Problem: Cultures and Hierarchies

Having been with the county health department for 6 months, you are very impressed with the physician who is the county health administrator. She seems to have a genuine concern for patient welfare. She has a tea for new employees each month to discuss the department's philosophy and her own management style. She says that she has an open-door policy, so employees are always welcome to visit her. Since you have been assigned to the evening immunization clinic as charge nurse, you have become concerned with a persistent problem. The housekeeping staff often spends part of the evening sleeping on duty or socializing for long periods. You have reported your concerns to your health department supervisor twice. Last evening, you found the housekeeping staff having another get together. This mainly upsets you because the clinic is chronically in need of cleaning.

Sometimes, the public bathrooms get so untidy that they embarrass you and your staff. You frequently remind the housekeepers to empty overflowing waste paper baskets. You believe that this environment is demeaning to patients. This also upsets you because you and your staff work hard all evening and rarely have a chance to sit down. You believe it is unfair to everyone that the housekeeping staff is not doing its share. On your way to the parking lot this evening, the health administrator stops to chat and asks you how things are going. Should you tell her about the problem with the housekeeping staff? Is this following an appropriate chain of command? Do you believe that there is a conflict between the housekeeping unit's culture and the nursing unit's culture? What should you do? List choices and alternatives. Decide what you should do, and explain your rationale.