The following situation was recounted by Ms

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The following situation was recounted by Ms. Jackson, who knew Evelyn Ross for several years and had also, on various occasions, worked in some of the same hospitals as her. Registered Nurse, Evelyn Ross began working at the age of 31 at Benton Hospital, an industrial hospital of Orange County, located just south of Los Angeles. The establishment had a potential of around 150 beds, and 50 to 100 patients weredaily treatments in its clinics. It had been built by a large shipyard, which ensured its management. All employees of company site could, with their dependents, receive medical care through the company's hospitalization plan. The nursing staff was headed by a director, assisted by two assistants in charge of nursing services, one in the hospital, the other, in the clinic. However, the two departments operated in one coordinated unit and exchanged personnel when the charge of Work was getting too heavy in one place or the other. The hospital's medical director, Dr. Peake, was energetic and had usually in pretty brutal ways. Straddling discipline and efficiency, he treated his staff fairly and respected him and was very cooperative. D r Peake had many innovative ideas and had helped to increase the hospital from 75 to 150 beds. His new ideas were discussed at staff conferences attended by the heads of departments or all those who risked suffering the effects of proposed changes.

Evelyn Ross worked as a head nurse, both in the hospital and in the clinic, during the time she worked there. (At the time, Ms. Jackson worked in the clinic, as assistant head nurse). She resigned to enter, as lieutenant, in the corps of nurses of the army, where she served two and a half years, which she spent, for the most part, on assignment in the southern Pacific. Promoted to rank of captain during her period abroad, she was transferred to the reserve when it left the body. Shortly after, she took a training

quarterly to supervision in the operating room.

In the meantime, Ms. Jackson had moved to the East Coast and worked in

a large industrial hospital in Manchester (Vermont), the Hughes Hospital. The

two women wrote to each other during this period and Ms. Jackson wrote that

the operating room supervisor position would soon open at the hospital and

that in her opinion, Evelyn Ross had a good chance of getting the job if she

wanted to settle on the east coast. The applicant applied for the

director of the hospital nursing services, was accepted for the post and

soon began to work on it.

Hughes Hospital had a structure broadly similar to that of

Benton Hospital. He was responding to the request for medical attention from the major

part of the community, while caring for Hughes Steel personnel

Company, the city's main employer. It was equipped with clinics for

emergencies and outpatient care. He had a

potential of 250 beds and clinic staff were treating significantly more

100 sick a day, but it often happened that we did not keep a

exhaustive assessment of the number of patients. The organization of the department

nurse was very similar to that at Benton Hospital, a

important exception: the hospital department and the clinic

operated as two completely independent units. The clinic is

was in a separate building from the hospital; consequently, the

moving a bedridden patient from the clinic to the hospital was a problem

extremely complex. Besides the proper equipment to move

patients were lacking, there was a lack of ward boys, and we had to

resort to beneficiary attendants to carry out this arduous task.

This shortage of personnel and equipment was particularly felt

when emergency patients and accident victims came to the

clinic and had to be transferred to hospital with minimal loss of

time and complications.

The Director of Nursing, Ms. Mahaffey, was approximately 45 years old

and had worked at the hospital for three years. M me Linden was controlling

hospital for six months and Ms. Hartman had worked in the same position at the

clinic for over a year. In the pavilions of the hospital worked 24

qualified nurses, 30 patient attendants and 10 women

housework. In the clinic, staff working with Ms. Hartman are

consisted of 5 qualified nurses, 4 patient attendants and

2 housekeepers. There were only six waiters for all

the three-eight: one available to the entire hospital in the evening shift, one

in the night shift, one in the clinic and in the operating room during

the day shift, and one for each of the two men's pavilions of

the hospital. In charge of supervision in the operating room, Evelyn Ross had

a staff of four nurses, three patient attendants and

of a waiter. In the operating room, nurses worked in

rotation, with guards every night for any emergency surgery.

Evelyn Ross found that the work was very demanding and resulted in

frequently through long hours, but she was very interested in him

which she never seemed to get tired of. She often stayed to help in case

emergencies in surgery, as a number of serious accidents occur

occasionally produced in steelworks served by the hospital. The

strengthening ' efficiency and cleanliness of operating rooms was worth it

praise unreservedly M me Mahaffey.

Nearly 65, Dr. McMillan, the hospital's medical director,

had worked, as a doctor at the Hughes Steel Company, for more than

20 years. He usually arrived in his offices at the hospital at nine o'clock.

morning, dictated answers to his correspondence, made

occasionally tours to some of the hospital pavilions (in particular

showing extremely rarely at the clinic), left quickly

lunch at noon and did not return to the ' hospital two or three times a week,

for a few hours after the midday meal. During his tours

fortuitous in the pavilions, he stopped at the nurses' floor office,

asked if everything was okay, before saying "Alright!" Very well! " and of

continue on his way. When Dr. McMillan suffered a heart attack enough

serious to prevent him from keeping his post at the hospital, it was necessary to find a

new medical director. The president of the steelworks company

knew the shipyard and knew that Dr. Peake had worked at the

Benton Hospital. He contacted him to see if he would be interested in the post of

medical director of the hospital. D r Peake agreed. He occupied the new

post with the blunt and forceful manner he was accustomed to

and toured the clinic and hospital daily. He was going

often a lot of time talking to patients, nurses,

attendants and staff physicians.

After about a month of in-depth observation of the current work of the

clinic and hospital, Dr. Peake held a conference with Ms. Mahaffey

and those responsible for nursing staff. He criticized "the attitude no

professional "of several nurses, and stated that many

patients had complained to him about the care they were receiving. II

asked why so many nurses seemed absent,

their pavilions during his morning tours. M me Mahaffey replied that

nurses were allowed to leave the lodges at intervals

between 9 a.m. and 11 a.m. for a coffee in the dining room of

hospital and that the time taken for this did not lead to an audit

rigorous. D r Peake also spoke to Dr. Dr. Allbright, staff physician

responsible for the clinic, as well as its nurses, in order to know

why patients often had to wait extremely long

to see a doctor there. (Most of this information came from

M me Jackson, assistant controller of the clinic). Clinic staff

recognized that this one really knew a "bottleneck",

while considering that the latter was mainly due to a shortage of

staff when it was needed most, to the difficulties

caused by the need to transport patients to the hospital and to

the absence of satisfactory laboratories in the clinic itself. D r Peake advised staff that new buildings under construction

at the hospital would be used by the clinic establishments. In the meantime, he

would try, he said, to help them find a way to simplify the

situation.

During the second week of August, that year, Ms.

Mahaffey asked Evelyn Ross to come to her office.

M me Mahaffey: Madam, D r Peake told me that you've worked with

him at Benton Hospital. I knew that ' he had been for a while,

but I did not know that c ' was during the period when you were working there. He had me

said you knew the scheme that worked there between the clinic and

hospital and asked me to release you from your current job, so that

you can help coordinate the units of our clinic and

our hospital.

M me Ross: I'm sorry for what I hear. I am very happy to

my current position. Will I be working in the clinic or the hospital?

M me Mahaffey: Both. I want you to know that in my

eyes M me Linden provides a very competent control and I do not want

not that it suffers from this new provision. Besides, I want to know

everything that's going on there. I expect at least one report from you

daily. I don't see what Dr. Peake expects you to do

what has already been done. It must recruit more people, s ' he wants

of this establishment a model hospital. Since his arrival here, he has

terminal to criticize.

M me Ross: I'll do my best. I know the structure that Dr. Peake

had in Benton. I may be able to contribute to its application here.

A few hours later, Dr. Peake walked into Evelyn's office

Ross, in the operating room unit.

D r Peake: Hi, Rossie, I have a new job for you.

M me Ross: M me Mahaffey told me about.

D r Peake: You know how things went in Benton. I

want units here to be organized exactly the same

way. During the last few months, I have made sure that another

doctor comes to help at the clinic during peak hours and we

recruited two additional patient attendants, but

things hardly seem to be improving. Maybe you can

help me find the causes of the difficulties. Our new program

construction has started and when it is completed I want the

two units operate as an integrated unit. I am bored of

steer clear of surgery - because you did a good job at it - but

I think you can help me improve the operation

joint units of the clinic and hospital.

M me Ross: I can try, Doctor.

D r Peake: Perfect! Now I don't want you to go through that

whatever - if you have any problems, come

directly see me.

Informed of the difficult relationship existing between Dr. Peake and Ms.

Mahaffey, Evelyn Ross was particularly reluctant to bypass the director

nursing staff, his immediate superior. She then decided that he

better to observe regular channels of communication.

She introduced herself to her new job and discussed the plans and ideas of the

D r Peake on the integration of the two units with ladies Linden

Hartman. She also explained to them the reason why he had it.

chosen for the job: she had worked at Benton Hospital under her

direction. They had learned that Ladies Ross and Jackson had

worked at this hospital while Dr. Peake was there.

None of the directors looked very surprised. M me Linden noticed

the case sounded like another of Dr.

Peake.

Ladies Linden and Hartman appeared concerned about the staff shortage

and declared that any change which would improve the situation would be the

welcome.

At the time, personnel issues were acute

particular to the hospital. Several staff members were off

disease and the number of patients was greater than usual. The

clinic was only open on Saturdays and Sundays for emergencies.

A nurse and two orderlies were on call during

on weekends, but without being rushed. Evelyn Ross organized the transfer

of the two patient attendants at the hospital during the weekend. M me

Linden was delighted with the extra help. The following Wednesday, the clinic

was very late in his work, due to the occurrence of a

emergency. Evelyn Ross went to M me Linden to see if anyone

could spend the afternoon there to assist, which resulted in the

following conversation:

M me Ross: M me Hartman is submerged. She had to deal with an emergency and

the other patients are not seen. Are you able to send

someone to help?

M me Linden: I will send someone to the clinic. They have one

sufficient help! There are too few of us here.

Evelyn Ross went to one of the pavilions and found there, in the kitchen,

two of the orderlies having a coffee. She

asked if they had any free time.

One of them replied, "Of course. We didn't have much to

to do this afternoon ".

Evelyn Ross returned to M me Linden and told him the episode. She

asked for one of the patient attendants to be sent to the clinic, to

give a hand. M me Linden accepted grudgingly.

Shortly thereafter, Ms. Linden took a two-week vacation. M me Mahaffey

asked Evelyn Ross to look after the hospital unit until her

return. From then on, it faced the problem of developing jobs in the

time of all nurses, patient attendants,

room boys and housekeepers working in the unit

hospitable. D r Peake was also asked to launch a study

to determine the staffing needs in the various pavilions of

hospital and clinic departments, and participate in

planning the layout of new equipment in extensions

buildings. During the two week absence of Ms. Linden,

Evelyn Ross discovered (1) that one lodge had more nurses than one

other, despite equivalent workloads and (2) that the women of

housekeeping did not perform the cleaning for which they were responsible and that

some did not even know the nature of their obligations. In

cooperation with Ms. Hartman and with the consent and permission of Ms.

Mahaffey, Evelyn Ross reassigned nursing staff,

so as to ensure that all the pavilions have equal numbers, in relation to

their workloads. She organized the timetables so as to

provide support from the clinic, depending on availability, to the hospital during

weekends and instructed housekeepers on their

tasks.

Patient care appeared, quantitatively and qualitatively,

progressively improve, and the placement of employees in tasks that

occupied them and in which they understood their obligations seemed

increase the satisfaction of the majority of them. Patients reported

improving the care received since the changes were made. D r

Peake praised Ladies Ross and Mahaffey for the success of the new

program.

Two days after the M back from vacation I Linden Evelyn Ross was

called to the office of the director of nurses.

M me Mahaffey: Madam M me Linden requested his transfer to the room

operation, because she doesn't think you will get along, all

both. She's doing a good job in the hospital and I don't want to lose her. AT

from now on you will not interfere with the operation of

the hospital unit and its staff. There, M me Linden will attend

of all.

M me Ross: I do not understand, ma'am. Do you mean that my

work stops there?

M me Mahaffey: No. You will continue to work at the clinic and there

contribute to the creation of new departments, as the

continuation of the construction program. I really don't see what has

made Dr. Peake think you would be able to do anything to

improve the situation. He will just have to understand that we

are understaffed.

Evelyn Ross walked out of the interview in confusion over her exact status,

because she knew that Dr. Peake would expect her to continue trying to

coordinate the two units.

By bringing out the relevant theoretical notions, answer the three

following questions.

1. What is (or are) the problem (s)?

2. What are the causes and consequences of the problem (s)?

 

3. Explain, providing as much detail as possible, how this

situation should be handled and why.