Carrie Wilson, a registered nurse with more than 10 years ofactive supervisory experience, was hired from outside

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Question:

Carrie Wilson, a registered nurse with more than 10 years ofactive supervisory experience, was hired from outside as nursingmanager for the emergency department of County Hospital. It wasCarrie’s style to develop insight into how to manage a givenoperation by putting herself where the action was and becomingtotally immersed in the work. She quickly discovered, however, thather tendency to become deeply involved in hands-on work drewreactions from staff members ranging from surprise to resentment.She also discovered that her predecessor, who had been in theposition for several years, had been referred to as “the InvisibleNurse.” As someone said about the former manager, “I think she wasa very pleasant person, but that’s hard to say because we almostnever saw her.”

In spite of the legacy of the Invisible Nurse, Carrie provided aconstant management presence and seemed determined to remain deeplyinvolved in the work of the department. She was also determined toimprove vastly the level of professionalism in the department, aquality that had struck her from the first as decidedlylacking.

In a short time Carrie had moved to reinstate and enforce along-ignored dress code for the department, eliminate personaltelephone calls during working hours except for urgent situations,curb chronic tardiness on the part of some staff members, bar foodand drink and reading materials from work areas (also a reemphasisof long-ignored rules), and curb the practice of changing scheduleddays of work after the time limit allowed by policy.

Carrie found her efforts frustrated at every turn. As she saidto her immediate superior, “I can’t understand the reaction. AllI’ve done is insist that a few hospital rules be followed—mostlyrules that have been there all along but were being ignored—andadded a few twists unique to the emergency department. Just that,and yet the bitterness and lack of support and even resentment areso strong I could slice them. I’m getting all-out resistance from afew people whom I would still have to describe as good,professional nurses at heart.”

Carrie’s boss, the Vice President for Nursing Service, said, “Doyou suppose you may have been pushing too hard, hitting them withone surprise after another without knowing how they felt andwithout asking for their cooperation?”

“That’s possible,” answered Carrie, “but now I’m committed onseveral fronts and I can’t back down on any of them without lookingbad to the department.”

“Don’t think of this as a contest of wills or a game,” said thevice president. “It may be necessary for you to back downtemporarily in some areas or at least hold a few of yourimprovements up in the air for a while. It may not hurt to fallback and involve a few of your staff in looking at the apparentneeds of the department.”

With a touch of impatience in her voice, Carrie said, “Oh, I’veheard all this stuff about participative management and staffinvolvement in making decisions. That may be the way for some, butthat’s never been my style. I’m paid to make decisions so I makethem—I don’t try to avoid responsibility by encouraging employeesto make my decisions.”

Questions

1. What are the weaknesses, if any, in Carrie’s final statementabout decision-making responsibility?

2. What has essentially been wrong with Carrie’s approach toraising the level of professionalism in the department?

3. How has Carrie’s behavior altered or otherwise affected theenvironment within which she expects her decisions to beimplemented?

4. Ideally, how should Carrie have initially approached her planto improve the emergency department?

5. Given the state of affairs Carrie is facing as of herconversation with the vice president, how should she go aboutattempting to salvage some of her ideas and proceed with theimprovement of the department? Keep in mind that at this stage heractions have probably had serious effects on her chances ofimplementing her plans, and some of the decisions she may havealready made may have to be revisited in different fashion.