Case

Barbara Norris: Leading Change in the General Surgery Unit
باربارا نوريس التغير القيادي في الجراحه
Harvard Business Review
Boris Groysberg
Nitin Nohria
Deborah Bell March-13-2009
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It was 10 PM and Barbara Norris, nurse manager for the large General Surgery Unit (GSU) at Eastern Massachusetts University Hospital (EMU) sat down at her desk to catch her breath. She had been on the unit since 6:30 AM but planned to stay for another two hours to help with the transition from the second to third shift and the orientation of two registered nurses (RN) from the float pool. It had been one month since she had assumed the nurse manager role for the troubled unit. During this time she felt, as she did this evening, tired and overwhelmed.
As nurse manager she was responsible for managing the staff, scheduling and budget for the unit. Her 33-person staff included 25 RNs and eight patient care assistants (PCAs). In her first month as nurse manager she had already lost two RNs and in the six months prior to her joining the unit three RNs had left. But because of the recently instituted hiring freeze at EMU, Barbara was not able to replace some of these positions.
The unit was short-staffed; stress levels were high and employee morale low. In fact, GSU had the lowest employee satisfaction scores and highest employee turnover rate among all of the departments at EMU. And although its patient satisfaction scores were average, they had been declining steadily over the past few years. Furthermore, GSU was infamous for its culture of confrontation, blaming and favoritism. Relationships were tense not only between the nursing staff but also with many of the unit’s attending physicians.
To make matters worse, over-time could no longer be offered due to additional cost cutting measures. Hence, if one of her