Chapter 2 – Case Study Questions
This activity contains 4 questions.
Risky Staff Performance and Ineffective Management
As nurse manager of a behavioral health unit in an acute care hospital, you are
responsible for the overall management and quality of care provided on a 30-bed
inpatient unit with an average length of stay of four days. Staffing is short, and you have
four new nurses with limited or no mental health experience. Last night a patient was
injured during a restraint procedure. You are reviewing the incident report in your office
and decide to review restraint data for the past three months. You are shocked when you
see that restraints have increased by 15% and that one nurse, who has been there only
four months, has been involved in 75% of these restraints regardless of the shift she
worked. You then review the medical records for these patients and find that
documentation of the incidents is not complete, there is little reevaluation of the patient
as required, and basic patient needs were not met effectively. You then talk to several
staff members who have worked with the nurse during the shifts when the restraints
occurred. They describe the nurse as “difficult” and “demanding” with “limited tolerance
for negative patient behavior.” She does not include staff in decision making such as
whether to restrain a patient. This all concerns you, so next you look at her personnel file.
The nurse had six months of previous mental health experience and two years of acute
care medical nursing experience. You notice that she should have had two to three
completed reference checks, but only one is in the file and that one is vague. You are
overwhelmed with what you have uncovered.
1.
What do you think about this nurse manager and how she has handled quality
improvement issues, personnel issues, and overall decision making in her unit?
2.
What are the legal and ethical issues related to the care this staff nurse has provided?
3.
How should the nurse manager respond to this nurse and to her multiple problems?
4.
Following this experience, what does the nurse manager need to do long term to improve
her own management competencies?
Chapter 2 – ANSWER KEY Case Study Questions
1.
Answers will vary based on the student’s perspectives and opinions related to the
scenario.
2.
Answer will vary but should include the following:
3.
Answers will vary according to student opinion. One possible response is as follows:
Nurses are obligated to follow the law and the profession’s code of ethics. How can
lawsuits be prevented as many occur even when quality care was provided? Why do
patients sue healthcare providers? Many patients who sue are typically angry with one or
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care, 2e
4.
Answers will vary according to student opinion. One possible response is as follows:
Nurses have responsibilities related to ethics, including maintaining knowledge of the