A Change Of Nursing Management Proposal

This report gives the thorough analysis of the current situation and an informed view of the future of Parkway Nursing Care. This report then provides a series of recommendations to close the gap between the current situation and desired future.

This study aims to investigate the implications, forms of resistance, and stress which are present in the daily work of Parkway Nursing Care and the way they handle these occurrences, as well as the types of mediating processes which occur within relationship which produce confrontation and the way these help them to comprehend and transform their own work.

The study concluded that problems, forms of resistance, and stress not only exist but also contribute to the reproduction of unequal relationships on the job and that these relationships occur between nurses and supervisors, home directors and auxiliary individual. Responding to this situation, nurses have been utilizing individual and informal resistance resolution. To avoid this resistance some collective resistance strategies suggest to overcome the resistance in Parkway Nursing Care.

Profit and growth these two are the major drivers of any company strategy. All companies mainly focus on profit and growth. In Parkway also, the management focused on profit and growth and in fact it has achieved these through its outstanding leadership in spite of many challenges. The current size of Parkway, numerous awards and its reputation in the market demonstrate these achievements. However, as the pressure for growth continues, especially when the focus is not supported by right resources/facilities and well motivated staffs, there bound to be some chances of occurring certain problems hindering to the momentum of growth. This may affect the company’s long-term performance. We cannot just go for profit and growth alone, but need lot of strategic thinking followed by implementation of the right plans through vital investments to meet the long-term objectives. It is important to have the right key people focused on these long-term objectives and also create a good image of the company. Developing a rigorous execution plans and its successful implementation will bring good outcome. As part of growth development plan, a good management should always be concerned about the warning signals that come out from its survey results.

The survey results shows the injuries, absences, turnover rate of staff and incidents per patients for the Parkway Nursing care between the 2000 to 2009.

First of all the total number of patients increased slightly between 2000 to 2007.In 2000 there was total number of patients about 21,200 .This rose sharply to about 24,500 an increase 15.57% between 2000 to 2007. In 2009 there was sudden increase in number of patients by 4.98% .There was significant increases in number of patients in both years 2001 and 2009 .The number of patients went up by 5.19% and 4.98% respectively.

It can be seen that there were significant changes in injuries per staff member, incidents per patient and certified absences per staff and others. The injuries, incidents, and absenteeism increased with the increase of patients in Parkway Nursing Care.

On contrary , we can see that the increase of injuries, incidents per patient, absences of staff cause to turnover rate. Turnover and absenteeism are the withdrawal behaviors and work-related injuries are a significant problem in the nursing profession and are commonly attributed to the stressful nature of the job.

The survey results indicate that many problems have developed while the organization was focusing on achieving its growth and profit objectives.

Number of patients increasing but all categories shown decline.

Costs associated with the problems exert pressure on profitability.

Problem exacerbated by reduction in funding and increased documentation.

All the above will make it difficult to meet stakeholders’ needs especially the venture capitalist.


As per surveyed the following problems has been identified in the Parkway Nursing Care.

3.1.Staffing :

Parkway Nursing Care has been facing one of the challenging problem is staffing. The staff injuries, absences, turnover these are main problems in parkway Nursing care. The major sources of injuries to nursing care workers are lifting and moving patients and overexertion. The injuries problems will contribute the work-related absenteeism and turnover in Parkway nursing care. Turnover is the one of the issue impacting the performance and profitability of Parkway Nursing Care. “voluntary” or “regrettable” turnover that occurs when a nurse that the organization would like to retain chooses to leave their job. Losing critical employees negatively impacts the bottom line of Parkway nursing care in a variety of ways including that decreased quality of patient care, loss of patients, increased contingent staff costs, increased staffing costs , increased accident and absenteeism rates. Employees are then forced to work harder and sometimes longer hours to make up for the lack of a sufficiently sized nursing staff. The Parkway Nursing Care facing another problem is hiring new employee .This was under scrutiny of Government requirement to hire skilled employee or registered nurse in nursing care industry.

3.2.Physical Demands :

Standing or sitting, listening to the patient, family, other health care workers, pushing the beds, gurneys, and wheelchairs, monitor poles, laundry and trash containers doors, pulling beds, gurneys, and monitor poles. Objects from shelves such as linen, supplies monitors, laundry and trash containers and doors these are essential physical functions nursing care .The problem is nurses demand the mechanical equipment to lifting patients and move patients from place to another place in order to prevent stress ,injuries and heavy load .These demand impact the other job turnover .The parkway not willing to purchase mechanical equipment because of it is cost oriented. This will increase the input cost and impacting the profitability of parkway nursing care.


The Parkway Nursing Care has been facing one of the problem was documentation. This was occurring due to Generation gap between old caregivers and young caregivers. It is the difference between the young and the old in priorities and perceptions. The younger generation is always quick to adapt to new situations. It is often the inability of older generation to accept the vigor ,vitality and extreme views of younger generation that leads to the generation gap and communication gap in workforce. This is one of problem is Parkway Nursing care due to this some of them uncomfortable with Electronic Documentation. In an age of rapid changes it is quite obvious that the gap widens , inevitably ending in conflicts. It is high time we accepted the need for an ideal society where the aspirations and views of both generations could be converged to make job more comfortable. Documentation is the mandatory thing in Nursing care industry. The government impose restriction on mode of documentation especially in the E-documentation.This leads to one of the problem in the parkway.

3.4. Focus on filling beds

This is the economic problem in the parkway nursing care .The parkway is focusing at filling of beds in order to get profitability. But this may cause the problem to workforce in terms of patient care and reputation. This problem contradict the sales of parkway nursing care why because it affect sales down and also impact on profit of parkway and also reputation. So this problem makes the dilemma to management of parkway nursing care.

These are the major problems impacting the performance and profitability of Parkway Nursing Care.


Change management isn’t working as it should. Both groups know that vision and leadership drive successful change, but far too few leaders recognize the ways in which individuals commit to change to bring it about. Top-level managers see change as an opportunity to strengthen the business by aligning operations with strategy, to take on new professional challenges and risks, and to advance their careers. For many employees, however, including middle managers, change is neither sought after nor welcomed. It is disruptive and intrusive. It upsets the balance. Senior managers consistently misjudge the effect of this gap on their relationships with subordinates and on the effort required to win acceptance of change. This leads to resistance in the organization.

Resistance to change:

Most people don’t like change because they don’t like being changed. When change comes into view, fear and resistance developed. Resistance to change is the action taken by individuals and groups when they recognize that the change may threat their interest. Resistance may be active or passive, overt or covert, individual or organized, aggressive or timid.

4.1 Forms of resistance:

Psychological Resistance :

The psychological Resistance can be fear of the unknown and fear of failure .No one can say precisely about the consequences of change, and this uncertainty builds up discomfort. The uncertainty and discomfort cause negative reactions among people and they are encouraged to resist change. The change may require advanced skill and abilities that may be beyond employees’ capabilities. In such situation, the employee may feel that his interests regarding jobs, power or status in an organization are at risk and this fear lead him to resist the change.

Logical Resistance :

The logical resistance can be of power and conflict, misinterpretation of change and not agreed with the impact of changes: Power and conflict comes from resistance to change also occurs when a change may benefit one department within the organization while harming another. Another reason is Misinterpretation of change. People resist change when they do not understand it. Such situation occurs when the proposed change is not consulted with the employees and supposed to be enforced as an order. People like to know what going on in their organization, especially if something is related with their jobs. When employees feel that the change would increase their working hours and duties and disturb but the benefits and rewards are not seen as adequate, they resist.

Sociological Resistance

The sociological resistance comes from group norms and disturbance in established pattern. Over a period of time, the members of a group develop understanding and interpersonal relationship. The group members resist the change when they believe that it will alter interpersonal relation and coordination among group. The employees and management are tending to develop a pattern of working. When they recognize that the proposed change can force them to modify their established pattern, they resist the change.

4.1.Resistance in Parkway

Parkway staffs also have some type of resistance to change . Inadequate information, failure to accept the need for change ,communication problem ,untrained staffs , etc are the examples in case of Parkway nursing care. In Parkway one of the reason to resistance comes with respect to documentation. Government kept some restrictions on healthcare industry should maintain the record in the form of E-documentation. This leads to communication problem between supervisors and workers. This old care givers resists change because of they have their own perceptions and organizations are resisting this change because this change impacting the operating cost of organization in order to maintain old records .These problems demand the Parkway nursing care recruit the new employee and accompanying training programs have been increase compensation costs and Parkway mainly focuses on filling their beds. This needs high physical demands of staffs. So staffs always resist this attitude of management. Staffing problem is another reason for resistance. The shortage of enough staffs also leads to the high physical demands of current staffs. So they definitely resist the changes. Nurses are increasingly dissatisfied with staffing reductions at hospitals. They are overworked, and they often do not have enough time to maintain a high quality of patient care. This is a direct result of spending more time with paperwork instead being “bed side” with the patient and having too many patients to care for. The next reason is that the experienced staffs also resist changes, because they have to give training for the new staffs. This is an extra work to the experienced staff, so they resist the attitudes of the management. Most of the staffs may resist to any changes which may affect their work-life balance such as security, friends and contacts, money, freedom, pride and satisfaction.

4.3 Overcoming the resistance

It is recommended that giving opportunities in change participation and involvement of staff to feel them ownership of the change. If staff understand the needs for change and what is involved they are more likely to co operate in that case management need to educate them and communicate with staff properly. Assess individual and team’s leadership effectiveness and also provide feedback to determine individual strengths and developmental priorities facilitate a session with the executive team to review team profile. This will contribute increased awareness regarding individual and team’s overall leadership effectiveness (strengths and gaps) and team dynamics. Individual and company objectives. Managers expect employees to be loyal and willing to do whatever it takes to get the job done, and they routinely make observations and assumptions about the kind of commitment their employees display. The terms of a job description rarely capture the importance of commitment, but employees’ behavior reflects their awareness of it. Employees determine their commitment to the organization along Nurses of all stripes have the need for open communication with their nursing leaders. Many feel resentment when not told pertinent information. Communicate regularly with your nursing staff so that they feel assurance when they hear from their nursing leadership. Remember, communication works both ways so prepare yourself to listen attentively when engaged by your nurses. Never underestimate the power of a hand-written note to express your thoughts. Check to see if your older nurses know how to be plugged into technology to receive the full benefit of all electronic communications. Remind your younger nurses that instant feedback may not be possible on all issues and to patiently wait for responses to issues that arise.


Facilitating the growth and development of staff is an important nursing leadership function.” Nursing depends on motivated nurses performing to their fullest potential. While many challenges face nurses in leadership positions, using nursing leadership strategies that motivate appropriately, communicate regularly and encourage effectively will ensure success for any nursing staff.

5.1.Creating Leadership Strategy

The first step in formulating the leadership strategy is to review the business strategy for implications for new leadership requirements. This analysis usually requires a team of experts composed of some people who know the business intimately and others who are familiar with processes for acquiring, retaining and developing leadership talent. Beginning with the business strategy, the first step is to identify the drivers of the strategy. Drivers are the key choices that leaders make about how to position the organization to take advantage of its strengths, weaknesses, opportunities and threats in the marketplace. They are the things that make a strategy unique to one organization as compared to another and dictate where tradeoffs will be made between alternative investments of resources, time and energy. Drivers are few in number and help us understand what it is absolutely essential for leaders and the collective leadership of the organization to accomplish.

5.2.Recommended leadership style :

Although many great nursing leaders emerged in the past ,most nurse were kept insubordinate positions .This subordinate has diminished as more nurse have learnt to apply their leadership skills to attain the ultimate goal of improved patient care. Nurses with leadership skills effect desired changes in the patients ‘health patterns , in the medical treatment facility , in the nursing profession and in the community. With education ,training and practice, every nurse can develop the following leadership qualities.

Professional Knowledge: Nursing involves knowledge in biology ,nursing science , social science , psychology and many other areas .Learn how to find and use appropriate reference materials and resource persons quickly and efficiently .Keep up with current nursing practices for validity ,reliability and applicability and share your knowledge with the peers and your subordinates.

A positive self -Image :Leaders must be enthusiastic , dynamic and self-directed. They must be comfortable with themselves and act as role models to their followers.

Assertiveness : Ability to state family and confidently and do quietly what you think to be right assertiveness enables a nurse to be professional.

An understanding of human needs :The highest level on Maslow’s Hierarchy of needs it’s self actualization which is the need for individual to reach her /his potential through development of her . his unique capabilities .Nursing is often described solely in terms of tenderness , love, devotion and similar qualities that are generally associated with mothers and angels.

Qualities That a nurse Needs :Nurses are the only healthcare professional dealing with hospitalized patients 24-hours a day. Nurses provide expert , skilled care when patients are acutely ill. Nurses also work outside the hospital settings in many different roles , including health promotion activities ,health lifestyle practices and disease prevention

People skills are essential , along with a sincere desire to help others. Leadership is another necessary .This includes organization and management skills ,good work ethics , and inner calm in the face of emerges .In our technologically advanced society computer skills , manual dexterity and the ability to operate various equipment are important.

Let us in mind that all the scientific and technological advancement cannot replace a caring nurses, professional competence and empathetic expertise .Her commitment on duty and selfless service make nursing a bole profession.

5.3.Leadership behaviors of home directors

The company is going to be making some major changes from top-level management to operational level management. The top-level home directors have the ability to prioritize the work, time management, good decision making, and also have good communication skill. The top-level management always communicate with middle level management and middle level management communicate with bottom level management and vice-versa. In Parkway, there are different departments and all these departments have different home directors. The management should communicate with these home directors. The management sends all relevant information to these directors and these directors send messages to supervisors. Also they send back information to top management. In all organization, successful leaders typically develop largely by first learning to be good followers. The home directors should have the clear vision and mission about the organization. The management gives permission to directors to involve in the decision-making and strategic planning. They should reduce employee dissatisfaction and actively involves in the effective process of delegation. The home directors should have more personal and active attitude towards goals. The home directors need to be continually engaged to co ordinate and balance to compromise conflicting requirements. The main jobs of home directors are planning, controlling, organizing and directing the activities.

5.4.Leadership behaviors of supervisors

The middle managements act as a bridge between top-level management and bottom level management. In Parkway, supervisors are in the middle of staffs and home directors. The supervisors collect the instructions from the home directors and send to the staffs. They also collect feedback from the bottom level and send to the directors. The supervisors do this to create team spirit around him and near him. They also involve in certain quality improvement activities. Supervisors should be good listeners and also a good communicator. Finally supervisors should be an influence for others, work wise as well as ethically. And also should be a good motivator. The supervisors should mainly focus on encouragement, motivation, and communication.

6.Job stress in Parkway

Over the past two decades, there has been a growing belief that the experience of stress at work has undesirable effects, both on the health and safety of workers and on the health and effectiveness of parkway. This particular concern has been expressed for the effects of stress on health-care professionals and, in particular, on nurses in Parkway nursing. The high turnover rates lend themselves to one of the stress-causing points in nursing, which is the very common experience of being short-staffed. Employees are then forced to work harder and sometimes longer hours to make up for the lack of a sufficiently sized nursing staff. Health care cost cutting is another factor contributing to this overwork problem. Enough nurses to fill the workload are often simply just not employed for financial reasons.

6.1.Sources of Stress

The main sources of stresses that may be affected in parkway are environmental factors, organizational factors and personal factors. Environmental factors include economic problems, political problems and technological problems. Organizational factors comprised of task demands, role demands and interpersonal demands. Finally, personal factors include mainly family and personal relationships, earning capacity and personality problems. All these three types of stresses are existing in Parkway. These stresses will affect the job of staffs, management and patients. Some stresses are related with challenges; i.e. workload, pressure to complete tasks, time urgency, etc. Some stresses are related to goals, etc. In parkway, there are mainly three different types of stresses.

Staffs cannot take time off when they need it. Some time they need some emergency time off due to personal problems. There is no contingency plan for these emergency cases. Most of the staffs have parents, children, etc. and they need to balance their family life with work life. In reality, the staffs do not get leisure time to get together with their family. There may be chances to develop stress in such situations. The staffs also have got high workload due to shortage of staff and more patients. This will leads to high physical demand of staffs and therefore stress for the staffs.

The communication gap is one of the reason that causing stress to staff in the parkway and there is no coordination between staff with paper based documentation. When a new shift begins, they don’t have much time to check on what happened in the previous shift. This communication gap will make conflict between the staff and also produce high stress to the staffs.

6.2.Stress Management plan

Actions or situations that place physical or psychological demands on people over time will cause stress. Both physical and mental stress are required for normal and healthy growth and moderate amounts in the workplace can increase productivity. But if not managed properly, stress can eventually lead to burnout as well as to physical problems. In the workplace, one of the chief causes of stress is the feeling of inequity or unjust treatment. Effective stress management addresses employees both physically and mentally. Easy and economical treatment at the workplace includes provisions for music and physical exercise with suggestions for rest, diet, and meditation. Management can also reassign tasks and provide more flexible work schedules. Workplace stress is expensive because it can cause absenteeism, increased sick leave and medical costs, and high turnover rates.

Parkway can give some relaxation programs to the staff like meditation, yoga etc. so that they can get relaxation. It helps people to reduce stress temporarily and also reduce the symptoms of stress. Few organizations have already established this for their staffs. We can also implement this in our organization. Another plan is biofeedback system. Conducting regular medical checkups to the staffs, their welfare The feedback provides the bio information of the staffs wherein the heartbeats, brain waves, etc. are measured. Parkway can coordinate some programs allowing sabbatical leaves to encourage stress relief and personal education. And also include some personal wellness program me . All these programs definitely reduce the stress of the staffs.

Parkway can also provide counseling sections to the staffs. It will help to employee to cope up with difficult situations. It seeks to staff’s mental health. Good mental health means that people feel comfortable about themselves, right about other people, and able to meet the demands of life. Counseling usually is confidential so that employees will feel to talk openly about their problems. Staffs can share their job problems as well as personal problems and reduce their stress through proper guidance. Some times the manager can do this counseling. Giving proper training to the staff is another way to effectively reduce the stress. For example, some staffs do not know how to use electronic machines, new technologies etc., and proper training to such people will help them a lot to reduce their stress. Always maintain a good communication with staffs as the communication controls the stress of the jobs. Having sufficient number of employees to work effectively will reduce workload stresses. The management can also provide some leaves related with employee sabbaticals. Conducting welfare programs that reduces the stress of employees will be another approach. These are planes can be implemented in Parkway.

6.3. Summary

In summary, the following are recommended to enhance the overall long-term performance of the Parkway:

Recruit additional staff in workforce to reduce workload

Mechanical lifting systems.

Flexible time schedule.

Electronic Documentation

Training to staff for new software/ equipment

Family outings/ social gatherings/ sports

Performance based bonus

Regular communications from top management to staff

Feedback from staffs

Personal wellness/ medical check up

Counseling services


It is recommended that the parkway’s management has been ambitious for profit and growth in the current competitive business model. For that They set some demanding goals for growth .The management should always be looking for better performances and changes necessary within the organization to meet the long-term objectives .This long-term gain may be possible by taking certain risks and through some short-term pain their earnings. This can only be accomplished with safety and security of its own employees which is the intangible asset of the company.