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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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You are serving on an ad hoc committee to construct a management development program. Your organization has requested that the charge nurses work with staff development and plan a 1-week training and education program that would be required of all new charge nurses before their appointment. Because the organization will be bearing the cost of the program (i.e., paying for the educators and employee time), you are required to select appropriate content and educational methods that will not exceed 40 hours, including actual orientation time by a charge nurse. ASSIGNMENT: Develop and write up such a plan, and share it with the class. Your plan should depict hours, content, and educational methods.

 

 
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You are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for providing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve this issue and others like it but are not quite sure where to start. ASSIGNMENT:  Assume that you are the supervisor in this case. Answer the following questions. 1. Who do I need to involve in this discussion and at what point? 2. How might I determine if the overarching organizational structure supports shared governance? How would I determine if external stakeholders would be impacted? How would I determine if organizational culture and subculture would support a shared governance model? 3. What types of nursing councils might be created to provide a framework for operation? 4. Who would be the members on these nursing councils? 5. What support mechanisms would need to be in place to ensure success of this project? 6. What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model?

 

 
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