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 Carrie’s 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 that’s 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 improve vastly 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 can’t understand the reaction. All I’ve done is insist that a few hospital rules be followed—mostly rules that have been there all along but were being ignored—and 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. I’m getting all-out resistance from a few people whom I would still have to describe as good, professional nurses at heart.” Carrie’s 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?” “That’s possible,” answered Carrie, “but now I’m committed on several fronts and I can’t back down on any of them without looking bad to the department.” “Don’t 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, I’ve heard all this stuff about participative management and staff involvement in making decisions. That may be the way for some, but that’s never been my style. I’m paid to make decisions so I make them—I don’t try to avoid responsibility by encouraging employees to make my decisions.”

Answer these questions

1-How has Carrie’s behavior altered or otherwise affected the environment within which she expects her decisions to be implemented?

2-Ideally, how should Carrie have initially approached her plan to improve the emergency department?