You are the chief nursing officer of County Hospital. Dr. Martin Jones, a cardiologist, has approached you about having an intensive care unit/critical care unit (ICU/CCU) nurse make rounds with him each morning on all of the patients in the hospital with a cardiac-related diagnosis. He believes that this will probably represent a 90-minute commitment of nursing time daily. He is vague about the nurse’s exact role or purpose, but you believe that there is great potential for better and more consistent patient education and care planning.
Audrey, one of your finest ICU/CCU nurses, agrees to assist Dr. Jones. She has always wanted to have an expanded teaching role. However, for various reasons, she has been unable to relocate to a larger city where there are more opportunities for teaching. You warn Audrey that it might be some time before this role develops into an autonomous position, but she is eager to assist Dr. Jones. The other ICU/CCU staff agree to cover Audrey’s patients while she is gone, although it is obviously an extension of an already full patient load.
After 3 weeks of making rounds with Dr. Jones, Audrey comes to your office. She tearfully reports that rounds frequently take 2 to 3 hours and that making rounds with Dr. Jones amounts to little more than
“picking up his pages and being a personal handmaiden.” She has assertively stated her feelings to him
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“her position” and his ability to have her removed from her job if she does not like being told what to do.
She is demoralized and demotivated. In addition, she believes that her peers resent having to cover her workload because it is obvious that her role is superficial at best.
You ask Audrey if she wants you to assign another nurse to work with Dr. Jones, and she says that she would really like to make it work but does not know what action to take that would improve the situation.
You call Dr. Jones, and he agrees to meet with you at your office when he completes rounds the following morning. At this visit, Dr. Jones confirms Audrey’s description of her role but justifies his desire for the role to continue by saying, “I bring $10 million of business to this hospital every year in cardiology procedures.
The least you can do is provide the nursing assistance I am asking for. If you are unable to meet this small request, I will be forced to consider taking my practice to a competitive hospital.” However, after further discussion, he does agree that eventually he would consider a slightly more expanded role for the nurse after he learns to trust her.
Answer the following questions:
1, Do you meet Dr. Jones’s request?
???Does it make any difference whether Audrey is the nurse, or can it be someone else?
???Is the amount of revenue that Dr. Jones generates relevant in your decision making?
???Should you try to talk Audrey into continuing the position for a while longer?
- ???While trying to reach a goal, people must sometimes endure a difficult path, but at what point does the means not justify the end?
???Be realistic about what you would do in this situation. What do you perceive to be the greatest obstacles in implementing your decision?
Expert Solution Preview
Introduction:
In this scenario, the chief nursing officer of County Hospital is approached by Dr. Martin Jones, a cardiologist, who wants an ICU/CCU nurse to make rounds with him daily on patients with cardiac-related diagnoses. The nurse, Audrey, agrees to assist Dr. Jones but after 3 weeks, she expresses concerns about the role and its lack of autonomy. Dr. Jones justifies the request by citing the revenue he brings to the hospital and expresses potential consequences if his request is not met. The assignment requires addressing several questions related to this situation.
1. Do you meet Dr. Jones’s request?
As the chief nursing officer, it is necessary to evaluate the implications of Dr. Jones’s request. While it is important to consider the potential benefits of improved patient education and care planning, it is also essential to assess the impact on the workload and job satisfaction of the ICU/CCU nurse. Therefore, a meeting between the nursing officer, Dr. Jones, and Audrey should be arranged to discuss the concerns raised and explore possible solutions that could meet the needs of all parties involved. The final decision should prioritize patient care and nursing staff well-being.
2. Does it make any difference whether Audrey is the nurse, or can it be someone else?
The choice of nurse to work with Dr. Jones should be based on competence, experience, and willingness to fulfill the role effectively. While Audrey has expressed her interest in an expanded teaching role, her dissatisfaction and distress raise concerns about her suitability for the position at this time. Therefore, it may be appropriate to consider assigning another ICU/CCU nurse to work with Dr. Jones after a careful evaluation of their qualifications and willingness to take on the responsibilities involved.
3. Is the amount of revenue that Dr. Jones generates relevant in your decision making?
While the revenue generated by Dr. Jones is an important consideration, it should not be the sole determining factor in the decision-making process. The primary focus should be on providing quality patient care and maintaining a positive work environment for the nursing staff. Consideration should be given to the potential long-term benefits of improved patient education and care planning, but not at the expense of the nurse’s well-being and job satisfaction. A balanced approach that considers both the financial aspects and the welfare of the nursing staff is warranted.
4. Should you try to talk Audrey into continuing the position for a while longer?
It is crucial to address Audrey’s concerns and determine if there are actions that can be taken to improve the situation before deciding whether she should continue in the position. Engaging in open and supportive communication with Audrey, understanding her perspective, and exploring potential solutions is essential. If possible, offering her additional opportunities for professional development or negotiating adjustments to her role could help alleviate her demoralization and demotivation. However, if it becomes clear that the role is not suitable for Audrey or cannot be adjusted to meet her expectations, it may be necessary to consider other options for fulfilling Dr. Jones’s request.
5. While trying to reach a goal, people must sometimes endure a difficult path, but at what point does the means not justify the end?
The means should not justify the end when the cost-benefit analysis indicates that the negative consequences outweigh the potential benefits. In this case, the difficult path of having the ICU/CCU nurse make rounds with Dr. Jones must be evaluated in terms of its impact on patient care, nursing staff workload, job satisfaction, and overall hospital operations. If the nurse’s role is deemed to be overly burdensome, demoralizing, or resulting in compromised patient care, it may be necessary to reevaluate the situation and consider alternative approaches to achieve the goal of improved patient education and care planning.
In implementing the decision, the greatest obstacles may include:
– Communicating and managing the expectations of Dr. Jones, nursing staff, and Audrey
– Balancing the workload of the ICU/CCU nurses to ensure patient safety and quality care
– Addressing potential issues of job satisfaction and morale among the nursing staff affected by covering Audrey’s workload
– Developing a clear roadmap for the expansion of the nurse’s role that ensures appropriate autonomy and professional growth
– Negotiating a solution that satisfies the needs of all parties involved while maintaining the hospital’s reputation and financial stability.
In conclusion, finding a suitable resolution to this situation requires careful consideration of the concerns raised by Audrey, the expectations of Dr. Jones, the impact on patient care and nursing staff, and the long-term goals of the hospital. Open communication, collaborative problem-solving, and a focus on patient-centered care should guide the decision-making process.
