Managing an Unhealthy Work Environment
Isabella is new to the management role and has been the nurse manager of the Mother Infant Care (MIC) unit for 6 months. She recently graduated with her master of science degree with an emphasis on leadership in micro healthcare systems. She was excited to be chosen from a candidate pool of five more experienced nurses, and she was eager to apply what she had learned in graduate school in shaping the culture of the MIC unit. After getting to know the staff and assistant nurse managers, Isabella made some changes to put structure and processes in place that would facilitate staff involvement in decisions related to patient care and their practice of nursing.
She encouraged the assistant managers to change from developing the staff schedule to allowing self-scheduling based on a few rules and principles that the staff had part in developing. It was decided that the more senior staff would have first choice in their schedule, followed by the part-time, and finally the per diem staff. Requests for time off were to be submitted to the assistant managers prior to the new schedule being posted so that the unit would be staffed appropriately.
All seemed to be going fairly well with the self-scheduling system for the first 4 months, but with the holiday season approaching, Isabella was receiving feedback that some of the staff were extremely unhappy with the system. There had been some arguments among staff in the nursing lounge, and Isabella was informed that one of the staff members left work in tears. Apparently, some of the more senior staff were being unreasonable with the less tenured full-time staff and refused to cover personal requests.
The assistant managers informed Isabella that a powerful clique had formed with a few senior staff who were bullying some of the new nurses and refusing to assist them in patient care activities or to answer any of their questions. It seemed as if the situation was becoming quite unsettling, and two of the newly hired nurses had put in a request to be transferred to another unit.
When Isabella interviewed the nurses who had resigned or were transferring to another unit, she was surprised to hear their stories of verbal abuse, the “silent treatment” with no communication, or refusal to cover for them during required break times. She was also told that several of the more senior nurses refused to assist in turning patients and often withheld information that was important to patient care. Although Isabella was not able to convince the nurses to stay on the unit, she realized that the culture of the unit had to be changed.
Isabella called all of the assistant managers together and told them that they needed to work as a team to change the culture on the unit. She listened to their perspectives on what was happening and quickly identified that some of the assistant managers may have contributed to the problem because they had refused to become involved in managing the situation on their shift. It seemed to Isabella that the assistant managers may have been afraid of some of the staff members, and therefore were not comfortable confronting them about their inappropriate behaviors in the workplace. The small group of senior staff seemed to have control over staff members as well as the assistant managers. Some ethnic clashes also contributed to the problem.
Isabella decided to meet with the human resources specialist for her area and her director to apprise them of the situation and to ask for assistance in developing a strategy to resolve the conflicts. After discussing the situation and identifying potential options for resolution, they decided that the problem needed to be discussed openly at staff meetings and that performance and clarification of expectations would be discussed with offending staff individually and all staff collectively. A series of short presentations by a clinical psychologist on workplace bullying was planned with follow-up discussions with the staff.
New group norms for professional behavior and consequences for unprofessional conduct were presented and discussed with the staff. Each staff member was asked to sign an agreement outlining his or her knowledge of and acceptance of the new behavioral standards. This process allowed Isabella to meet with each staff member with the individual’s assistant manager to reinforce the importance of acceptable behaviors in the workplace. Isabella and the human resources specialist helped the assistant managers give disciplinary warnings to the more offending staff members, and Isabella reiterated her expectation to these staff members that if they could not accept the new behavior standards or demonstrate the necessary changes, she would assist them in “making other career choices.”
Finally, Isabella announced a zero-tolerance policy for workplace bullying and unprofessional conduct. She told the staff, “Everyone has a right to feel safe, respected, and valued when at work. How we feel at work affects our ability to provide the best possible care to our patients.” She told the staff that each of them could expect to be treated fairly and that she wanted them to feel safe in expressing their feelings in a professional and positive manner.
She listened to their views on how to improve the self-scheduling process to ensure fairness for all. Isabella also arranged for every staff member to attend educational sessions that included discussions on cultural, gender, and age diversity in the workplace. Every staff meeting included open discussion on progress that was being made on each shift toward resolving the conflicts and creating a healthier work environment for all of the staff. She encouraged the staff to meet with her if they had any concerns about conflicts on the unit, and she made frequent rounds to speak with individuals and to make her presence visible among the staff.
Isabella also worked with her assistant managers to increase their leadership competencies in facing conflict and developing strategies to resolve the conflict rather than choosing to ignore the situation. She reminded them of their responsibility as leaders to face conflicts early, before they became unmanageable.
She discussed the need for improved teamwork among the assistant managers to ensure support for one another during these times of crisis. She reassured them that she would be available to each of them to support them through any difficult situation, and that she would secure any resources needed to create a healthy work environment for them and for the staff.
Questions
What were some of the sources and possible causes of the conflict that emerged on the unit?
What were some of the signs that the conflict had escalated to an unacceptable level?
What leadership roles did Isabella assume in managing the conflict process?
How did the assistant managers’ actions affect the level of conflict and the resolution of the conflict?
If you were Isabella, how would you have handled the conflict and mediated the situation?
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