CASE: PAID TO MAKE DECISIONS?
Background
Carrie Wilson, a registered nurse with more than 10 years of active supervisory experience, was hired from outside as nursing manager for the emergency department of County Hospital. It was Carries style to develop insight into how to manage a given operation by putting herself where the action was and becoming totally immersed in the work. She quickly discovered, however, that her tendency to become deeply involved in hands-on work drew reactions from staff members ranging from surprise to resentment. She also discovered that her predecessor, who had been in the position for several years, had been referred to as the Invisible Nurse. As someone said about the former manager, I think she was a very pleasant person, but thats hard to say because we almost never saw her.
In spite of the legacy of the Invisible Nurse, Carrie provided a constant management presence and seemed determined to remain deeply involved in the work of the department. She was also determined to vastly improve the level of professionalism in the department, a quality that had struck her from the first as decidedly lacking.
In a short time, Carrie had moved to reinstate and enforce a long-ignored dress code for the department, eliminate personal telephone calls during working hours except for urgent situations, curb chronic tardiness on the part of some staff members, bar food and drink and reading materials from work areas (also a reemphasis of long-ignored rules), and curb the practice of changing scheduled days of work after the time limit allowed by policy.
Carrie found her efforts frustrated at every turn. As she said to her immediate superior, I cant understand the reaction. All Ive done is insist that a few hospital rules be followedmostly rules that have been there all along but were being ignoredand added a few twists unique to the emergency department. Just that, and yet the bitterness and lack of support and even resentment are so strong I could slice them. Im getting all-out resistance from a few people whom I would still have to describe as good, professional nurses at heart.
Carries boss, the vice president for nursing service, said, Do you suppose you may have been pushing too hard, hitting them with one surprise after another without knowing how they felt and without asking for their cooperation?
Thats possible, answered Carrie, but now Im committed on several fronts and I cant back down on any of them without looking bad to the department.
Dont think of this as a contest of wills or a game, said the vice president. It may be necessary for you to back down temporarily in some areas or at least hold a few of your improvements up in the air for a while. It may not hurt to fall back and involve a few of your staff in looking at the apparent needs of the department.
With a touch of impatience in her voice, Carrie said, Oh, Ive heard all this stuff about participative management and staff involvement in making decisions. That may be the way for some, but thats never been my style. Im paid to make decisions so I make themI dont try to avoid responsibility by encouraging employees to make my decisions.
Questions
1. What are the weaknesses, if any, in Carries final statement about decision-making responsibility?
2. What has essentially been wrong with Carries approach to raising the level of professionalism in the department?
3. How has Carries behavior altered or otherwise affected the environment within which she expects her decisions to be implemented?
4. Ideally, how should Carrie have initially approached her plan to improve the emergency department?
5. Given the state of affairs Carrie is facing as of her conversation with the vice president, how should she go about attempting to salvage some of her ideas and proceed with the improvement of the department? Keep in mind that at this stage her actions have probably had serious effects on her chances of implementing her plans, and some of the decisions she may have already made may need to be revisited in a different fashion.