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Ch. 10 Case Studies – Challenges of Nursing Management and Leadership
Case Study 1 – Management & Leadership Characteristics
As a recent graduate nurse, you accepted a position on an intermediate care unit. At your first unit meeting, Cathy Jones, unit manager, informs the nurses that the patient satisfaction rating fell two points from the previous month. She asks everyone to reflect over the past month and submit their top three concerns to their charge nurses by the next unit meeting. Cathy states, “This is unacceptable. It is your problem, and it concerns me. We will increase our rating at least three points by the next quarter. I want reasons for this problem and expect each of you to submit your ideas to your charge nurses promptly.” Three charge nurses, one from each shift, were asked by Cathy to make sure that the nurses addressed the issue.
Sherrie, the day shift charge nurse, decided to ask each nurse individually over the next month for her ideas on the problem. To encourage a higher response rate, Sherrie had pizzas brought in on the day she presented the findings. She compiled the responses and reviewed them with the day shift nurses with a consensus on the top three responses. Sherrie was able to obtain a 100% response rate by including all individuals in the decision.
Linda, the evening shift charge nurse, made a list of possible reasons and selected the top three. She then told the evening shift nurses what the three reasons were and that she would submit the list to Cathy for them. She spoke only to the nurses working on a particular evening and, when questioned by the absent staff, Linda told them that they could speak to Cathy individually. She added, “Like she said, it’s your problem. Do what you want, but I’m not responsible for whatever happens with Cathy.”
As the midnight shift charge nurse, Tracy let the nurses decide on reasons and submit the responses independently. She thought that the nurses had the right to accept or refuse participation and to be accountable as individuals. Tracy stated, “The responses might be personal. I believe we have the right to stand up for our own conclusions and I will stand behind each of you.” Tracy also achieved 100% participation by the nurses.
A. What management style did each of the three charge nurses (Sherrie, Linda, and Tracy) display? Give a rationale for your choices.
B. What type of management style do you feel most comfortable working under as a student? Are there situations when you feel comfortable with a different type of management style?
C. By looking at the outcomes from each shift, describe how effective each charge nurse was based on her management and leadership characteristics.
D. How would using a transformational leadership style address the issue?
E. What type of power does Cathy, the unit manager, possess? What about each of the charge nurses? Give examples from the case study to defend your choices.
F. Describe situations when you apply the different types of power. Use examples from areas such as home, school, and work.
Case Study 2 – Change
A recent restructuring of the local hospital has resulted in several changes to patient care units. The closure of a rehabilitation unit required reassigning the nurses to other areas of the hospital where staffing was low. The staff nurses displayed various attributes of the different phases based on their ability to accept the change. The following table presents the nurses and the characteristics observed.
A. Identify the emotional phase for each of the following nurses’ characteristics.
Open to explore possible new opportunities; willing to put energy into the transition.
Looks for ways to keep the old unit open; keeps telling others, “If only we could try one more time.”
Lethargic at work; nothing seems to be going right for her; states she feels lost.
Blames administration for playing this “evil trick”; resents that he will be the one to have to change.
Open and ready for the transition; looks for a new unit and has researched patient care in other areas.
Ignores the change; thinks that it might not happen.
Takes charge of her immediate future by looking for new ideas and projects for her new unit.
Feels a loss of power over her career; insecure over her knowledge of nursing in other areas.
Displays some energy towards the change; is willing to try various areas to see if it will “fit” with his style of nursing.
Frequently states “whatever” when others talk about the move; displays no enthusiasm for the change but does not reject the change.
B. Which of the above nurses would you consider as resisting change? What might be some causes for the resistance?
C. How could these possible causes be addressed during the change process using Lewin’s change theory?
D. Select one of the leadership styles presented in the chapter. Describe how the leadership style selected would affect the acceptance of the staff from question A.
Case Study 3 – Management Theories
You are the manager of a cancer unit. Your responsibilities involve managing and directing a team of 22 nurses and 9 support staff. In addition, you have the responsibility for the functions and outcomes of the cancer unit. An issue of contention between the nurses and support staff is the scheduling of outpatient chemotherapy treatments. The nurses propose that there must be at least five support staff positions available in the outpatient treatment center during hours of operation. The support staff states that only two need to be present because their responsibilities are limited in this area. The nursing staff presented the issue to the Chief Nursing Officer, bypassing your authority to make a decision.
A. Adopt the traditional management theory. How would you address this scenario?
B. Apply propositions of the systems theory to how you would address this scenario.
C. The contingency model involves propositions of the discussed management theories. How would you motivate the two sides to cooperate in solving the problem?
D. Identify your generation based on the information in Box 10-2. Using Boxes 10-2 and 10-3, reflect on the motivational strategies. Which do you feel works best for you? What would you add? How will you address others from different generations?
Case Study 4 – Leadership Types
During your clinical experiences, you have more than likely witnessed many types of leadership—from your clinical instructor, from the charge nurse, from the nursing supervisor, or even from yourself. Contingency, situational, interactional, and transformational leadership theories can describe the types of leadership styles that you have encountered.
A. Reflect on your most recent past clinical nursing experience. Which leadership theory most closely aligns with your care of your assigned patient?
B. During your current clinical experience, identify the leadership theory that most closely represents the charge nurse on the unit. Is this an effective style? Explain your response.
C. Which leadership theory most closely aligns with what you believe a leader should be? in which situation the leadership theory is applied?
D. Based on the explanation in the chapter of a transformation leader, evaluate someone in a leadership position for their ability to demonstrate transformation leader characteristics.
Case Study 5 – Generational Staffing
· • You are a new nurse on a medical-surgical unit. Your nursing colleagues include the following individuals:
· • Ben is also a new graduate. During orientation, he used his smart phone to find answers to the questions posed. He shared apps with others that related to nursing practice, explaining how the apps could help nurses at the point of care.
· • Mary is a nurse who others describe as being present when they built the hospital. She has over 35 years of experience on the medical-surgical unit.
· • Dawn has been in her position for a year. She is the unit champion for computerized charting and documentation systems. She is pursuing a master’s degree in Nursing Informatics.
· • Lee is always busy. When he is not working, he is providing care for his older mother who lives with him, his wife, and their three young children.
· • LaShay is also a new employee, although she has been a nurse for 10 years. This is her fifth nursing position at four different hospitals. She says she loves the challenges that the new positions bring and loves how this hospital uses self-scheduling.
A. What types of generations do the nurses represent?
B. The Unit Director decided to assign Mary to orient Ben and Lee to orient LaShay. Why would the Unit Director place the different generations together?
C. Your text describes improving patient care as requiring, “…more nurses, better educated nurses and revised systems and environments for delivering patient care.” Based on this statement, how can each generation of nurses contribute to improving patient care?
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