The Case of Disgruntled Nurses

By majillani | Studymode.com

The Case of the Disgruntled Nurses

Introduction:
At the board of directors meeting, board president received a letter from staff council of
Oneida Home Health Agency (OHHA), highlighting various staff concerns and
suggestions. Rachel Nelson, who had been hired as the executive director of OHHA,
was shocked and angered to see the letter, since this was a clear violation of
organizational hierarchy and brought her management skills into question. Rachel had
replaced Chuck about two years ago, who left the agency in a bad financial position.
Soon after her induction, she was joined by Annemarie as nursing director, replacing the
previous director Dorothy who had resigned. Rachel and Annemarie had been trying
hard to deal with the financial deficit and introduced systems to improve accountability,
productivity, quality and efficiency of staff and their documentation. These systems and
the intended changes were not viewed positively by some of the staff and started a
conflict with the management. The differences grew and resulted in the above
mentioned letter being sent directly to the board. Rachel recalled the events that had led
to the current state of affairs. Problems and their causes:
With a broad scope of problems at their hands, Rachel and Annemarie felt the need for
changes in organization structure. They discussed the new organization with the staff
and found a positive response. This demonstrates an important trait of an effective
manager, who shares the information with the staff and welcomes their response.
However, it also brings out the point that Rachel and Annemarie were unaware of the
hidden negative reactions of their staff, which demonstrates a lacking on their part, since
todays gossip may be tomorrows fact.i The senior nurses, on the other hand, felt the
new organization structure was bureaucratic and restricted their direct access to
management for any favors. This behavior was caused by years of lenient supervision
by Dorthy, who always accommodated their demands. If Dorthy rejected their demands,
nurses got around her to make successful personal appeals to Chuck. Without any
criticism and feedback from the management, nurses were denied the opportunity to
improve and develop their skills. As a result, nurses failed to comprehend the
importance of new and actual roles of management and disgruntlement started. Another
problem was documentation which Dorthy had tried to solve by adopting problemoriented medical record (POMR) method, but it was an extremely difficult system to
master and nurses were finding it hard to adjust to the new system. Annemarie took

steps to improve experience with POMR methods, but without the consent of the staff.
The modified-POMR methods increased their paper work and nurses had to spend more
time on office work, the time which they preferred to spend providing home care. The
senior nurses liked their job as it gave them flexible work timings, focus on direct patient
care and relatively paper free work. The previous organization culture had kept the
nurses happy and motivated by lenient supervision and praise without criticism. There
were no penalties for poor performance and senior nurses were satisfied, as they never
considered their job as a profession with future growth prospects. The staff was still
motivated to work in the relatively work-free environment. Herzbergs two theory factor
provides evidence for this type of behavior by stating that hygiene factors (Company
policy, supervision, interpersonal relations) are less important in motivating the
employees than motivating factors (Achievement, work itself, responsibility).ii Annemarie
tried to communicate and work with the nurses, but found the doors closed in defiance.
Both justified their positions and accused each other of neglecting other partys views.
With the passage of time, Annemarie and nurses developed a negative perception about
each other. In the absence of any communication, the positive/negative affects took root.
The individual negativity produced negative group affect and agency witnessed lesser
cooperative behavior.iii The agency was operating with a high mistrust between
Annemarie and senior nurses. In the office, when Annemarie faced the nurses, they felt
that she was spying on them and when she closed the doors, nurses wondered if she
was plotting something against them. Annemarie also had doubts about the professional
behavior of the nurses. She introduced more control to keep things in her hands by
monitoring productivity, directing all phone calls to her, making nurses sign in and out
and scheduling of holiday coverage without discussing with the nurses. This led to the
general feeling amongst nurses that they were losing their independence to do the work
they liked, i.e. provide home care. Annemarie also hurt the self esteemiv of the senior
nurses by preferring younger nurses, who had shown positive response towards her
stricter standards and control procedures. Annemarie failed to understand that she had
two different kinds of employees with different needs. The new nurses were motivated
by their need for achievement, since they had their professional growth and
development in mind. The senior nurses were motivated by their need for affiliation to
their work as home care providers, which gave them respectable status and warm
relationships with the people in community. Annemarie also preferred new nurses
because of their educational degree, which reflected bad on her part, as she failed to
realize that their customers preferred quality over education. The senior nurses also felt
strongly that their quality of work was being ignored because of an educational degree.
They perceived the situation as inequitablev and this drove them further away from
Annemarie. Although organization was satisfying the first two needs of physiological
needs and safety in Maslows hierarchyvi, it failed to address love and self esteem of the
senior nurses. The increasing negative sentiments towards each other were the result of

Pygmalion effect or self fulfilling prophecy, which explained the selective negative
perceptions of Annemarie and senior nurses based on their low expectations from each
other.vii Annemarie failed to understand the importance of communications in
organization and never attempted to see the perspective of senior nurses. She ignored
the fact that people perceive the same thing differently and their assumptions,
perceptions and feelings must be understood to be able to better communicate with
them.viii The nurses also ignored that managers require cooperation, reliability and
honesty from their subordinates. Had they tried to understand the goals and pressures of
Annemarie, things could have been brought under control with open communication and
feedback sessions.ix The lack of mutual respect and collaboration resulted in the
problems being faced by OHHA. Recommendations:
First solution could be to fire the senior nurses, who had no career orientation and were
reluctant in adopting the new systems and procedures. They could be replaced by newer
nurses, who were well liked by Annemarie and had shown the willingness to learn and
adopt new systems, working for individual and organizational growth. However, this
might not be viewed negatively by the clients and local population, who held them in high
regard. Since Annemarie is at the centre of this conflict, an alternate solution could be to
fire her. In order to achieve her goals, she had alienated people who did not cooperate.
She had taken decisions without any feedback from her subordinates and her
communication skills were under question. However, with high self efficacy, extensive
nursing administration experience in different capacities and her dedication to work and
patients, her separation would be a loss for the agency, when Rachel is still new to
home health field. Third option is to adopt the path of reconciliation between Annemarie
and senior nurses. The clients respected the senior nurses and mostly asked for them
by name. They also had a credible experience of home care, which if used positively can
bring extensive opportunities for the agency. Annemarie, on the other hand can focus on
nursing administration in an unbiased way. The collaboration between the two can
extremely benefit the agency. Solution and its implementation:
The third option presents a win-win situation for the agency. However, considering the
bitter past, it would be the most difficult to achieve. Rachel needs to re-open the direct
communication between Annemarie and the disgruntled nurses, in an attempt to sort the
resolution of conflict. Rachel can first discuss and understand the individual perspectives
of Annemarie and nurses. This can lead to a meeting between the concerned parties for
discussion about mutual goals and understanding the differences. Given the complexity
of the relationship between them, one meeting will never be enough to resolve the
issues. Rachel should make sure that meetings continue and she should keep a check
on the outcome of these meetings. To develop a better coordination between
management and staff, Rachel should encourage healthy speak up sessions, in which

management and staff can share their concerns and suggestions. Management can also
use these sessions to discuss any proposed changes and involve the staff in
understanding and implementing those changes. This would implement the key trait of
Type Z organization, i.e. instilling a sense of strategic vision in the employees.x To
redeem the esteem of the senior nurses a training scheme could be introduced, in which
senior staff volunteers and trains the newer staff. This would give a sense of privilege to
disgruntled nurses, who would feel that their experience is being rewarded and
respected. Younger staff can benefit from this experience and their attitude towards their
disgruntled colleagues would change to feelings of respect. This way, staff can also
realize the benefits of collaboration and team work. Rachel can introduce employee
appraisal, reward and promotion schemes to fully involve the staff in their work and
promote a culture of healthy competition. Appraising the staff on objective and subjective
performancexi would push them to work harder while cooperating and assisting each
other. These schemes would act as a positive KITAxii to move the staff towards the right
direction and away from conflict. Trainings can be conducted for Annemarie on how to
be an effective manager, who successfully plays the interpersonal, informational and
decisional rolesxiii. This will significantly improve the performance of Annemarie and
hence, the organization. Similarly, trainings can be conducted for nurses on how to
manage their bosses, so they can understand that forging tiesxiv with Annemarie based
on mutual respect. To oversee the proposed solutions, Rachel needs to be more
involved in day to day activities of the agency. This would give a feeling to the nurses
that the management understands their concerns and the importance of resolving those
concerns. Conclusion:
The analysis of this case brings out the fact that open and effective communication has
a very important role in successful operations of an organization. The manager needs to
understand employees and their assumptions, perceptions and feelings. Employees
need to understand the goals, pressures, strengths and weaknesses and working style
of their managers. By working together and communicating openly a win-win situation
can be achieved, as desired by all organizations. Bibliography
The ideas presented in this analysis draw from several sources included in
Organizational Behavior reading pack for MBA - 2015 and interested readers can pursue
the following sources for more details.