Part 1

As a new supervisor hired from outside the hospital, it took you very little time to learn that morale in the department had been at low ebb for quite some time. As you started getting acquainted with your employees by meeting with them individually, you quickly became inundated with complaints and various other evidence of discontent. Most of the gripes concerned perceived problems with administration and building services, but there was also a significant number of complaints by your staff about other employees in the department and some thinly veiled charges suggesting that a couple of staff members have consistently been complaining about the department to your boss. (Your boss has said nothing to you about this.)

It sounded to you as though a number of common themes ran through the group's complaints, and it seemed to you that a number of differences could be cleared up by airing these issues with the entire group. You planned a meeting for that purpose, instructing all employees to be prepared to air their complaints (except for those directly involving other staff members). Your employees seemed to believe this was a reasonable idea, and several led you to believe they would be happy to speak up.

However, your meeting turned out to be brief. Hard as you tried to get people to air their gripes, no one spoke up. You tried again 2 weeks later, with the same results: no one uttered a word of complaint. Yet all the while, the negative undercurrents continued to circulate through the department.

- Why do you suppose you get only silence from these employees when you attempt to deal with them as a group? Explore possible causes of this frustrating condition.

- How long do you believe it will take to bring this group around to where you need them to be? Why?

Part 2

You are administrative supervisor of the hospital's department of radiology. The department has been having problems with the special procedures area; you have had considerable difficulty recruiting and retaining special procedures technologists. You presently have your allotted staff of three such technologists, but these people are fully utilized, and at least two of them have recently made comments about staffing being inadequate for the work load.

The senior technologist, Carl Smithers, has recently been especially vocal in his comments about understaffing. Several times, and as recently as Monday the 7th of this week, he spoke with you concerning his perception of the need for another technologist. Today, Wednesday the 9th, you received the following note from Smithers:

"As I suggested I would do in our conversation of Monday this week, I am going on record notifying you that additional technologist help must be available by Monday the 21st. If you are unwilling or unable to provide the needed help, I will be unable to continue in my present position beyond Friday the 18th."
- Concerning the ultimatum delivered by your employee, should you:
• Immediately request the added staff to retain Smithers? Why or why not?
• Call his bluff; that is, wait until the 18th to see if he does indeed resign? Why or why not?
• Take some other approach, and, if so, what should it be?

Part 3

There are 15 people in your department at City Hospital. It has been your practice to hold a weekly staff meeting at 3:00 PM each Wednesday. Rather, we should say you attempt to hold it at 3:00 PM because about half of your staff are more than 5 minutes late, and a couple of them are usually late by 15 minutes or more. One of these latecomers can always be counted on to ask, "What have I missed?" You have made repeated announcements about being there on time, but to no avail. Come Wednesday at 3:00 PM you usually find yourself and the same six or seven punctual attendees present and waiting for the latecomers

- Without immediately resorting to disciplinary action (which should always be the last resort), what can you do to improve punctuality in attending your staff meetings?

Part 4

Melissa Jones is nurse manager of a 40-bed, long-term care unit that is essentially a small nursing home contained within Community Hospital. The unit is almost always fully occupied. A number of the patients spend several hours each day in wheelchairs, but most return to their beds for a couple of hours in the afternoon.

Melissa has a constant concern that her limited staff is only marginally able to fill the needs of the elderly patients, especially given that some patients who go without visitors for prolonged periods are eager to engage staff members in conversation. Melissa has determined that a number of apparent patient needs, especially the need for socialization, could be met with volunteers, so she developed a volunteer roster consisting of persons who indicated their willingness to help, after which she developed a 30-day schedule for volunteer support.

On the initial day of the schedule, three of the five scheduled volunteers failed to show up. On the following day, two did not appear. Only one appeared on each of the third and fourth days, and on the fifth day - a Friday with gorgeous summer weather beckoning all to the outdoors - no volunteers were present in the unit. Melissa gave up on her schedule.

Melissa was thoroughly discouraged by the volunteers' lack of dependability. And because she had made no secret of her new volunteer program, a number of patients were similarly discouraged, and several complained that Melissa had not delivered as promised. As Melissa complained to her friend, Carol, "I had a couple dozen supposedly willing volunteers on my list, but when I need them, they're nowhere to be found!"

- Because volunteers, as unpaid help that essentially supplement the regular staff, may often feel no compelling need to function by the clock, what might Melissa consider doing to encourage a more reliable volunteer presence?

- How might Melissa have her regular staff assist in encouraging a continuing volunteer presence?

Assume you have been head nurse of the same medical-surgical unit for nearly 20 years. One of your employees, a licensed practical nurse named Hilda, has been part of the unit's day shift for even longer than you've been head nurse. In fact, Hilda is the only original member remaining of the crew that existed when you first took over the unit.

About 6 months ago, Hilda returned to work after an extensive illness that left her noticeably changed in a number of ways. Where once she was energetic and seemed to possess considerable stamina, now the hustle and bustle of the days shift and always being on her feet and on the move seem to wear her down rapidly. You have felt a growing concern for Hilda, and for the rest of the team as well, because it has become obvious to you that Hilda is not bearing her share of the load. Other members of your already overworked crew are working extra hard to make up the difference.

Your concern reached a peak this week when three of your staff nurses came to talk to you about Hilda. Although they came with apparent reluctance - Hilda had always been well liked by both staff and patients - they were quite convinced that something had to be done for both Hilda's sake and the sake of the department. It seems that Hilda has barely been able to accomplish half of what she should be expected to do in an 8-hour shift.

Hilda only knows nursing; she has been an LPN for all of her working life. She will not be eligible for retirement for 5 more years. It is evident that you need to make a decision concerning Hilda and her apparent inability to keep up with the work.

- Identify at least three alternatives (or more if you wish) that you believe might be possible solutions.
- Which alternative appears sufficiently workable to be the first one attempted? And what information do you need to assemble in preparing to justify your decision?
- If your initial decision is found unworkable or unacceptable, which alternative would be your second choice? Why?