Case Study One: Case of the Reluctant Associate

ASSIGNMENT 1

Introduction:

Case Study One: Case of the Reluctant Associate

You are the chairman of the department of surgery at an urban community hospital and the head of a large general surgery practice. The oldest member of the group is about to retire, and you need to recruit a new partner. You are hoping to recruit a person relatively new out of training to provide succession planning for the group, because you know that in the next five to seven years you will be retiring.

You’re in your office when one of the junior surgeons, Dr. Simon, asks to speak to you. He presents you with several credentialing packets for out-of-state licensure. He is on the staff of your hospital; however, he primarily works at another hospital in the area. You ask Dr. Simon if he would be interested in staying and joining your practice. He states his family is in the area, but he’s not sure whether he wishes to be a junior associate in another practice or not. You spend time discussing how this particular practice runs and what his duties would be and inform him that in a very short time he could become a fully integrated member of the group with equal say in medical matters and compensation equal to the amount of work that he produces. He asks several unusual questions such as “How many times a day will you call me?” “Will you be checking up on me?” and “Will I be able to make my own clinical decisions?”

It becomes apparent from this discussion that Dr. Simon probably has been treated poorly in his existing practice. He has not been allowed to make his own schedule and his decision making was second-guessed. The senior member of the practice created extensive work for him, while Dr. Simon was compensated for a small percentage of the work that he actually performed and the senior partner was making a large profit.

At this point, you explain how this new opportunity would be different and that Dr. Simon would be a partner in two years, joining with the other three members of the group. The members of the group all feel that he is well qualified and would be an asset to the group. You are willing to offer him a position in the practice. After much discussion and cajoling, he finally agrees to join the practice.

Tasks:

Discussion Questions

  • What are the main concerns in this case?
  • Which of the organizational theories of management describes the behaviors of Dr. Simon’s first practice experience? The second? Provide a rationale for your response.
  • Is succession planning important for medical practices? Give examples of the techniques that are available to recruit new physicians.
  • Discuss the pitfalls of a new physician joining a practice. From the example in the case, outline what principles should guide a physician in taking on a new associate/partner.
  • How long should a physician be in a practice before he or she becomes a partner? Should he or she ever become an equal partner?

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words

 

ASSIGNMENT 2

Introduction:

Case Study Twenty-Four: Medication Error

You are a physician making rounds on your patients when you arrive at Mrs. Buckman’s room. She’s an elderly lady in her late ’70s who recently had a colon surgery. She is also the wife of a prominent physician at the hospital. She has been known to be somewhat confrontational with the nursing staff. However, today she states she was just given a shot of insulin to cover her elevated blood sugar and the amount of insulin did not seem to be the usual amount. Even though Mrs. Buckman often complains, you are somewhat concerned about this observation and decide that it would be best to check on this. You ask the charge nurse to review the dose of insulin given. She, in turn, finds Mrs. Buckman’s nurse, who states that, as ordered, she had given the patient 80 units of insulin.

You immediately become quite alarmed, as this is an extraordinarily large dosage. You make sure that the patient is given a large amount of glucose supplement and that her blood sugar is monitored every fifteen minutes for the next two hours. To follow up, you also review the chart and note an order from the house physician to give Mrs. Buckman 8.0 units of insulin.

You can readily see how this could easily appear to be 80 units. You meet with the charge nurse, the nursing supervisor, the director of nursing, and the treating nurse to determine what can be done to prevent this type of error in the future.

Tasks:

Discussion Questions

  • What are the facts in this case?
  • What are the management issues that need to be addressed in this case?
  • Is it reasonable for the nurse to have given this dose of insulin?
  • Should the nurse have questioned giving this large amount of insulin without checking with the doctor?
  • Should the pharmacist have questioned the dosage?
  • What mechanisms can be put in place to prevent this from occurring in the future?
  • Should this be considered a sentinel event? Should a root cause analysis be performed?

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words

ASSIGNMENT 3

Introduction:

Case Study Forty-Five: Nurse Bullying: Unprofessional Conduct

Raymond was one of the two male nurses working in an ICU in an inner-city hospital. The nurse manager always put him in charge of the ICU whenever he worked his twelve-hour shift. When Raymond was in charge, problems were handled quickly and without drama. His efficient demeanor during a code comforted families, staff nurses, and even the medical interns and residents. Attending physicians requested that Raymond care for their sickest patients as well as their family members. In addition, letters were often written to the hospital about his outstanding care and his attention to details. His exceptional customer service and outstanding patient care made Nordstrom’s customer service department look bad!

However, if there was a question that needed an answer, Raymond knew it and wasn’t shy about letting everyone else around him know it too. His self-assured behavior came across as overconfident and conceited. It didn’t help him win any popularity contests as he was the only master’s-prepared nurse on the unit; most of the nurses didn’t even have their bachelor’s degree. He tried to fit in with the other nurses by joking with them or giving the best assignments to the most popular nurses. Raymond didn’t realize it, but the nurses in the most popular group were always putting him down and criticizing him behind his back. During morning rounds with physicians, the other nurses would challenge Raymond and try to embarrass him or roll their eyes whenever he spoke.

Raymond wanted to join the “in gang” and so started to share some personal information with the other nurses about his deteriorating relationship with his wife. She was unable to work due to a chronic medical condition and was becoming increasingly needy with repeated hospitalizations. The other nurses rallied around him pretending to offer support when they were actually scheming to teach him a lesson since he was a “know it all.” One nurse got his personal e-mail, while the other nurse planned the prank.

A few weeks later, Raymond started receiving e-mails from a secret admirer named Terry. Their e-mail relationship lasted several months before he told his coworkers about it. He shared stories with his interested coworkers about the admirer and told them that he was actually thinking about leaving his wife for her. Later, Raymond found out that not only did the entire staff in the ICU know about this prank but his e-mail conversations were distributed to the unit’s nursing and support staff.

Tasks:

Discussion Questions

  • What are the facts of this case?
  • What is the nature of the organizational behavior problem?
  • Which theory or theories do you believe best explain the behavior of Raymond’s coworkers?
  • As the nurse leader, what interventions would be useful in dealing with workplace bullying?
  • What types of workplace behaviors define bullying?
  • Have you ever experienced or observed workplace bullying? Describe what happened and how it was managed.
  • How does bullying impact the workplace morale? Productivity? Patient care? Can you think of the other effects of bullying in the workplace?
  • How does the leadership or management team contribute to bullying?
  • What types of ethical issues are identified in this case study?
  • What kind of financial impact do you think the behavior of the nurses and their supervisor may have on the hospital?
  • Provide your reflections and personal opinions as well as your recommendations for addressing this problem.

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words

Assignment 4

Introduction:

Case Study Sixty-Three: Pray with Me

You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient who is a Wiccan. When the patient and her primary care nurse, Penny Baker, were discussing her religious practices and how she prays, Penny’s immediate supervisor, Ruth Goose, walked into the room and stated, “Thou shalt not suffer a witch amongst you,” and told Penny not to discuss the “satanic religion” with the patient any more. The patient demands an apology and threatens to go to the media. She feels she has been discriminated against because she is a Wiccan and that her patient care experience was poor during her hospitalization because of her spiritual beliefs. You convene a meeting with Penny and Ruth.

Ruth is wearing a large gold cross on her neck. Penny wears no jewelry and is dressed in her blue scrubs. When you ask Penny what happened, Ruth answers for her. “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?” Penny can’t get a word in edgewise. Ruth keeps repeating “Thou shalt not suffer a witch amongst you, it says so in Leviticus!”

What should you do?

Tasks:

Discussion Questions

  • What are the facts of this case?
  • What is the nature of the organizational behavior problem?
  • What are the three factors contributing to this dilemma?
  • What are the top three management issues in this case?
  • Who should be responsible for addressing these organizational issues?
  • What kind of differences in spiritual and religious practices are you familiar with? What if the patient had asked Penny to pray with her? Should she have done so? Discuss the pros and cons of praying with patients. Provide your reflections and personal opinions as well as your recommendations for addressing the issue of praying with patients.

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words

Assignmetn 5

Introduction:

Case Study Seventy-Four: Ethical Issues over DNR Orders

Mr. Warden, a 93-year-old white male, is admitted to Centerville Community Hospital from Centerville Estates Nursing Home. Mr. Warden has had multiple strokes and is only partially responsive to painful stimuli. He does not recognize or respond to nursing staff, physicians, or family members. In addition, he has flexion contractures and a large infected decubitus ulcer over his left sacral area. Further evaluation shows Mr. Warden has extremely poor heart function and is in congestive heart failure. The notes from Centerville Estates Nursing Home indicate Mr. Warden has had one visitor in the past six months; that visitor was not a family member.

Tasks:

Discussion Questions

  • What are the facts in this situation?
  • Autonomy, nonmaleficence, beneficence, and justice are the cornerstones of ethical decision making. What ethical dilemmas does this case illustrate?
  • Have any principles of ethical decision making been violated in this case? What ones have been supported? How might our cultural upbringing, personal assumptions, and opinions influence our decisions as health care managers? Provide rationales for your responses.
  • Based on what you know from this short case; why do you think Mr. Warden’s daughter is so insistent on wanting “everything” done for her father?
  • What if Mr. Warden was wealthy and had a large estate? Would that change your opinion of the son and his responses? Provide a rationale for your response.
  • If the son had no power of attorney, how could this issue be resolved? Can a physician decide to withdraw care without the consent of the family? Who has the final say in the care of a patient in this condition? Provide your reflections and personal opinions as well as your recommendations and rationale for your responses.

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words