What Would You Do?

1. What Would You Do? High Performance Human Resource Policies Case Study This material was designed by Quality Partners, the Medicare Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. Contents do not necessarily represent CMS policy. 8SOW-RI-NHQIOSC-082006-2

2. Leadership Practices Drill-DownCase Example At 8:00 am, the DON asks the charge nurse on Unit 1 to send a CNA to Unit 2 where they are short by two call-ins. The charge nurse asks a CNA, to go over and take an assignment. He refuses, saying, “I’ve just finished my fourth resident and now you want me to do 12 more? No, I won’t do it.” The charge nurse, in the presence of the DON, says, “Either go over there or go home.” He says, “I’m going home.” She asks a second CNA with the same results.

3. Questions For Discussion • What do you think of how the nurse handled the situation? What else could she have done? • Why would the CNAs refuse to go to the other unit? • What happens when this is treated as a disciplinary issue. What management practices contributed to the problem?

4. Drill Down: What management practices contributed to this outcome? Leadership Valuing Caregivers Short on Unit 2 and 2 CNAs down on Unit 1 Work Design HR Policies

5. Scheduling Success • Post assignments well in advance • Allow staff to trade days • Honor requests for time off • Increase FT; decrease PRN and PT • Have back-up plan for no-shows • Primary assignments and days