Question: A Nursing Officer's Dilemma You are the chief nursing officer of County Hospital. Dr. Martin Jones, a cardiologist, has approached you about having an ICU/CCU nurse make rounds with him each morning on all of the patients in the hospital with a cardiac-related diagnosis. He believes that this will probably represent a 90-minute commitment of nursing time daily. He is vague about the nurse's exact role or purpose, but you believe that there is great potential for better and more consistent patient education and care planning. Beth, one of your fi nest ICU/CCU nurses, agrees to assist Dr. Jones. Beth has always wanted to have an expanded teaching role. However, for various reasons, she has been unable to relocate to a larger city where there are more opportunities for teaching. You warn Beth that it might be some time before this role develops into an autonomous position, but she is eager to assist Dr. Jones. The other ICU/CCU staffagree to cover Beth's patients while she is gone, although it is obviously an extension of an already full patient load. After 3 weeks of making rounds with Dr. Jones, Beth comes to your office. She tearfully reports that rounds frequently take 2 to 3 hours and that making rounds with Dr. Jones amounts to little more than "carrying his charts, picking up his pages, and being a personal handmaiden." She has assertively stated her feelings to him and has attempted to demonstrate to Dr. Jones how their allegiance could result in improved patient care.
She states that she has not been allowed any input into patient decisions and is frequently reminded of "her position" and his ability to have her removed from her job if she does not like being told what to do. She is demoralized and demotivated. In addition, she believes that her peers resent having to cover her workload because it is obvious that her role is superficial at best. You ask Beth if she wants you to assign another nurse to work with Dr. Jones, and she says that she would really like to make it work but does not know what action to take that would improve the situation. You call Dr. Jones, and he agrees to meet with you at your office when he completes rounds the following morning. At this visit, Dr. Jones confirms Beth's description of her role but justifies his desire for the role to continue by saying, "I bring $10 million of business to this hospital every year in cardiology procedures. The least you can do is provide the nursing assistance I am asking for. If you are unable to meet this small request, I will be forced to consider taking my practice to a competitive hospital." However, after further discussion, he does agree that eventually he would consider a slightly more expanded role for the nurse after he learns to trust her.
ASSIGNMENT: Do you meet Dr. Jones's request? Does it make any difference whether Beth is the nurse, or can it be someone else? Does the revenue that Dr. Jones generates supersede the value of professional nursing practice? Should you try to talk Beth into continuing the position for a while longer? While trying to reach a goal, people must sometimes endure a difficult path, but at what point does the means not justify the end? Be realistic about what you would do in this situation. What do you perceive to be the greatest obstacles in implementing your decision?