close knit group, both at work and outside of work, who worked well together as a team), in the GSU there were tense relationships between not only the nursing staff, but with many of the attending physicians. Barbara soon learned firsthand of the conflict in the department through one on one meetings with the staff. A major problem was that the senior nurses, instead of taking on a mentor role for the new staff members, were highly critical and would complain about the new staff members. On top of that, most of the unit’s RN’s (both new and old) were becoming frustrated with the inadequate training and skill sets of the patient care assistants. On top of all of the conflict she was encountering now, Barb learned of another problem; the records of the staff’s annual performance and reviews were not complete or accurate. Barbara knew from her own personal experience that open communication and transparent review systems contribute to growth and...
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