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Comprehensive Case Notes Page
Case 5
The Stress of Caring
Learning Goals
One of the most consistent changes in the structure of work over the past few
decades has been a shift from a manufacturing economy to a service economy.
More workers are now engaged in jobs that include providing care and assistance,
especially in education and medicine. This work is satisfying for some people, but it
can also be highly stressful. In the following scenario, consider how a company in the
nursing care industry is responding to the challenges of the new environment.
Major Topic Areas
Stress
Organizational change
Emotions
Leadership
The Scenario
Parkway Nursing Care is an organization facing a massive change. The company was
founded in 1972 with just two nursing homes in Phoenix, Arizona. The company was
very successful, and throughout the 1980s it continued to turn a consistent profit
while slowly acquiring or building 30 more units. This low-pro/le approach changed
forever in 1993 when venture capitalist Robert Quine decided to make a major
investment in expanding Parkway in return for a portion of its profits over the coming
years. The number of nursing homes exploded, and Parkway was operating 180
homes by the year 2000.
The company now has 220 facilities in the southwestern United States, with an
average of 115 beds per facility and a total of nearly 30,000 employees. In
addition to health care facilities, it also provides skilled in-home nursing care.
Parkway is seen as one of the best care facilities in the region, and it has won
numerous awards for its achievements in the field.
As members of the baby boom generation become senior citizens, the need for
skilled care will only increase. Parkway wants to make sure it is in a good position to
meet this growing need. This means the company must continue expanding rapidly.
The pressure for growth is one signiticant challenge, but it’s not the only one. The
nursing home industry has come under increasing government scrutiny following
investigations that turned up widespread patient abuse and billing fraud. Parkway
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The Problem
As growth has continued, Parkway has remained committed to providing dignity and
it can to keep positions filled, and I don’t always agree with who is hired. Some of the
basic job skills can be taught, sure, but how to care for our patients—a lot of these
new kids just don’t pick up on that.”
“The problem isn’t with sta7—it’s with Parkway’s focus on /lling the beds,” says
too many patients to see.”
A recent college graduate with a B.A. in psychology, Dalton Manetti is more stressed
than he expected he would be. “These aren’t the sweet grannies you see in the
movies. Our patients are demanding. They complain about everything, even about
being called patients, probably because most of them think they shouldn’t be here in
in anyway.”
Carmen Frank has been with Parkway almost a year and is already considering
finding a new job. “I knew there were going to be physical parts to this job, and
I thought I’d be able to handle that. It’s not like I was looking for a desk job, you
know? I go home after every shift with aches all over—my back, my arms, my legs.
job. They don’t see the patients as people, more like inventory. If they want to work
with inventory, they should get a job in retail.”
Last month, the company’s human resources department pulled the following
information from its records at the request of the board of directors. The numbers
immediate /ring).
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Year Patients Injuries Per
Staf
Member
Incidents Per
Patient
Certied
Absences
Per Staf
Other
Absences
Per Staf
Turnover
Rate
2000 21,200 3.32 4.98 4.55 3.14 0.31
2001 22,300 3.97 5.37 5.09 3.31 0.29
2002 22,600 4.87 5.92 4.71 3.47 0.28
2003 23,100 4.10 6.36 5.11 3.61 0.35
3004 23,300 4.21 6.87 5.66 4.03 0.31
2005 23,450 5.03 7.36 5.33 3.45 0.28
2006 23,600 5.84 7.88 5.28 4.24 0.36
2007 24,500 5.62 8.35 5.86 4.06 0.33
2008 24,100 7.12 8.84 5.63 3.89 0.35
2009 25,300 6.95 9.34 6.11 4.28 0.35
Performance
The company wants to use such organizational development methods as appreciative
inquiry (AI) to create change and re-energize its sense of mission. As the chapter on
organizational change explains, AI procedures systematically collect employee input
and then use this information to create a change message everyone can support. The
the same direction.
Many suggestions concerned schedule Cexibility. One representative comment was
this: “Most of the stress on this job comes because we can’t take time o7 when we
need it. The LPNs [licensed practical nurses, who do much of the care] and orderlies
can’t take time o7 when they need to, but a lot of them are single parents or primary
would be a lot better.”
Other suggestions proposed a better method for communicating information across
shifts. Most of the documentation for shift work is done in large spiral notebooks.
When a new shift begins, sta7 members say they don’t have much time to check on
what happened in the previous shift. Some younger caregivers would like to have a
documentation.)
Finally, the nursing care sta7 believes its perspectives on patient care are seldom
given an appropriate hearing. “We’re the ones who are with the patients most of the
time, but when it comes to doing this the right way, our point of view gets lost. We
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Your Assignment
Parkway has taken some initial steps toward a new direction, but clearly it has a lot of
the following points:
2. The company is going to be making some signiticant changes based on the AI
Parkway?
3. Given the board of directors’ desire to re-energize the workforce, what advice
would you provide for creating a leadership strategy? What leader
behaviors should nursing home directors and nurse supervisors demonstrate?
4. What are the major sources of job stress at Parkway? What does the research
among employees.
5. Based on the information collected in the focus groups, design a survey to
hand out to employees. What sort of data should the survey gather?
What types of data analysis methods would you like to employ for these
data?
Case Discussion
CC-30. What do the data on employee injuries, incidents, absences, and turnover
suggest to you? Is there reason for concern about the company’s direction?
Suggested discussion: The data suggest that all categories are increasing
as the number of patients increases. This is a disturbing assessment. All
categories are potential cost increases for operations and will erode
productivity and profitability.
CC-31. The company is going to be making some signiticant changes based on the AI
process, and most change effort are associated with resistance. What are the
most common forms of resistance, and which would you expect to see at
Parkway?
Suggested discussion: Resistance to change is something any new
implementation can experience. Resistance can be from any of /ve reasons:
a. Habit: Life is complex, to cope with having to make hundreds of
decisions everyday, we all rely on habits or programmed responses.
b. Security: People with a high need for security are likely to resist change
because it threatens their feelings of safety.
the known.
e. Selective information processing: Individuals shape their world through
their perceptions. Once they have created this world, it resists change.
Any of the /ve types will be present among employees of the company.
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on providing inspiration to employees to set goals and expectations for
productivity that contributes to the organizational success. Students may
focus on Authentic Leadership. These behaviors would build relations between
the managers and the employees based on trust and similar values. The result
manager’s activity.
CC-33. What are the major sources of job stress at Parkway? What does the research
on employee stress suggest you should do to help minimize the experience
of psychological strain for employees? Create a plan for how to reduce stress
among employees.
strategies include implementing time management techniques, increasing
physical exercise, relaxation training, and expanding the social support
network. Organizational Approaches that management might want to consider
include:
Improved personnel selection and job placement
Use of realistic goal setting
Training
Redesigning of jobs
Increased employee involvement
Improved organizational communication
offering employee sabbaticals
Establishment of corporate wellness programs
data?
Suggested discussion: The response to this issue will differ depending on
the students’ preparation with research methodology. Most students will
merely assemble questions they believe address the research question they
de/ne. Seldom are undergraduate students aware that construction of a valid,
only be valid if the survey uses something like the item analysis technique to
be created.
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