Question: Decision Making: Conflict and Dilemma

You are the director of a small Native American health clinic. Other than yourself and a part-time physician, your only professional staff members are two RNs. The remaining staff members are Native Americans and have been trained by you. Because nurse Bennett, a 26-year-old female BSN graduate, has had several years of experience working at a large southwestern community health agency, she is familiar with many of the patients' problems. She is hard working and extremely knowledgeable. Occasionally, her assertiveness is mistaken for bossiness among the Native American workers. However, everyone respects her judgment. The other RN, Nurse Mikiou, is a 34-year-old male Native American. He started as a medic in the Persian Gulf War and attended several career-ladder external degree programs until he was able to take the RN examination. He does not have a baccalaureate degree. His nursing knowledge is occasionally limited, and he tends to be very casual about performing his duties. However, he is competent and has never shown unsafe judgment. His humor and good nature often reduce tension in the clinic.

The Native American population is very proud of him, and he has a special relationship with them. However, he is not a particularly good role model because his health habits leave much to be desired, and he is frequently absent from work. Nurse Bennett has come to find Nurse Mikiou intolerable. She believes that she has tried working with him, but this is difficult because she does not respect him. As the director of the clinic, you have tried many ways to solve this problem. You feel especially fortunate to have nurse Bennett on your staff. It is difficult to find many nurses of her quality willing to come and live on a Native American reservation. On the other hand, if the Native American health concept is really going to work, the Native Americans themselves must be educated and placed in the agencies so that one day they can run their own clinics. It is very difficult to find educated Native Americans who want to return to this reservation. Now, you are faced with a management dilemma. Nurse Bennett has said that either Nurse Mikiou must go, or she will go. She has asked you to decide.

ASSIGNMENT: List the factors bearing on this decision. What (if any) power issues are involved? Which choice will be the least damaging? Justify your decision.