Case Study:

Read the following case study and answer the questions that follow:

A good friend of yours is director of nursing at a 220- bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital "up to speed" within 3 years. At present CPOE is being implemented. The general medical and surgical units went live last month. The ICU and pediatrics and obstetrics units are scheduled to go- live next month. The plan is to work out any kinks or problems on the general units and then go- live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, there are three physicians who have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior they began to write the orders on scraps of paper and put these in the patient's charts or leave them at the nurses' station. When they were informed that these were not "legal orders" they began smuggling in order sheets from the non activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital's goals and the need to maintain a good working relationship with these physicians.

Questions

1. How would you use the theories presented in this chapter to diagnosis the problems demonstrated in this case. List your diagnoses and explain your analysis.

2. What actions would you recommend to your friend and what reason (theories) would you use as a basis for your recommendations?