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 today’s gossip may be tomorrow’s fact.
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 problem-oriented 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. Herzberg’s 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).
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 party’s 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.
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 esteem 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 inequitable and this drove them further away from Annemarie. Although organization was satisfying the first two needs of physiological needs and safety in Maslow’s hierarchy, 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.
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. 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. 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.
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 performance would push them to work harder while cooperating and assisting each other. These schemes would act as a positive KITA 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 roles. 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 ties 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.