The Stress of Caring
Source: Robbins, S. P., & Judge, T. A. (2015). Organizational Behavior (16e), pp. 585-587g).
Professor Ron Stone
Keller Graduate School
Note: This case is provided as the basis for class discussion.
The Stress of Caring
One of the most consistent changes in the structure of work over the past few decades has been a shift from a manufacturing economy to a service economy. More workers are now engaged in jobs that include providing care and assistance, especially in education and medicine. This work is satisfying for some people, but it can also be highly stressful. In the following scenario, consider how a company in the nursing care industry is responding to the challenges of the new environment.
Major Topic Areas
• Organizational change
Parkway Nursing Care is an organization facing a massive change. The company was founded in 1972 with just two nursing homes in Phoenix, Arizona. The company was very successful, and throughout the 1980s it continued to turn a consistent profit while slowly acquiring or building 30 more units. This low-profile approach changed forever in 1993 when venture capitalist Robert Quine decided to make a major investment in expanding Parkway in return for a portion of its profits over the coming years. The number of nursing homes exploded, and Parkway was operating 180 homes by the year 2000.
The company now has 220 facilities in the southwestern United States, with an average of 115 beds per facility and a total of nearly 30,000 employees. In addition to health care facilities, it also provides skilled in-home nursing care. Parkway is seen as one of the best care facilities in the region, and it has won numerous awards for its achievements in the field.
As members of the baby boom generation become senior citizens, the need for skilled care will only increase. Parkway wants to make sure it is in a good position to meet this growing need. This means the company must continue expanding rapidly.
The pressure for growth is one significant challenge, but it’s not the only one. The nursing home industry has come under increasing government scrutiny following investigations that turned up widespread patient abuse and billing fraud. Parkway has always had outstanding patient care, and no substantiated claim of abuse or neglect in any of its homes has ever been made, but the need for increased documentation will still affect the company. As the federal government tries to trim Medicare expenses, Parkway may face a reduction in funding.
As growth has continued, Parkway has remained committed to providing dignity and health to all residents in its facilities. The board of directors wants to see renewed commitment to the firm’s mission and core values, not a diffusion of its culture. Its members are worried there might be problems to address. Interviews with employees suggest there’s plenty to worry about.
Shift leader Maxine Vernon has been with Parkway for 15 years. “Now that the government keeps a closer eye on our staffing levels, I’ve seen management do what it can to keep positions filled, and I don’t always agree with who is hired. Some of the basic job skills can be taught, sure, but how to care for our patients—a lot of these new kids just don’t pick up on that.”
“The problem isn’t with staff—it’s with Parkway’s focus on filling the beds,” says nurse’s aide Bobby Reed. “When I started here, Parkway’s reputation was still about the service. Now it’s about numbers. No one is intentionally negligent—there just are too many patients to see.”
A recent college graduate with a B.A. in psychology, Dalton Manetti is more stressed than he expected he would be. “These aren’t the sweet grannies you see in the movies. Our patients are demanding. They complain about everything, even about being called patients, probably because most of them think they shouldn’t be here in the first place. A lot of times, their gripes amount to nothing, but we have to log them in anyway.”
Carmen Frank has been with Parkway almost a year and is already considering finding a new job. “I knew there were going to be physical parts to this job, and I thought I’d be able to handle that. It’s not like I was looking for a desk job, you know? I go home after every shift with aches all over—my back, my arms, my legs. I’ve never had to take so much time off from a job because I hurt. And then when I come back, I feel like the rest of the staff thinks I’m weak.”
“I started working here right out of high school because it was the best-paid of the jobs I could get,” says Niecey Wilson. “I had no idea what I was getting myself into. Now I really like my job. Next year I’m going to start taking some night classes so I can move into another position. But some of the staff just thinks of this as any other job. They don’t see the patients as people, more like inventory. If they want to work with inventory, they should get a job in retail.”
Last month, the company’s human resources department pulled the following information from its records at the request of the board of directors. The numbers provide some quantitative support for the concerns voiced by staff.
Injuries to staff occur mostly because of back strain from lifting patients. Patient incidents reflect injuries due to slips, falls, medication errors, or other accidents. Certified absences are days off from work due to medically verified illnesses or injuries. Other absences are days missed that are not due to injuries or illnesses; these are excused absences (unexcused absences are grounds for immediate firing).
Year Patients Injuries Per Staff Member Incidents Per Patient Certified Absences Per Staff Other Absences Per Staff Turnover Rate
2000 21,200 3.32 4.98 4.55 3.14 0.31
2001 22,300 3.97 5.37 5.09 3.31 0.29
2002 22,600 4.87 5.92 4.71 3.47 0.28
2003 23,100 4.10 6.36 5.11 3.61 0.35
3004 23,300 4.21 6.87 5.66 4.03 0.31
2005 23,450 5.03 7.36 5.33 3.45 0.28
2006 23,600 5.84 7.88 5.28 4.24 0.36
2007 24,500 5.62 8.35 5.86 4.06 0.33
2008 24,100 7.12 8.84 5.63 3.89 0.35
2009 25,300 6.95 9.34 6.11 4.28 0.35
Using Organizational Development to Combat Stress and Improve Performance
The company wants to use such organizational development methods as appreciative inquiry (AI) to create change and re-energize its sense of mission. As the chapter on organizational change explains, AI procedures systematically collect employee input and then use this information to create a change message everyone can support. The human resources department conducted focus groups, asking employees to describe some of their concerns and suggestions for the future. The focus groups highlighted a number of suggestions, although they don’t all suggest movement in the same direction.
Many suggestions concerned schedule flexibility. One representative comment was this: “Most of the stress on this job comes because we can’t take time off when we need it. The LPNs [licensed practical nurses, who do much of the care] and orderlies can’t take time off when they need to, but a lot of them are single parents or primary caregivers for their own children. When they have to leave for childcare responsibilities, the work suffers and there’s no contingency plan to help smooth things over. Then everyone who is left has to work extra hard. The person who takes time off feels guilty, and there can be fights over taking time off. If we had some way of covering these emergency absences, we’d all be a lot happier, and I think the care would be a lot better.”
Other suggestions proposed a better method for communicating information across shifts. Most of the documentation for shift work is done in large spiral notebooks. When a new shift begins, staff members say they don’t have much time to check on what happened in the previous shift. Some younger caregivers would like to have a method that lets them document patient outcomes electronically because they type faster than they can write. The older caregivers are more committed to the paper-based process, in part because they think switching systems would require a lot of work. (Government regulations on health care reporting require that any documentation be made in a form that cannot be altered after the fact, to prevent covering up abuse, so specialized software systems must be used for electronic documentation.)
Finally, the nursing care staff believes its perspectives on patient care are seldom given an appropriate hearing. “We’re the ones who are with the patients most of the time, but when it comes to doing this the right way, our point of view gets lost. We really could save a lot of money by eliminating some of these unnecessary routines and programs, but it’s something management always just says it will consider.” Staff members seem to want some way to provide suggestions for improvement, but it isn’t clear what method they would prefer.
Parkway has taken some initial steps toward a new direction, but clearly it has a lot of work left to do. You’ve been brought in as a change management consultant to help the company change its culture and respond to the stress that employees experience. Remember to create your report as if for the leadership of a major corporation. When you write your recommendations, make sure you touch on the following points:
1. What do the data on employee injuries, incidents, absences, and turnover suggest to you? Is there reason for concern about the company’s direction?
2. The company is going to be making some significant changes based on the AI process, and most change efforts are associated with resistance. What are the most common forms of resistance, and which would you expect to see at Parkway?
3. Given the board of directors’ desire to re-energize the workforce, what advice would you provide for creating a leadership strategy? What leader behaviors should nursing home directors and nurse supervisors demonstrate?
4. What are the major sources of job stress at Parkway? What does the research on employee stress suggest you should do to help minimize the experience of psychological strain for employees? Create a plan for how to reduce stress among employees.
The Stress of Caring
Parkway Nursing Care Company is going through tough times at the moment. With the ever increasing need for better patient care services in the world, the organization has struggled with serving the increased number of people (Hayes et al., 2013). Consequently, the organization has also been struggling with change. Because there has been an increased interest by the government in the documentation and the quality of service being provided by these healthcare institutions. The level of performance has since increased and will continue increasing in spite of the work stress that the employees in such organizations like parkway nursing care experience.
The report below will focus on the type of changes that can be done to an organization to increase the quality of service and employee performance. The subject of the report is Parkway Nursing Care Company that has been in the healthcare industry for over a century. However, in the recent years there has been a lot of stress that has negatively affected the healthcare institution. Therefore, the report will focus on the specific causes of the adverse effects, understand them and suggest methods for conquering these influential aspects of the organization.
After carefully analyzing the situation at Parkway nursing care. It was realized that the most effective way to ensure that the organization continued to thrive was by changing the perspective by which work was being done at the organizational level. The employees, although not most of them, have no idea about what nursing care entails. Consequently, the patients in the care of the staff at the Institute are at sometimes treated as products of some kind and not human beings. Therefore, as we see there are a lot of changes that need to be put in place to neutralize the situation and ensure that the organization moves towards ensuring better care for their patients above all other things.
Most of the information collected was through interviews. Some of the interviews created a basis for the report. The foundation of the report was considered to be the included I=in the following points of discussion.
Firstly, the government has since structured a policy that would increase the documentation to avoid cases of inappropriate billing and cover-up of patient abuse. Consequently, the government has also requested that the documentation be done in such a way that it would be easy to correct and alter the information.
The issue has caused a lot of problems at the Parkway nursing care institute. One of the problems regards the use of an electronic software system that would make use of current technology to implement the documentation of patients. Moreover, the old nurses that are not so equipped with technology have some resistance to the adoption of the new system and would like to keep the old system of documentation in use. But, the younger nurses vouch for the new system considering that they can type faster than they can write. Thus, a lot of time is saved from the documentation process that can be used in more serious work.
Secondly, from the data provider about employee injuries and other aspects. Per staff, member absences have increased to a high of 4.28, and that is not good for any business. The absences that have gone unnoticed in the institution have caused a lot of stress to other staff members. For instance, licensed nurse does almost all of the work in the organization. Reason being most of them have the expertise regarding nursing and care. Therefore, when a licensed nurse takes time off. All the other staff members are forced to work extra hard, and this causes some stress on their performance. Eventually, the quality of service offered goes down. Employee job satisfaction decreases. More staff members ask for time off due to excess fatigue and the cycle continues. The situation above is dangerous for such an organization. The organization should try and find ways to neutralize the situation before it gets out of hand.
Thirdly, the appreciative inquiry that was used to depict what type of change the organization requires. The AI process went smoothly apart from some resistance to change from some staff members. One thing the organization needs to consider is that change will happen one time or another time, but eventually it will happen. Then it is crucial to consider the benefits of this change happening earlier than later in spite of all the resistance it is going to face. It is quite normal for change not to be accepted. However, from a management perspective, change is inevitable. Therefore, it most happens. But for the change to be of positive effect on the organization. There must be some ways put in place to counter the resistance that will be faced. To effectively manage the resistance, we have to understand the common types of resistance that might be witnessed in this situation. The most common type of resistance might be shown through reduced employee performance or morale. To counter this, it is prudent that the management considers creating a change message that would be a motivating factor that would put the staff in the organization in support of the proposed changes for the betterment of the organization.
The most crucial part of an organization is considered to be the leadership (Perrewé et al., 2013). In this case, job stress at Parkway has been there, and the management has considered doing some changes to solve the issue. However, if the leadership structure and behavior of the organization are not changed, the proposed changes will have no significant effect on the organization. Therefore, it is wise first to ensure that the leadership is up to today’s standards and will uphold the core values of the organization. Hence, the board of directors need to ensure that the leadership behavior in the organization is bent towards the betterment of the quality of service provided.
Another key aspect of the organization is the number of staffs. The staff seems to be less and overworked at some point. For instance, when one staff member gets tie off work. The result is the other staff members working very hard to counter the absence of one of them. Therefore, it is wise to employee new staff members with diverse skills to reduce work stress at the organization. Increasing the number of staffs will not only reduce the work ration per employee but also increase the individual attention or care given to the patient (Chung et al., 2011). Hence, in the long run, increasing the quality of services offered at Parkway nursing care.
Lastly, the organization needs to keep up with technology. In these modern times, technology has become the backbone of most businesses and eventually the global economy. It is considered a crucial aspect of the success of any business or organization. Therefore, the organization needs to adopt a software system that would solve the issue of documentation. The system must be modern, easy to use and have tight security to maintain the integrity of the documents.
Parkway nursing care has had a lot of years of experience in the healthcare industry. With the growing need for specialized healthcare, the organization needs to change to deal with the demand in an efficient and effective manner that ensure the quality of service. Hence, change has to be done swiftly and the transformation process successfully.
Chung, C. E. E. (2011). Job stress, mentoring, psychological empowerment, and job satisfaction among nursing faculty.
Hayes, B., Bonner, A., & Douglas, C. (2013). The levels of job satisfaction, stress and burnout in Australian and New Zealand haemodialysis nurses.
McVicar, A. (2015). Scoping the common antecedents of job stress and job satisfaction for nurses (2000–2013) using the job demands–resources model of stress. Journal of nursing management.
Perrewé, Pamela L. The Role of Emotion and Emotion Regulation in Job Stress and Well Being. Eds. Jonathon RB Halbesleben, and Christopher C. Rosen. Emerald Group Publishing Limited, 2013.