CASE ANALYSIS

CASE 1

Two new associate-degree graduates were hired for the pediatric unit. Both worked
three 12-hour shifts a week, Jan in the day-to-evening shift and Ronnie at night. Whenever their
shifts connected, they would compare notes on their experience. Jan felt she was learning
rapidly, gaining clinical skills and beginning to feel at ease with her colleagues. Ronnie,
however, still felt unsure of herself and often isolated. "There have been times," she told Jan,
"that I am the only registered nurse on the unit all night. The aides and LPNs are really
experienced, but that's not enough. I wish I could work with an experienced nurse as you are
doing."
"Ronnie, you are not even finished with your 3-month orientation program," said Jan.
"You should never be left alone with all these sick children. Neither of us is ready for that kind
of responsibility. And how will you get the experience you need with no experienced nurses to
help you? You must speak to our nurse manager about this."
"I know I should, but she's so hard to reach. I've called several times, and she's never
available. She leaves all the shift assignments to her assistant. I'm not sure she even reviews the
schedule before it's posted."
"You will have to try harder to reach her. Maybe you could stay past the end of your
shift one morning and meet with her," suggested Jan. "If something happens when you are the
only nurse on the unit, you will be held responsible."

1. In your own words, summarize the problem that Jan and Ronnie are discussing. To what
extent is this
problem due to a failure to lead? Who has failed to act?
2. What style of leadership was displayed by Ronnie and the nurse manager? How effective was
their leadership? Did Jan's leadership differ from that of Ronnie and the nurse manager? In
what way?
3. In what ways has Ronnie been an effective follower? In what ways has Ronnie not been so
effective as a follower?
4. If an emergency occurred and was not handled well while Ronnie was the only nurse on the
unit, who would be responsible? Explain why this person or persons would be responsible.
5. If you found yourself in Ronnie's situation, what steps would you take to resolve the
problem? Show how the leader characteristics and behaviors found in this chapter support your
solution to the problem.
CASE 2
Joe Garcia has been an operating room nurse for 5 years. He was often on call on
Saturday and Sunday, but he enjoyed his work and knew that he was good at it. Joe was called
to come in on a busy Saturday afternoon just as his 5-year-old daughter's birthday party was
about to begin. "Can you find someone else just this once?" he asked the nurse manager who
called him. "I should have let you know in advance that we have an important family event
today, but I just forgot. If you can't find someone else, call me back, and I'll come right in." Joe's
manager was furious. "I don't have time to make a dozen calls. If you knew that you wouldn't
want to come in today, you should not have accepted on-call duty. We pay you to be on-call,
and I expect you to be here in 30 minutes, not one minute later, or there will be
consequences."
Joe decided that he no longer wanted to work in the institution. With his 5 years of
operating room experience, he quickly found another position in an organization that was more
supportive of its staff.

1. What style of leadership and school of management thought seemed to be preferred by Joe
Garcia's manager?
2. What style of leadership and school of management were preferred by Joe?
3. Which of the listed qualities of leaders and managers did the nurse manager display? Which
behaviors? Which ones did the nurse manager not display?
4. If you were Joe, what would you have done? If you were the nurse manager, what would you
have done? Why?
5. Who do you think was right, Joe or the nurse manager? Why?

CASE 3
Tanya Washington will finish her associate's degree nursing program in 6 weeks. Her
preferred clinical area is pediatric oncology, and she hopes to become a pediatric nurse
practitioner one day. Tanya has received two job offers, both from urban hospitals with large
pediatric populations. Because several of her friends are already employed by these facilities,
she asked them for their thoughts.
"Central Hospital is a good place to work," said one friend. "It is a dynamic, growing
institution, always on the cutting edge of change. Any new idea that seems promising, Central is
the first to try it. It's an exciting place to work."
"City Hospital is also a good place to work," said her other friend. "It is a strong, stable
institution where traditions are valued. Any new idea must be carefully evaluated before it is
adapted. It's been a pleasure to work there."

1. How would the organizational culture of each hospital affect a new graduate?
2. Which organizational culture do you think would be best for a new graduate, Central's or
City's?
3. Would your answer differ if Tanya were an experienced nurse?
4. What do you need to know about Tanya before deciding which hospital would be best for
her?
5. What else would you like to know about the two hospitals?
CASE 4
A not-for-profit hospice center in a small community received a generous gift from the
grateful family of a patient who had died recently. The family asked only that the money be
"put to the best use possible."
Everyone in this small facility had an opinion about the "best" use for the money. The
administrator wanted to renovate the old, run-down headquarters. The financial officer wanted
to put the money in the bank "for a rainy day." The chaplain wanted to add a small chapel to
the building. The nurses wanted to create a food bank to help the poorest of their clients. The
social workers wanted to buy a van to transport clients to health-care providers. The staff
agreed that all the ideas had merit, that all of the needs identified were important ones.
Unfortunately, there was enough money to meet only one of them.
The more the staff members discussed how to use this gift, the more insistent each
group became that their idea was best. At their last meeting, it was evident that some were
becoming frustrated and that others were becoming angry. It was rumored that a shouting
match between the administrator and the financial officer had occurred.

1. In your analysis of this situation, identify the sources of the conflict that are developing in this
facility.
2. What kind of leadership actions are needed to prevent the escalation of this conflict?
3. If the conflict does escalate, how could it be resolved?
4. Which idea do you think has the most merit? Why did you select the one you did?
5. Try role-playing a negotiation among the administrator, the financial officer, the chaplain, a
representative of the nursing staff, and a representative of the social work staff. Can you
suggest a creative solution?

CASE 5
A large health-care corporation recently purchased a small, 50-bed rural nursing home.
A new director of nursing was brought in to replace the former one, who had retired after 30
years. The new director addressed the staff members at the reception held to welcome him.
"My philosophy is that you cannot manage anything that you haven't measured. Everyone tells
me that you have all been doing an excellent job here. With my measurement approach, we
will be able to analyze everything you do and become more efficient than ever." The nursing
staff members soon found out what the new director meant by his measurement approach.
Every bath, episode of incontinence care, feeding of a resident, or trip off the unit had to be
counted, and the amount of time each activity required had to be recorded. Nurse managers
were required to review these data with staff members every week, questioning any time that
was not accounted for. Time spent talking with families or consulting with other staff members
was considered time wasted unless the staff member could justify the "interruption" in his or
her work. No one complained openly about the change, but absenteeism rates increased
rapidly. Personal day and vacation time requests soared.
Staff members nearing retirement crowded the tiny personnel office, overwhelming the
single staff member with their requests to "tell me how soon I can retire with full benefits." The
director of nursing found that shortage of staff was becoming a serious problem and that no
new applications were coming in, despite the fact that this rural area offered few good job
opportunities.

1. What evidence of resistance to change can you find in this case study?
2. What kind of resistance to change did the staff members exhibit?
3. If you were a staff nurse at this facility, how do you think you would have reacted to this
change in administration?
4. Why did staff members resist this change?
5. What could the director of nursing do to increase acceptance of this change? What could the
nurse managers and staff nurses do?