Introduction
The management of healthcare facilities requires a solid framework for decision-making that considers essential procedures and interactions between personnel. Depending on their style and approach, managers implement their decision-making in various ways, especially since there are different tools and methods available to them. What is essential to understand is that the approach taken by a manager may not be welcomed by other employees, which creates complications and further dilemmas. The case study “Paid to Make Decisions” explores the gap in decision-making perceptions of a nursing manager, Carrie, at an emergency department and the personnel. The differences in opinions have led to opposition to change on the part of the emergency staff as well as a misunderstanding on the part of the manager.
Weaknesses in Manager’s Final Statement
In her statement about decision-making and nurse management, Carrie mentioned that the participation of workers was not important to her. The fact that she did not want to engage her subordinates in a conversation about the changes in the department pointed to her excessive independence. The manager said that she was “paid to make decisions” and that she “did not try to avoid responsibility by encouraging employees to make decisions,” which pointed to a high level of control and an approach that does not include other people. Collaborative efforts could have saved the problem with the lack of consensus between the manager and nurses, and their absence represents the fundamental weakness of Carrie’s statement.
Disadvantages in the Manager’s Approach Toward Change
The sudden changes that took place at the emergency department of County Hospital were a shock to employees who were used to the usual daily processes. Nurses did not have to follow a strict dress code or comply with a no-phone policy because the previous manager, which was called “the invisible manager,” did not enforce the rules upon them. However, when Carrie was hired to oversee the management and make changes to the department, her work became clearly visible to the employees. The staff did not adhere to changes well because Carrier was insisting on complying with rules that were not considered important by the workers because they did not enhance the quality of services. The enforcement of such regulations as restrictions with schedule changes, no food and drinks at the workplace, punishments for tardiness, and others were seen as aggressive. The approach was not welcomed because the manager was making all decisions on her own, failing to engage nurses in a dialogue. It could have been useful for Carrier to interview her subordinates about the changes that were made and what impact they would have on the work process.
Influence of the Manager’s Behaviors
With the arrival of Carrie as the new nursing manager at the emergency department, the leadership style changed from laissez-faire to authoritative. Such a significant shift with no prior discussion and collaboration could not have had any other effect. The nurses at the department were dissatisfied with the management style because no one had prepared them for the changes that would be enforced. While Carrie was dedicated to the job and tried to streamline processes and establish a cohesive set of rules, the lack of consideration for the opinions of other people is a significant disadvantage in her management behavior. Because of this, the implementations at the department were met with hostility and a general lack of understanding of why the changes would need to occur. What is also notable is that the department was not lacking in the quality aspect of services. Despite the fact that some nurses would have their food in the workplace or phone home, they cared for their patients. Thus, the authoritative changes that Carrie had made over a short period of time had an adverse effect on the attitudes and behaviors of nurses.
Initial Approach That Should Have Been Implemented
Prior to implementing the plan for the emergency department changes, Carrie should have interviewed the staff and asked them about their opinions and perceptions. A comprehensive assessment of the advantages and disadvantages of the existing nursing management framework could have pointed to the specific issues that should be changed. The staff, which deals with patients on an everyday basis, is more likely to notice problems with the management. Therefore, when initially approaching the plan for emergency department improvement, Carrie should have been more attentive to the environment within the team and listened to their suggestions. The radical approach that she wanted to take could have been balanced by the creative ideas of her subordinates, making the process to change implementation easier and more tolerable among the staff. In addition, getting to know each employee personally could have given Carrie an idea of individual needs and situations that may require a flexible schedule or the ability to make phone calls when necessary.
Salvaging the Situation
Carrie should hold regular meetings with nurses and ask them about their perceptions of the changes. Nurses could have interesting and innovative ideas on how their work can be improved. A collaborative effort is essential for salvaging the situation at the department because, without it, the radical changes would exasperate further opposition from employees. To facilitate such an effort, it is recommended for Carrie to acknowledge the limitations of her approach and communicate to nurses that the critical goal is to improve everyone’s work. Since the manager’s actions had a tremendous effect on the perceptions of workers and their attitudes toward change, it is imperative to create an environment of understanding and mutual respect. The changes at the department, therefore, should be revisited in the form of a conversation and collaborative effort that would engage both the manager and her subordinates. It may also be a good idea to implement a system of feedback that would allow nurses to give anonymous reports on the processes at the emergency department. Such an approach would provide Carrie a better idea of what aspects of work require the most attention.
Concluding Remarks
The exploration of the case study revealed the importance of collaboration with employees when it comes to nursing management. Caring for patients is a complex process that requires dedication on the part of personnel, and making sudden and unsupported changes to the nursing environment can be met with opposition and hostility. Nursing managers who start working at a new facility should avoid the “paid to make decisions” narrative and instead engage employees in a conversation about their needs and expectations of the work process. The example of Carrie showed that the nursing management environment is complex and multi-dimensional, which is why it is imperative to engage employees in the decision-making process.