Carol Greely had been a registered nurse for 25 years and a nurse manager for more than 10 years when she was asked to take over as nurse manager of a particular medical/surgical unit known throughout the hospital, none too affectionately, as the “hot seat.” Although she had heard a few things about this floor, because of the size of the hospital and her recent assignment in a relatively removed area, Carol had little information about why the hot seat was so designated. After three months on the job, however, Carol had formed some strong opinions regarding the bases of many of the unit’s problems. To her, the majority of staff on the unit exhibited a complete lack of professionalism. Carol became convinced of this for a number of reasons, including the following:

There were many appearance problems and many violations of the department’s none-too-often-enforced dress code. If there were a worst-dressed list maintained, Carol concluded, surely her nurses would be on it.

The unit’s rate of absenteeism was the worst of any unit within the nursing department.

Two (thankfully unsuccessful) attempts by unions to organize the hospital’s nurses had apparently originated with the nurses in Carol’s unit.

Carol had never before seen a unit with such a high level of schedule juggling—shift trades, requests for specific days off, and especially changes to the schedule at the last minute.

It was not long before Carol found herself becoming highly cynical about the unit and its future. It seemed to her that nursing meant no more to many of these people than the paycheck and that they constantly put their social lives and personal preferences before the needs of the patients.

When she had been on the job six months, Carol received a startling piece of secondhand information from a friend in the nursing department who swore her to secrecy as to the source. It was apparently a closely guarded secret in nursing administration that her particular unit was deliberately maintained as a concentration of marginal employees. It was, in the words of Carol’s friend, “to keep the butterflies and malcontents all in one place as much as possible, so they wouldn’t disrupt other units.” Carol was further led to believe that she could expect to be reassigned after about 18 months on the job, when it would then be someone else’s turn to sit in the hot seat.

Carol’s initial reaction to what she had learned was anger; however, the more she thought about the position in which she found herself, the more she became determined to do something with the time left to her in the unit. She decided she was going to do everything in her power to turn the hot seat into a real nursing unit.

Instructions:

1. Make a list of three critical steps that Carol should consider to help her accomplish her admittedly difficult objective or to go as far toward accomplishing it as possible.

2. Include at least one step that the human resource department can probably provide positive advice or assistance, and describe the likely nature of the human resource involvement.