Decision Making; Delegation; Leadership

i Used to rUN tHis UNit

Primary Topic—Change Management

Additional Topics—Decision Making; Delegation; Leadership

For several years Community Hospital, a small, rural institution, had difficulty find- ing enough registered nurses to fill all of the positions ordinarily held by RNs. As a result of this shortage, for nearly 2 years Unit 2-A had a licensed practical nurse, Ms. Adams, serving as head nurse. She had been appointed as “acting” head nurse, but she was in place for so long that the “acting” designation had fallen out of use.

Recently a registered nurse, Ms. Williams, was hired as head nurse of 2-A. Ms. Adams was left within the unit as one of the staff. Although the change was clearly a demotion for Ms. Adams in terms of leaving supervision, her pay was left unchanged. In fact, she had recently received an increase after a favorable performance evalua- tion. However, these changes left her “red circled,” carrying more than the maximum rate for an LPN with no room left for further financial advancement.

Ms. Adams said little about the change for some weeks, but neither was she particularly friendly or communicative. When finally Ms. Williams was able to get Ms. Adams to speak about the change in her assignment, Ms. Adams said, “I can see why the hospital prefers a registered nurse in charge of the unit. But I ran this unit for 2 years. My evaluations have been good; I’ve gotten regular raises and there’s never been any real criticism of my work. Sure, I was called “acting” head nurse at first; but that got dropped after a while, and since then I’ve been given no reason to believe that the job was anything but permanent.”


1. How should Ms. Williams go about managing Ms. Adams so as to minimize hard feelings and gain her cooperation?

2. If Ms. Adams becomes resentful to the point of being uncooperative, what alternatives can Ms. Williams pursue?

3. How could this problem possibly have been avoided in the first place?

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