Tutor's Note
This case study is useful for student examination of the skills and tensions involved in staff appraisal and counselling feedback. It offers role playing briefs which may enable some simple simulation in a class situation.Case Study/Role Playing Exercise
The following extracts are from two conversations about Ann Tredwell, a nurse manager who runs a general medical ward of 30 beds.
What are they saying about me?Senior Nurse Pat Rodway
Pat says the following about Ann Tredwell:-
"Ann is generally nice to work with, she isn"t too demanding. Basically she seems to appreciate that we work under a lot of pressure and makes allowances for us when things become a little chaotic.ANN'S LINE MANAGER; CLARE HARRISONWhen we are busy she is more than prepared to 'roll-up her sleeves' and give a hand, and I must say that the staff and patients really appreciate her for this. Staff and patients always know that she is prepared to give of herself.
I think though that she particularly wants us to like her and on the whole we do. However, her 'happy family approach' can be stifling at times. She wants us to be contented members of the team yet it is obvious sometimes that we are individuals who don't all have the same approach as she does.
The spirit of nursing in the ward and standards are satisfactory given the experience of the current staff. There are improvements though that could be made in terms of the way the ward is administered and staff supervised.
Ann tends to lead by direct example. She spends as much if not more time personally with patients than working through other nurses in the team.
One thing that is interesting about working with her is that she likes to chat about nursing issues and practices. There are many occasions when over coffee we discuss issues and techniques although some of these develop into conversations about what is right and wrong in the hospital. Often these discussions don't lead anywhere we end up facing the same scene everyday without action being taken.
Generally the staff wouldn't criticise Ann yet there is some frustration about the flavour of the way she runs the ward. Its not something you can put your finger on but there are things such as co-ordination and precision about what is expected of you where she could work better. One example of this is that there are some ward tasks which she could share out amongst staff in her nursing team. Sometimes she does too many tasks herself the experience of which other nurses would find benefit."
Clare says the following about Anne:-
"Sister Tredwell is a very dedicated nurse. However, I don't think she has so far made the transition from bedside nurse to her present role. The patients get good care when she is on duty she often overlooks the fact that many of her staff don't respond quickly when she is not there.Similarly she often appears too busy to discuss arrangements for ward changes that are proposed as part of hospital policy. Various members of the medical staff have commented to me that she looks harrassed and the nurse teachers are worried about the amount of supervision that the learners get.
She is well liked by her staff but overall I am worried that she gets bogged down in detail and excepts routine ways of doing things rather than being analytical, working to priorities and achieving carefully worked out plans.
Ann doesn't seem to be aware of this although I have tried to discussed this with her. She seems to get so hooked on day to day tasks and problems such that some of the important leadership functions are missing from the ward. I get the impression from her staff appraisal reports that her staff recieve insufficient, penetrative feedback about all aspects of their performance. Indeed, whenever we meet together she seems reluctant to question and probe. She is generally passive at meetings - more inclined to agree with what others say or only minimally express her views. At appraisal time I have to resort to the "direct telling" approach rather than Ann herself being ready with a self-appraisal of ward achievements and areas for improvement.
She finds it difficult to talk about herself - her strengths and weakness with a view to further professional development.
She has been at this hospital from her nursing training onward. I know she has more ability than she is displaying currently and I only wish I could find ways of 'freeing-up' this potential in her. She needs to be stretched but in the first instance this has to be done via of her present role."
Participant Briefs for Role Playing
Counsellor's Brief.
You are a senior manager how knows Ann well. You are aware that lately she is resentful of things that are occurring and feels powerless to influence matters. She seems, you think, to have lost her way in her career as a professional.You have invited her to have lunch with you and rather than go to the hospital dining room have persuaded her to join you in a local Indian restaruant you both like - not too expensive. It should be quiet enough in the restaurant to have a talk and you think that it is quite possible that she may wish to open up on her problems.
You wish thogh to be very careful by not making matters worse by suggesting to Ann that he problems are the fault of others - she has to work out her own plan.
Ann's Brief.
You are fed up for many reasons - some of which are indicated in the attached case study. You feel quote vulnerable right now and don't see exactly what you can do.A friend has invited you for lunch and you feel that talking to her may open up some ideas for you - in particular how you can get on top of your job better and feel that you have mastered certain key aspects which elude you at the moment. You feel particularly disgruntled with your present superior and are inclined to think that unless you get more support you will resign.
Written © by Chris Jarvis for the BOLA Project.