Barbara Norris: Leading Change in the General Surgery Unit

Barbara Norris facing many difficulties. The GSU which she lead is currently short-staffed and does not perform as she expected. Her staffs have low morale and low motivation to do their daily job. On top of that, there is a cultural issue where confrontation, blaming, and favoritism are typical in her unit. She also facing a budget problem where overtime has been eliminated due to cost cutting measure implemented on the hospital. The budget cut make it difficult to Barbara to allocate a right personnel in case of some staff take a personal or vacation leave.

In many cases, she has to rely on nurses from general float pool to cover the staff on leave, but this often lead to negative effect to her staff dynamics because the substitute nurses is not familiar with the GSU. There are three broad problem Barbara has to solve: lack of collaboration and teamwork, staff conflict either within her unit or within the hospital, and lack of transparent performance appraisal procedures.

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All of this three issues need to be address simultaneously to ensure that the unit perform as Barbara expected. It is evident that there is conflict between junior nurses, senior nurses, and PCAS’s which lead to ineffective collaboration among them. Junior nurses feels like the don’t belong to the team and they don’t get positive feedback from senior nurses. On the other hand, senior nurses feels that many junior nurses and PCA’s are incompetent and feel overwhelmed to support them.

To solve this issues, Barbara need to redefine a clear role among the nurses and make sure that the role is properly understood by all her staff. In redefining the role, she must include advice from her staff to ensure that the role definition fit within her unit. She also need to develop a transparent communication mechanism to solve any role discrepancy within her unit. To address the performance appraisal issues, Barbara needs to start creating a transparent review process.

Although she still facing a budget constraint, she can utilize non-monetary approach to reward her staff. This can be in form of formal recognition in staff meeting or announcement of monthly best-staff. Although it would not directly impacted to her staff salary, it can be a great motivational tools for the junior staff to feel recognized. Barbara should also make a system where senior nurses can have a positive feedback in performance review by helping a junior nurses. Whenever possible, Barbara should persuade the hospital director to increase her unit budget.If approved, she could make a proper adjustment to the staff salary and position based on their previous performance.