business

NUR 400 Case Study Long View Memorial Hospital is an acute care hospital that is owned by the Marley Corporation. The corporate offices are in Dallas, and Marley Corporation (for-profit) owns 20 other acute care hospitals located in Kansas, Utah, Arizona, and New Mexico. Long View Memorial Hospital (LVMH) is a 54-bed facility licensed by CMS and accredited by the Joint Commission (TJC). The next on-site survey by TJC is to be sometime within the next three months. During the last quarter, all reportable core measures were at 87%. This was a decline from the previous quarter, when all core measures were at 93%. In addition, performance improvement indicators for all hospital-acquired infections (HAIs) had declined by 5% during the last quarter. The leadership at LVMH consists of a chief executive officer (CEO), a chief nursing officer (CNO), a chief financial officer (CFO), and a chief quality officer (CQO). The chief of staff has been in her role for one year, and the Medical Executive Committee consists of the medical and surgical specialties that are offered by LVMH. Those are internal medicine, surgery, urology, cardiac medical, obstetrics, orthopedics, and emergency medicine. Organizationally, the communication structure is hierarchical. The aforementioned executive C-suite reports to the CEO, and the nursing unit directors report to the CNO. The CEO is accountable to Marley Corporation. Nursing staff and several directors are primarily associate-degree graduates, though there is some verbal push from corporate headquarters for advanced education of its staff and nursing directors. Financially, the facility is solvent due to average daily census being at hospital capacity for the past six months. There has been some decline in reimbursement due to the new restrictions under the Affordable Care Act. A number of patients are being readmitted for pneumonia and heart failure exacerbation under the 30-day requirement, and hence reimbursement for these diagnoses is being financially penalized. The recent increase in the number of HAIs and the decline in core measures also pose financial reimbursement challenges for the hospital.

The Case

Marcellina has been the clinical manager in surgical intensive care for five years. She has observed an increasing level of change in technology and clinical practice over the past five years in the surgical intensive care unit. She is also pursuing her master’s degree, as this is required for her position and for future advancement. New capital expenditures to accommodate new technological advances have been required, and Marcellina has met with the leadership concerning budget allocations for these purchases. Because of the new technology, patients who are more seriously ill are now receiving higher levels of complex and intense care. At the same time, the demand to reduce the length of stay has accelerated as costs have increased and the revenue margin has tightened. The once-diligent performance monitoring of surgical site infections and hospital-acquired MRSA and C. difficile infections in Marcellina’s unit has declined given the acuity of patients combined with decreased staff and increased sick calls by staff. The nursing staff have varied levels of education. Two nurses with 20+ years of critical care experience are resisting returning to school. Several nurses are pursuing the baccalaureate degree. At times,

Marcellina is indecisive as to how to proceed with the diverse viewpoints of her staff and providers pertaining to changing practice patterns that accompany new technological advances. Marcellina’s immediate supervisor, the director of nursing is, at times, openly critical of Marcellina’s efforts to rally her staff, and she also tends to denigrate Marcellina’s contributions at meetings of the leadership team. Some staff members have been talking about ways to improve matters on the unit. The ideas involve more shared governance as pertains to staffing and input at staff meetings. Marcellina is at once pleased and a bit concerned about the staff nurses’ initiative. Is she “losing her edge” in this stressful mid-level management role? The leadership at Marcellina’s organization tends to manage from their offices at the front of the healthcare facility. The strategic plan has been approved by the Board of Trustees, and nursing managers are expected to begin implementation of the plan’s initiatives at the start of the next fiscal year, two months from now. Marcellina just learned today that a deceased patient’s family has named two of her staff nurses in a negligence lawsuit for a patient’s fall and resulting injuries and death subsequent to the fall. Marcellina may be added to the suit pending initial review by plaintiff’s counsel. Marcellina has never carried liability insurance. Marcellina is certain that the healthcare organization will provide her and her staff with an excellent defense.