Assignment: This case example was written by Jenna Green and Will Haithcock. Questions to discuss the exercise follow the case example.
About The Hospital
Prairie Regional Medical Center (PRMC), located in central Kansas, is a 245-bed hospital that offers a comprehensive range of inpatient and outpatient medical services to resident's central Kansas. The medical staff of PRMC consists of more than 125 physicians and dentists representing a number of specialties, including the following:
- Comprehensive cardiac care
- Neurosciences
- Women's health
- Emergency medicine, including a 24-hour trauma center
- Rehabilitation
Among the specialized units and facilities at PRMC are the following:
- Dedicated women's unit
- Skilled nursing facility
- Comprehensive inpatient rehabilitation unit accredited by Commission on Accreditation of Rehabilitation Facilities International
- Community resources center
- Laboratory accredited by the College of American Pathologists and American Association of Blood Banks
- Women's imaging center
- Wound care unit
PRMC is fully accredited for all services surveyed by The Joint Commission.
The Situation:
Felix, a 68-year-old man, presented to PRMC with a peptic ulcer and underwent abdominal surgery (a diagnostic laparotomy). He was admitted to the patient tower for an anticipated four-day monitoring and recovery stay after his surgery, which was performed without any complications. Other than the recent operation, Felix has been in relatively good health for his age, but does have diabetes and wears hearing aids in both ears.
Renee, a registered nurse, was assigned to Felix's care during his recovery. She would be able to monitor and care for Felix for his entire recovery because she works a unique schedule of five days on, five days off, which was specifically arranged for her starting three years ago. Renee works 12-hours days from 7:00 a.m. to 7:00 p.m.
By day 3 of Felix's recovery, he began to notice that communicating with Renee had become somewhat difficult compared with the previous two days. She was short in response to his and his family's questions and noticeably yawned when she came in for routine checks. His wife also noticed that Renee had begun to take markedly longer to respond to his call lights. Later that evening before shift change, Renee took his vitals as she had done the previous two days. Everything appeared normal, so she returned to her other patients on the floor for one last check-in.
By day 4, everything had changed. Renee returned to her fourth shift at 7:00 a.m. to find that Felix's status was declining. He had a temperature of 102 degrees Fahrenheit, his blood pressure was low, and he had difficulty breathing. Renee tried to quickly get caught up with all that she had missed throughout the night, but she was on edge when someone mentioned that the temperature spike likely occurred during her previous shift and was missed by the nursing staff. She knew that she was the last person to sign off on Felix's chart before the night-shift transition and could not help but feel an overwhelming sense of guilt.
Pam had to consider whether firing an employee over a single mistake was at all justified to further protect the reputation of the hospital.
Questions for Discussion:
Q1. How should Pam handle the complaint by the patient? What is the danger of disregarding the patient's complaint? Need Assignment Help?
Q2. Should Pam consider changing Renee's shift schedule? Are there any limits to the number of shifts or hours that nurses should work? Do you think there should be?
Q3. How should Pam respond to Felix's wife's demand that Renee be fired?
Q4. Should this situation be addressed by a QI team, or is this simply an unfortunate situation arising from a troubled employee?
Q5. Could this situation have been avoided if the organization's human resources management systems had been different? If so, what HR systems might have played a role in this situation?