SWOT ANALYSIS

1. EVALUATING STAFF-Dacuma, Cabauatan, Bornales

Brenda Tice has been nurse manager for the medical intensive care unit (MICU)
in a large urban hospital for 6 months. The MICU rarely has staff openings and the
average nurse has 12 years of experience in the unit. Brenda herself was a nurse on
the unit for 10 years prior to her promotion to nurse manager.

Lori Cook has been an RN in the MICU day shift for the past 18 months. Lori is
pleasant and tries hard to please her patients and coworkers. However, she consistently
stays late to complete her charting, relies heavily on her coworkers to help her
throughout the shift, and has little confidence in her own ability to handle complex
patients. Often Lori will breakdown and cry during a patient code and is seemingly
overwhelmed by the code process. Although the other nurses are supportive of Lori,
they are aware of her limitations. Several nurses have complained when they have
been assigned to two high acuity patients and Lori is assigned to one lower acuity
patient.

Brenda has arranged for Lori to attend several training programs designed
specifically for ICU nurses, provided opportunities for experienced nurses to mentor Lori
on more complex patients, and provided her with reference materials to reinforce Lori’s
skill set. Brenda also reviewed Lori’s personnel records for the past 18 months. While
Lori is rated high in attendance and in her interpersonal skills, her clinical skills are rated
as fair. Brenda notices three separate performance counseling documents dated within
the past 12 months, with little improvement noted in her clinical performance.

Following another code incident in which Lori started crying and was asked to
leave by a physician, Brenda determines that while Lori has many positive qualities, she
does not have the clinical skills necessary to function independently in the MICU. After
contacting the Human Resources Department to discuss the transfer process, she
schedules a meeting with Lori to discuss her performance issues. Brenda reviews the
performance concerns with Lori and informs her that she has 30 days to accept
reassignment within the hospital to a unit that more closely matches her clinical abilities.
Lori decided to interview for positions in the geriatric psychiatric unit and the psychiatric
day treatment program.
STRENGTHS

WEAKNESSES

OPPORTUNITIES

THREATS

2. SCHEDULING- Barcos, Bodota, Cruz

Tori Abraham and Jillian Moore are both nurse managers of general Med/Surg
units at separate hospitals that are part of a large metropolitan health care system.
Staffing among the Med/Surg units has been problimatic due to increased patient
volume and cost control measures enacted by the health care corporation. Staff
members have complained numerous times that extra shifts are only offered to part time
employees and premium pay shifts are given to those with more seniority. As the
holiday approach, staff tension increases as a lottery system has traditionally been used
to assign shifts for major holidays. Adtionally, since employees are free to transfer
within any of the eight metropolitan hospitals, there has been significant turnover on the
Med/Surg units as employees decide to transfer to Ambulatory Care and Same Day
Surgeries facilities.

Tori and Jillian have volunteered to be part of a new scheduling system for their
health care system. Nurses and nursing assistants will be able to view open shifts on
each unit and e-mail Tori or Jillian with request to staff shifts for which they are qualified.
By allowing staff to have greater control over which additional shifts and at which facility
they prefer to work, the nurse managers hope to decrease agency staffing and increase
employee satisfaction. Additional units are expected to come online, which will also
allow staff to have experience on oncology, skilled nursing and orthopedic patients. The
Education Department will provide a database of employee certifications to managers to
ensure staff wishing to work away from their home units is qualified for the job.
 After 90 days of using the new open shift scheduling system, Tori and Jillian are
pleased with the results. Agency staff use has decreased by 60 percent and staff
members report they are happier with the ability to schedule their own additional shifts
as well as work at a different facility withouthaving to transfer. Holiday staffing has been
easieras those employees who prefer to wotk premium pay for holidays are able to self
schedule. Toti and Jillian present their findings to this chief nurse officer and will be part
of the team implementing system wide use of open shift scheduling.

STRENGTHTS

WEAKNESSES

OPPORTUNITIES

THREATS

3. Progressive Discipline- Barte. Ayaon, Casinao, Colminas

Katie Connors is nurse manager of the birthing center in a metropolitan hospital. The hospital has
several different nursing programs that utilize various patient care units for clinical instruction. A
student nurse, Amber Schroeder, was assigned to work with Natalie Cole RN, for the day shift.
Natalie and Amber’s patient arrives at the birthing center for induction of labor. During the
admission process, the patient confides to Natalie and Amber that she is terrified that she might
need a caesarian section. Amber tells the patient that a young woman and her baby recently died at
the hospital during an emergency C-section. The patient begins to hyperventilate, refuses to let
Natalie continue with the admission, and threatens to leave the birthing center. Natalie is so angry at
Amber for scaring the patient she grabs her by the arm and pulls her out of the room. Natalie loudly
berates Amber in the hallway to the point that Amber is crying.
Katie hears the commotion in the hallway and instructs Amber to sit in the staff lounge until her
instructor can return unit. Katie and Natalie reassure the patient, who allows Natalie to complete the
 admission process. Throughout the shift, Natalie tells every staff member and physician about
Amber’s “stupid comment”. Katie speaks with the nursing instructor and Amber about the incident.
She also checks back with the patient and gently gathers facts about the incident.
Katie is concerned about Natalie’s response to the situation. While Natalie has excellent nursing
skills, she has often been abrupt or rude to other staff members. Katie has coached Natalie on her
communication skills in three other specific incident and verbally warned Natalie her lack of
professional communication. After discussing the incident with the human resources manager, Katie
agrees that a written warning will be placed in Natalie’s personal file.
At the end of the shift, Katie request that Natalie come to her office to discuss what happened with
the student nurse. Katie informs Natalie she is disappointed in how she reacted to the inappropriate
comment made by the student nurse. Specifically, physically grabbing the student and verbally
attacking her in front of patients and staff was unacceptable and violates hospital policy. Further,
Natalie continued to disparage the student to other staff and physicians, which is also unacceptable.
Natalie expresses her frustration at the thoughtlessness of Amber’s comment. Katie tells Natalie that
while Amber’s comment was inappropriate. Natalie’s response was also inappropriate. Katie
reinforces to Natalie the importance of professional communication at all times and reviews the
communication points she had provided to Natalie in the past. She also informs Natalie she will have
a written warning placed in her personnel file. Natalie apologizes for her actions and assures Katie
she will work on her communication skills. Katie documents the incident and follow-up action in
Natalie’s personnel file.

Strength

Weakness

Opportunities

Threats