Reference no: EM133234536

Susan sighed and closed her office door so that she could have a few moments to herself and figure what her next step should be. The events of the last hour had been very difficult for Susan, nurse manager for the neonatal intensive care unit (NICU) at Pleasant Valley Memorial Hospital. Susan had to discuss with Pamela, one of her most dedicated nurses who has worked in the NICU for the past four years, that she cannot reassign her patient load to other nurses because she has "issues" with the mothers' lifestyles of some of the babies in the NICU. Over the past several years, Susan has found that she has had more and more of these types of conversations with her nursing staff.

Susan reflected on the change in the cultural makeup of the nursing staff during the past decade. Over the past 10 years, she has observed the nursing staff change from what were once predominantly white non-Hispanics to approximately 75% black made up mostly of Caribbean Island nurses. For the most part, the Caribbean Island nurses were educated in the British education system. Susan also noticed that most of the Island nurses were deeply religious. Many brought their Bibles to work and were often seen reading at the patients' bedsides or discussing their religious beliefs with one another. Susan wondered if cultural backgrounds played a part in the increased number of conflicts occurring in the NICU over the years between her staff and the patients' families. Should she change her hiring practices to avoid these increasing conflicts?

Susan recalled a particular incident two years ago involving one nurse's refusal to take care of a baby because the mother had an abortion with a prior pregnancy. Nurse Karen had requested that she not be assigned to this baby and had gone so far as to ask her friends on the 11pm to 7am shift to make sure of it before she would report to work each morning. When Susan found out about the reassignment of Karen's patient load, she requested a meeting with Karen. It was during the meeting that Karen explained to Susan that abortion was against her religious beliefs and she would not take care of a baby whose mother had a previous abortion. Susan explained to Karen that she was in the field of nursing and was obliged to take care of any patient assigned to her no matter what religious beliefs she held. Susan also explained that as a nurse, Karen had no right to judge the mother because she did not know what the mother's circumstances were at the time of the abortion or if the abortion was spontaneous or deliberate. Over the course of the next few weeks, Karen did take excellent care of the baby, although reluctantly. Karen was one of her nurses who could often be found reading the Bible at the patients' bedsides and frequently requested not to be scheduled on Sundays so she could attend church services. Susan had a difficult time understanding how someone with such strong religious beliefs could be so judgmental towards another person?

Another incident that Susan recalled occurred several months ago involved several nurses and a family member of one of the babies in the NICU. The parents of the baby were 16 years old, African Americans and not married. The father of the baby dressed in the "hip-hop" style of today's youth with oversized pants and shirt, tattoos and dreadlocks. One morning the baby's father asked if he could have a few minutes of Susan's time. He had a list of complaints about the nurses taking care of his baby. He claimed that the nurses treated him as if he was invisible with no parental rights. He went on to say that some of the nurses always ask him for identification even though for the past 3 weeks he visits the baby daily and sometimes twice a day. He said noticed that many of the other babies' parents were never asked for identification. He also said that whenever he asked a question about his baby's condition he was told that he would have to ask the doctor, but again he noticed that many of these same nurses gave information freely to other babies' parents. Susan assured the father that she would look into the matter. After quietly observing the interaction between the nurses in question and the baby's father, Susan had concluded that the father's allegations were correct. Should she enroll her nurses in a Customer Satisfaction Program?

Susan also noted an increasing trend for assigning Hispanic nurses to Hispanic babies. Susan became aware of this trend when several of her Hispanic nurses complained to her that the charge nurses automatically assigned Hispanic babies to them, without regard to their current patient load. When asked by Susan if patients were assigned to nurses according to their cultural make-up, all four charge nurses admitted to this practice with the explanation "Hispanics understand each other better so there is no need to call for a translator." Susan remembered that she was so surprised by the charge nurses' response, she asked them if they also assigned the black babies to black nurses and white babies to white nurses! Should she arrange for a cultural competency workshop for her staff?

Susan came to the conclusion that enough was enough and that all these issues needed to be out in the open and discussed with her nursing staff. Now she wondered, how could she best accomplish her goal?

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