Question

Case 10: The Toxic Leader

Marie-Elena Barry

Kyle was a BSN-prepared psychiatric nurse with two years of nursing experience under his belt, and was viewed by his peers as being a senior nurse. Currently, he attends a graduate program part-time to earn his MSN, with hopes to be a manager of an inpatient psychiatric unit. Whenever Kyle was on duty he was always in charge of the 12-bed inner city psychiatric unit. He worked on 3 West caring for young adult patients who suffered from developmental disabilities with a codiagnosis of psychiatric conditions such as schizophrenia, autism, or bipolar disease.

Every Tuesday and Thursday afternoon, the unit participates in patient care conferences. The purpose of the conference is to discuss patients who represent a challenge for staff or someone who has behaviors that require interdisciplinary collaboration in order to provide a safe and therapeutic milieu. In order to maintain compliance with The Joint Commission, the psychiatrist, nurse manager, pharmacist, psychologist, and representatives of nursing, social work, and recreational therapy are expected to attend. Jackie, the unit manager, is the Chair of the patient care conferences.

The psychiatric unit follows a primary care nursing model, and Kyle was the primary nurse for K.C. Kyle reflected that just two days prior to the scheduled care conference, K.C. was verbally threatening to staff and patients. Additionally, he stopped eating and was banging his head on the wall. On the day of the patient care conference, K.C. had physically assaulted another patient. Kyle, having just two years of nursing experience, was having difficulty in managing K.C.’s disturbing behavior. Kyle acknowledged that K.C. was a danger to himself and others, and Kyle was looking for guidance and support from the health care team.

Thursday at 2 pm, Kyle entered the conference room, as expected, only to find that he and the recreational therapist were the only staff present. This wasn’t unusual since when Jackie, the unit manager, sporadically attended rounds, she was often late. Ten minutes after the meeting was supposed to start, Jackie passed by the conference room while talking on the phone, and asked the person she was speaking with to hold on for a minute. As she hurriedly walked away, Jackie told Kyle and the recreational therapist the meeting was cancelled and, “Oh, by the way, didn’t you get my e-mail?” Kyle was speechless. He had never received an e-mail from Jackie, and was disappointed as yet another patient care conference went unattended by the management team.

In the meantime, Kyle was at a loss on how to positively manage the care for K.C. The unit was getting out of control as K.C. was becoming more aggressive with other patients. On the afternoon of the cancelled meeting, Kyle saw Jackie and asked her for a moment of her time. Jackie stated that she was late for an appointment as she briskly walked towards the door. She asked Kyle to e-mail her so they could set up an appointment for a more convenient time. Immediately, Kyle sent an e-mail to Jackie stating that he was accessible anytime, even on his days off. Days went by and Kyle never received a reply.

On Kyle’s next shift, he patiently waited for his unit manager to arrive. He needed to discuss the care of K.C. with her. When Jackie finally arrived at work, she was wearing a too-short sequined dress, large gold hoop earrings, and three-inch heels. As she had barely entered the psychiatric unit, Kyle noticed that she was hanging on Martin’s arm and giggling flirtatiously. Kyle remembered that Martin was complaining earlier that morning that he had scheduled a meeting with Jackie to discuss a staff squabble. To make matters worse, Martin, who was a younger and less senior nurse followed Jackie into her office

and closed the door.

Discussion Questions

7. How would you handle this scenario if you were Kyle?

8. Provide your reflections and personal opinions as well as your recommendations for addressing this problem.

Answer 1

7-If I would be in Kyle’s place, I would still be doing my job perfect even after seeing the disturbing scene between Jackie and Martin. Also to discuss the care of the patient, I would mail Jackie and her supervisor about the care to be discussed in regards to the patient. This will automatically garner her response for the discussion.

8-If one takes the while to envision a typical daytime at work through your boss's perceptiveness, you might originate earlier to considerate why she disregards you. It might be that she's overawed with all of her other errands. Additional likelihood is that she's dissatisfied with Kyle’s presentation. Moreover, one should antagonize the subject. Once Kyle devotes some while speaking to Jackie, he can recognize the origin of the problematic situation and commence to make the essential variations.