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You are a manager in a public health agency. In reading the morning paper before going to work today, you peruse an article about the influx of Hmong families in your county. There has been an increase of 10% in this population in the last year, and it is expected to continue to rise. You ponder how this will affect your client population and your agency. You decide to gather your staff together and develop a strategic plan for dealing with the problems and opportunities that this change in client demographics presents. ASSIGNMENT: In examining the 10 steps listed in development of strategic plans, what are things that you can personally influence, and what other individuals in the organization should be involved with the strategic plan? Make a list of 10 to 12 strategies that will assist you in planning for this new client population. What other statistics will you need to help you plan? What are some other future developments in your county that could have a positive or negative influence on your plan?

 

 
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You are a Hispanic RN who has recently received a 2-year grant to establish a family planning clinic in an impoverished, primarily Hispanic area of a large city. The project will be evaluated at the end of the grant to determine whether continued funding is warranted. As project director, you have the funds to choose and hire three healthcare workers. You will essentially be able to manage the clinic as you see fi t. The average age of your patients will be 14 years, and many come from single-parent homes. In addition, the population with which you will be working has high unemployment, high crime and truancy levels, and great suspicion and mistrust of authority figures. You are aware that many restraining forces exist that will challenge you, but you feel strongly committed to the cause. You believe that the high teenage pregnancy rate and maternal and infant morbidity can be reduced. ASSIGNMENT: 1. Identify the restraining and driving forces in this situation. 2. Identify realistic short- and long-term goals for implementing such a change. What can realistically be accomplished in 2 years? 3. How might the project director use hiring authority to increase the driving forces in this situation? 4. Is refreezing of the planned change possible so that changes will continue if the grant is not funded again in 2 years?

 

 
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Assume that morale and productivity are low on the unit where you are the new manager. In an effort to identify the root of the problem, you have been meeting informally with staff to discuss their perceptions of unit functioning and to identify sources of unrest on the unit. You believe that one of the greatest factors leading to unrest is the limited advancement opportunity for your staff nurses. You have a fixed charge nurse on each shift. This is how the unit has been managed for as long as everyone can remember. You would like to rotate the charge nurse position but are unsure of your staff’s feelings about the change. ASSIGNMENT: Using the phases of change identified by Lewin (1951), identify the actions you could take in unfreezing, movement, and refreezing. What are the greatest barriers to this change? What are the strongest driving forces?

 

 
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You work in a public health agency. It is the agency’s policy that at least one public health nurse is available in the office every day. Today is your turn to remain in the office. From 1 PM to 5 PM, you will be the public health nurse at the scheduled immunization clinic; you hope to be able to spend some time finishing your end-of-month reports, which are due at 5 PM. The office stays open during lunch; you have a luncheon meeting with a Cancer Society group from noon to 1 PM today. The RN in the office is to serve as a resource to the receptionist and handle patient phone calls and drop-ins. In addition to the receptionist, you may delegate appropriately to a clerical worker. However, the clerical worker also serves the other clinic nurses and usually is fairly busy. While you are in the office today trying to finish your reports, the following interruptions occur: 8:30 AM: Your supervisor, Anne, comes in and requests a count of the diabetic and hypertensive patients seen in the last month. 9:00 AM: An upset patient is waiting to see you about her daughter who just found out that she is pregnant. 9:00 AM: Three drop-in patients are waiting to be interviewed for possible referral to the chest clinic. 9:30 AM: The public health physician calls you and needs someone to contact a family about a child’s immunization. 9:30 AM: The dental department drops off 20 referrals and needs you to pull charts of these patients. 10:00 AM: A confused patient calls to find out what to do about the bills that he has received. 10:45 AM: Six families have been waiting since 8:30 AM to sign up for food vouchers. 11:45 AM: A patient calls about her drug use; she doesn’t know what to do. She has heard about Narcotics Anonymous and wants more information now. ASSIGNMENT:  How would you handle each interruption? Justify your decisions. Do not forget lunch for yourself and the two office workers. Note: Attempt your own solution before reading the possible solution presented in the back of this book.

 

 
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