Indiana Wesleyan University H

Case study

A large healthcare corporation recently purchased a small, 50-bed rural nursing home.  A new director of nursing was brought in to replace the former one, who had retired after 30 years.  The new director addressed the staff members at the reception held to welcome him.  “My philosophy is that you cannot manage anything that you haven’t measured.  Everyone tells me that you have all been doing an excellent job here.  With my measurement approach, we will be able to analyze everything you do and become more efficient than ever.”

The nursing staff members soon found out what the new director meant by his measurement approach.  Every bath, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded.  Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for.  Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the “interruption” in his or her work.

No one complained openly about the change, but absenteeism rates increased rapidly.  Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the single staff member with their requests to “tell me how soon I can retire with full benefits.”  The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.


In your textbook, Leading and Managing in Nursing, read Chapter 18, “Leading Change”. 

Read the case study background information.

Prepare to discuss the following prompts:

  1. What is the perceived problem?  Is a change needed?  What evidence of resistance to change can you find in this case study?  Support your answer by citing and referencing one current reliable source other than your textbook.

If you were a staff nurse, how do you think you would have reacted to this change in administration?

  1. Discuss the nature of change in this scenario.  What change management approaches will probably be needed?  What could the director of nursing do to increase acceptance of this change?  What could the nurse managers and staff nurses do?  Justify your selections.

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