BARBARA

NORRIS: Leading
Change in the
Genaral Surgery
Unit
QUESTION’s –
1. What would you suggest to develop employee satisfaction and
job motivation at Barbara?
2.How can you manage change management and managing a
crisis in the Barbara Case?
3.How can you develop employee morale, control employee
turnover, and help to develop teams, and help in retention?

Saqib Mukhtar08208016, Sadia

tanweer08208028,
Rabia Tanweer08208029, Mehwish nazir
08208027,
QUESTION 1- What would you suggest to develop employee
satisfaction and job motivation at Barbara?

Ans: The exercise which barbara conducted among her

senior and junior RNA’s revealed several problems and
issues that the employees were facing and infact the issues
were more than barbara had expected. It was revealed that
employees had major issues with respect to interpersonal
relationship. Barbara Norris struggled to address the many
problems facing her as a recently promoted nurse manager
in the General Surgery Unit (GSU) at Eastern Massachusetts
University Hospital (EMU). She has inherited a unit with the
lowest employee satisfaction scores and highest employee
turnover rate among all of the departments at EMU.
Furthermore, her new unit was infamous for its culture of
confrontation, blaming and favoritism. The staff that has
remained is dissatisfied, unmotivated and not functioning as
a team to deliver patient care. In fact, GSU's patient
satisfaction scores, although average, had been declining
steadily over the past few years. Barbara has been asked by
EMU'S Director of Nursing to turn the unit around in the
midst of an economic crisis and deep cost-cutting measures
throughout the hospital.

Incivility is manifested in complaints of a lack of

collaboration, contribution acknowledgement, and
advocation on the staff’s behalf. Occasionally, staff
interactions are punctuated with bursts of frustration and
anger. Work overload is evident in that older nurses tend to
overlook their responsibilities as mentor in favor of getting
their own work done as fast as possible, resulting in feelings
of stagnation and isolation among the younger staff
members. Lack of task control is apparent in the belief that
assignments are random and unearned, the perception of
favoritism, the secretive performance review process, and
the inescapable shift from traditional nursing duties to
perceived excessive administrative responsibilities.
 With her team having gone from the more beneficial
form of stress known as eustress to outright and long-term
distress, it is no longer capable of functioning at peak
efficiency. Symptoms of this include job-dissatisfaction,
angry and negative emotions, impatience with younger co-
workers, and lowered organizational commitment resulting
in excessive staff loss during a hiring freeze. Barbara must
get a handle on this situation before GSU suffers from even
lower levels of job performance, decision-making, and
potentially higher levels of workplace accidents.

In order to bring better employee satisfaction among

employees the following issues should be resolved:

i) Miscommunication
ii) The senior staff should take some more
responsibility.
iii) The senior staff should be trained and
motivated.
iv) The senior staff should be more
accomodating to the junior staff and they should
be more hospitable. ( it wil bring and atmosphere
of mutual trust and respect).
v) Lack of collaboration and teamwork.
vi) Lack of reward for job performance.
vii) Lack of fairness.
viii) Lack of feeling supported are all problems
that relate to the diversity of the GSU team
Job Motivation can be brought through different ways which
are mentioned below:

i) Better attitude towards the employees.

ii) The management should bring in an environment of
trust and motivation.
iii)The management should offer incentives to own the
working environment.
iv)Vote of confidence to make the employees feel that
they are the crucial part of the working environment.
QUESTION 2- How can you manage change management
and managing a crisis in the Barbara Case?

Ans: The motivational system at GSU, or lack thereof, is

playing a significant role in the attitudes and behaviors of
Barbara’s staff. As explained in Expectancy Theory, the staff
is going to focus its job efforts on those tasks that will
provide the most desirable rewards. There are three parts
to Expectancy Theory, but the problem at GSU lies in the P-
to-O portion. The staff believes that if they put in the effort,
there is a very high probability they will achieve the
performance levels they desire. Spending personal time
learning new technologies in order to more efficiently
perform daily tasks and tending to patients requests so they
get the care they need were a couple comments made by
the staff that demonstrates this understanding. The issue is
that once they achieve the expected performance, there
aren’t any desired outcomes or rewards that motivate them
to continue these behaviors. The rewards don’t necessary
have to be in the form financial compensation, but they do
need to be desirable. The reward could be simple public
recognition within the unit, a plaque of some sort, or choice
of shift for a period of time.
One of the major obstacles that Barbara has identified
and needs to overcome within her unit is the lack of
intellectual transfer and training that goes on on at GSU.
This can be directly attributed to poor organizational
citizenship, wherein some staff members seem unwilling to
go beyond their formal job descriptions. Establishing a
mentoring system that is directly tied to year-end reviews
would assist in additional training for the younger staff
members by those more tenured, while also providing some
specific guidance as to what contributes to the evaluation
process. Regardless of what Barbara chooses to do in terms
of rewards, she must find a way to motivate her staff to put
forth the effort that she wants to see. The employees need
to view the outcomes or rewards as something positive for
them, as described in the Outcome Valences section of the
Expectancy Theory. Establishing a reward system that no
one wants will not change the situation. The major
constraint Barbara is going to face is the financial
restrictions GSU is going through. Given the economic
situation presented in the case and shortage in staff,
Barbara will probably need to develop rewards that do not
involve financial compensation or time off. Fortunately, from
the comments made directly by her staff during the off-site
forum, they are mainly looking for some recognition and
constructive feedback, which could build an emotional
connection among the members of the unit and which are
within her power to provide even in difficult financial times.

QUESTION 3- How can you develop employee morale, control

employee turnover, and help to develop teams, and help in
retention?

Ans: Frustration, hopelessness, despair and overall feelings

of under appreciation came out in the feedback that Barbara
solicited in the off-site meeting. Emotions play a large part in
shaping attitudes, and the emotions and attitudes that the
staff at GSU is experiencing contribute to a demoralizing
work environment.
It’s clear that some level of cognitive dissonance is
occurring at the GSU. In this case, the staff states that the
reason they entered the nursing profession was to help
people. However, they feel as if they are being asked to
perform their duties in such a way that conflict with those
beliefs. For example, they are spending less time caring for
patients and more time filing paperwork and handling
administrative tasks. This dissonance is leading to negative
attitudes around the workplace. Additionally, the emotional
labor present in a hospital setting, compared to that of an
office or factory setting, is adding stress to a situation in
which lives hang in the balance.
While Barbara has a tough job ahead of her, she is off
to a good start in showing the staff that she’s genuinely
interested in hearing their problems. She is demonstrating
that she is open to feedback, and likely to earn the trust of
some of the staff that are suspicious of management. If she
is successful in solving one or two problems early on, it is
probable that the stress levels will decrease concerning
those particular areas. Barbara can institute participatory
and transparency policies and procedures to fix some of the
problems that have been identified, but it will be difficult,
though not impossible, to change the emotions, attitudes,
and stress levels of the staff.
Barbara recognizes that attitudes affect behavior. With
that in mind, she is trying to assuage the negative attitudes
in her new unit by addressing at least one of the assessed
feelings she has recognized in her short stint as head of
GSU, namely that of staff having little or no input into the
matters that greatly affect them. By introducing a more
participative process, she hopes to increase the affective
commitment of her employees and reduce
counterproductive work behaviors. While this is an excellent
idea on her part, she is not likely to experience significant
success for two main reasons: poor prioritization and poor
execution.
Specific to her prioritization, she has charged herself
with addressing a list of nine general grievances. If these
grievances were in perceived order of importance, she would
be addressing issue number eight of nine. With such high
levels of stress due to work overload, incivility, and low task
control, it is doubtful that a collection of individuals can unite
in anything constructive at this point without addressing
several other issues first; attacking the low-hanging fruit on
her list would be more appropriate at this point. Even
without the power of offering material reward, other
grievances that could be better addressed up front are
simple acknowledgment of work well done, valuing
contributions through better feedback, and implementing a
better, more transparent review system, with which she is
clearly very familiar.
The second reason she is unlikely to experience
significant success in her efforts is simply poor execution of
an otherwise terrific idea. In her attempt to institute the
more participative process, she has chosen to involve
everyone in the decision concerning resource allocation.
Such participation would be better offered to a reasonable
few who have clearly earned the right to participate at that
level. This group of dissatisfied individuals is in clear need of
a leader, not someone who will simply turn decision making
over to the entire group as proposed in her moment of
desperation at the end of the off-site meeting. In doing so,
she is also losing one of the few precious rewards she has to
offer her team, which is acknowledging and valuing
individual contributions. Without recognizing this, she is
potentially heading down the same road as her predecessor.