Nursing and Midwifery - Tyrone - Nursing Case Study Assessment Answer

Nursing Case Study Assessment Task

Case Study A
Sharni is a new graduate registered nurse working in the ward of a small rural hospital. She writes to the Director of Nursing and Midwifery (DONM), Vanessa, regarding being bullied by Patsy, who is the Nurse Unit Manager (NUM) of the ward on which she is placed. Vanessa commenced the role of DONM at the hospital about three months earlier (having previously been in the same role in a hospital interstate), and Patsy has been in the position for five years. Sharni alleges that the NUM changed her shift time without consultation in the preceding week, has caused her to have breaks between shifts that are less than those stipulated industrially, and has repeatedly criticised her work within earshot of patients and other staff. She also alleges that the NUM ‘chased’ her down the ward corridor, shouting at her about her work.
Vanessa reads the email and decides to take action immediately, since she does not want bullying allegations affecting her reputation or that of the ward. She is confident that she knows how to deal with the issue because she still remembers the relevant policy and procedures from her previous hospital. She walks down to the relevant ward and asks to speak to Sharni. A colleague tells her that Sharni is currently with a patient, and Vanessa asks if she could pass a message on to Sharni to please contact her ASAP regarding ‘the bullying issue’.
Later in the shift, Sharni comes to Vanessa’s office. She is visibly upset, and Vanessa pours her a glass of water, and reassures her that complaints of bullying and harassment are taken seriously in the hospital. She takes care to make sure that the door is closed and switches off her email. Vanessa tells Sharni that she needs to ask her some questions about issues raised in the email.
In the meeting, Sharni tells Vanessa that he has raised these concerns with several senior colleagues and is disappointed that nothing seems to have happened. She listens carefully without interrupting, and does not take notes because she wants to fully focus her attention on what is being said. Sharni does not specify dates or times, but instead talks generally about Patsy ‘always picking on her. Vanessa thanks her for her time and for coming forward about her experiences, and says that she will stay in touch to let her know how the investigation is going.
After Sharni has left, Vanessa summons Patsy, the NUM, to her office. She advises Patsy that Sharni has made a complaint of bullying against her. Patsy becomes agitated and demands to know the detail of the allegations. She also suggests that Sharni should be brought in to the meeting so that the allegations can be discussed. Vanessa does not share the detail of the allegations and says that is not appropriate for Sharni to be involved in discussions at this point. She says that the best course of action is for Patsy to take leave while an investigation is undertaken. Patsy reluctantly agrees.
Vanessa appoints an acting NUM and emails all staff to notify them that Patsy has taken leave without notice, and walks back down to the ward to let Sharni know what she has done to progress the investigation.
The conversation with Sharni occurs in a corridor and several staff members overhear and ask what is happening. One staff member comments that ‘it is about time someone did something about Patsy’.
Vanessa comments to that staff member that the hospital has a ‘zero tolerance’ approach to bullying and that Patsy will be disciplined and may even lose her job over what she did to Sharni. An investigation is subsequently undertaken and it is identified that there is an established culture of bullying on the ward in question and that the NUM is the leader of a group of senior nurses who routinely treat junior nurses in similar ways. Patsy returns to work following the investigation, is informed in writing that she is guilty of bullying, receives a ‘first and final warning’, and the matter is closed.

Case Study B
Tyrone, who is the Director of Allied Health (DAH) receives an e-mail from Fiona, a nurse, who is concerned about the conduct of a colleague named Patrick (who is a social worker employed by the same organisation). The email contains a screen shot of a social media conversation between Fiona and Patrick, which implies that Patrick is currently engaged in an intimate relationship with a former patient. The patient, Melitta, had been admitted after sustaining an orthopaedic injury whilst intoxicated, and had a long-term history of alcohol abuse. Tyrone thanks Fiona for bringing this issue to his attention, tells her not to mention anything about this to Patrick or anyone else, and then he returns to some urgent work associated with accreditation. Tyrone is under a lot of pressure at work due to an upcoming audit and is feeling overwhelmed about his workload. Although he intends to pursue the issue, several weeks pass before he thinks of it again. Tyrone tells his partner about the situation and together they look up Patrick’s social media profile to see whether the allegations are true. They do find photos of Patrick with the former patient, but agree that this does not constitute evidence that Patrick and Melitta are in a relationship, or that he has done anything wrong. The next day, Tyrone contacts the HR department and asks for advice about how to deal with allegations of misconduct. There has been a lot of staff turnover in the department, and the first person he speaks to says they don’t think the organisation has specific procedures for dealing with such issues unless there is a potential criminal case. Tyrone is relieved to hear this, since it is one less thing he needs to think about.
Later that week, Tyrone is meeting with his mentor, Amir. They are discussing strategies for Tyrone to deal with his workload and associated stress, and he mentions about the issue involving Patrick. Amir asks Tyrone what he plans to do about it and asks whether there is an applicable Code of Ethics. Tyrone admits that he is not ‘across the detail’ of the code. Amir is also concerned that Tyrone tends to avoid difficult conversations, and he suggests that he should go back to the HR department to make sure he has been provided with the correct information. Reluctantly, Tyrone agrees to follow up.

Tyrone later discovers that the organisation does have a policy and associated procedure, including a flow- chart to guide decision making. He also locates his copy of the relevant Code of Ethics. However, because is so busy, he asks Fiona to undertake the work ‘since she’s the one who was first aware of the issue’. Fiona is uncertain about proceeding and thinks that her involvement is not appropriate. Tyrone gives her the Code, flowchart and policy. He insists that she send the formal letter to Patrick outlining the allegations of an improper relationship with a patient, and also contact him to arrange a formal meeting involving the three of them.
During the meeting, Patrick admits being in a relationship with Melitta, but he is angry at Fiona for reporting him and said everyone should ‘mind their own business’ because Melitta is no longer a patient. Fiona attempts to chair the meeting but is finding Patrick’s animosity difficult to deal with. Tyrone speaks very little during the meeting, but he does take notes about key details including when Patrick says Melitta was a patient, and when their relationship commenced.
In the course of the ensuing investigation, Patrick reveals that he sent Melitta a ‘friend request’ on Facebook while she was a patient in the facility. Furthermore, he admits that Melitta was a patient when he said that he was sexually attracted to her and that he looked forward to spending more time with her. He also admits
that they are now living together as a couple, since she had ‘had nowhere else to go’ after her discharge from hospital.
Fiona presents Tyrone with a brief report outlining the findings of the investigation. Based on this report, the Chief Executive determined that the social worker should be dismissed and a notification made to the Australian Association of Social Workers relating to professional misconduct.

Case Study C
Katherine, Harvey, Zali and Mei are all experienced physiotherapists employed at a busy physiotherapy unit in a large public hospital. The hospital is under considerable financial pressure as a result of funding cuts and increased admissions, and staff morale is generally low. The physiotherapy unit is facing complex issues relating to high staff turnover in the senior management position, budget cuts, and uncertainty surrounding restructuring and longer-term job security. The four physiotherapists have worked together for several years and generally work well as a team. However, over recent months, Boris (the senior Unit Manager) has noticed a higher number of
disagreements between them and a tendency for documentation to be improperly completed – the latter of which has implications for his regular reporting to the senior management team. Just before the start of a shift, Zali telephones Boris and says that she needs to urgently to fly to Africa because of some family issues. She says she does not know how long she will be away. Zali does not go into detail but is very emotional and seems keen to end the call. Boris says that she should just go and they can ‘sort out the paperwork later’. The call ends without any contact details being exchanged. After the call,
Boris arranges for someone to cover Zali’s shift and investigates the options for longer-term cover. When the others commence their shift, Boris notifies them of the situation with Zali. Neither Mei nor Harvey
seem particularly concerned, but Katherine asks a lot of questions about why Zali has gone, and why she didn’t give more notice. She seems very irritated about the situation. Boris acknowledges that it is a difficult time for this to happen but says that he’ll do everything he can to minimise the impact on everyone’s workload. He wonders how long Zali will be away for and regrets not asking for her contact details while she is overseas.
During that shift and over the next few days, Katherine is terse with her colleagues and seems generally distracted. Harvey attempts to find out whether something is bothering her and she simply snaps “Isn’t it obvious?” before rushing off. Boris notices this and asks Harvey if he is okay, at which he shrugs and continues with his work. As he is leaving, Boris reminds Harvey that he can access confidential counselling through the Employee Assistance Program.
When Zali does return to work, she does not want to talk to her colleagues about the family issue, and the period of leave is soon forgotten. However, one day soon afterward she arrives fifteen minutes late for a shift and says that it is because her husband forgot to put petrol in the car. The following week she is late again. She appears flustered and says something about her daughter being unwell. Boris is concerned about this becoming a pattern of behaviour but decides not to say anything about it because she seems stressed.
The annual performance review meetings are scheduled soon, so he decides to raise it with Zali at that time. Unfortunately, Zali’s unreliable behaviour continues and she is not only frequently late for work, but also takes longer than scheduled breaks, calls in sick, and sometimes leaves early without discussing with anyone.
One day after a busy shift Boris walks past the tearoom and overhears Mei, Katherine and Harvey discussing the situation with Zali. He decides against letting them know that he heard the conversation, and continues down the corridor.
During Zali’s performance review meeting, Boris indicates that he is very concerned about her frequent absences and her apparent lack of commitment to her work. He recommends that new performance targets be put in place, with monthly reviews. Zali initially appears shocked, then becomes angry and defensive. She demands to know why nothing has been said to her before now. She is angry that her record will reflect underperformance, and that she was not given the opportunity to explain herself or change the behaviour.

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