Leadership Chapter 25: Problem Employees: Rule Breakers, Marginal Employees, and Those With Substance Use Disorder

24. Which is a management function associated with dealing with a problem employee? A) Applies a progressive discipline model when employees fail to meet standards B) Ensures that the rights and the responsibilities of both the manager and the employee are considered in addressing worker grievances C) Examines the work environment for stressors that contribute to substance use disorder D) Understands group norms and is able to work within those norms to mold group behavior

Ans: A Feedback: Applying progressive discipline when needed is an important management function. The other options are leadership roles.

30. A nurse-manager discovered that a nurse was retrieving narcotics from sharps containers and has been abusing these medications for several months. When addressing this behavior and assisting the nurse, what factor should the manager prioritize? A) The safety of clients and families B) The integrity of the unit C) The nurse's well-being D) The nurse's personal growth

Ans: A Feedback: As with all nursing situations, the safety of clients is prioritized over other factors.

29. After the first few months on the job, the nurse-manager has recognized that an experienced practical nurse at the clinic is a marginal employee. What strategy by the manager is most likely to be effective? A) Create a personalized improvement plan with the nurse and work with the nurse to promote improvement. B) Place the nurse on probation and set firm requirements for reinstatement. C) Arrange for the nurse to receive an education leave and complete remedial courses in basic nursing knowledge. D) Apply disciplinary measures that have the potential to motivate the employee.

Ans: A Feedback: Coaching can be a time-demanding, but effective, method of improving the performance of marginal employees. Probation does not give the nurse tools to improve. For some employees, increased learning does not translate into improved performance. Similarly, it is possible for the nurse to be motivated yet still remain marginal.

17. A manager is preparing to confront an employee regarding suspected chemical impairment. What response should the manager anticipate? A) Emphatic denial and defensiveness B) Reluctant acceptance C) Gratefulness for finally being discovered D) Silence

Ans: A Feedback: Employee denial and defensiveness are the most common behaviors in those who are confronted with their impairment, even though the other responses are possibilities.

12. A nursing aide has been given a formal written warning regarding arguing repeatedly with the team leader about the given assignment. Today, the nursing aide has taken four lengthy personal phone calls during work time. This is the first offense of this nature. How will the manager deal with this disciplinary situation? A) Provide a verbal warning that includes the rules related to personal telephone calls. B) Monitor the employee's behavior closely for the next few weeks. C) Present the employee with a formal written reprimand. D) Suspend the employee for a week.

Ans: A Feedback: The best choice of action in this case would be to provide an explanation for the rule and proceed to give a verbal admonishment. Because this is a new infraction, the progressive discipline starts with a verbal warning again and none of the other options.

8. Which statement is accurate when describing performance deficiency coaching? A) It is less spontaneous and requires more planning than ongoing coaching. B) It is a one-time way of solving problems. C) It requires the manager to assume the role of enforcer rather than supporter or enabler. D) It occurs as a component of an employee's annual performance appraisal.

Ans: A Feedback: This form of coaching is less spontaneous and requires more managerial planning than ongoing coaching. In performance deficiency coaching, the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies. This activity could not be compressed into the time of a performance appraisal.

3. The nurse-manager is updating the unit rules and is trying to ensure that they are fair and effective. What actions should the manager perform? Select all that apply. A) Make sure all employees know that rule violations will result in discipline. B) Avoid issuing more than two warnings before an employee's rule violations are punished. C) Maximize the number of rules and regulations so employees are clear about expectations. D) Make sure that discipline for rule violations is consistent and impartial. E) Administer discipline as soon as possible after a rule is broken.

Ans: A, D, E Feedback: Forewarning, consistency, and immediacy are characteristics of effective rules. An organization can have too many rules, making enforcement very difficult. Giving repeated warnings before administering discipline devalues a rule.

6. What action should the nurse-manager perform when preparing for and conducting a disciplinary conference? A) Soften criticisms to reduce the employee's defensiveness and emotional response. B) Schedule the conference in advance at a time agreeable to both the employee and the manager. C) Ask a small number of trusted employees to join the conference so it can be used as a teaching tool. D) Adopt a nurturing and counseling role to ensure the conference ends on a positive note.

Ans: B Feedback: All formal disciplinary conferences should be scheduled in advance at a time agreeable to both the employee and the manager. The manager should be clear and assertive, not softening necessary criticisms. Privacy must be ensured, and it is inappropriate for the manager to adopt a nurturing or counseling role.

23. What is the principle that guides constructive discipline? A) Constructive discipline is fair but punitive in nature. B) The focus of constructive discipline is employee growth. C) Constructive discipline employs the manager as a counselor and support. D) Increased motivation is the desired outcome of constructive discipline.

Ans: B Feedback: Constructive discipline uses discipline as a means of helping the employee grow. Even though punishment may be necessary, this is not the guiding principle or purpose of the activity. The manager is not the employee's counselor. Not every employee who requires discipline is lacking in motivation.

27. A nurse-manager has been managing a medical unit for several weeks and has just learned that a nurse has a reputation among colleagues for avoiding work responsibilities. What is the manager's best initial action? A) Canvas the employees on the unit to identify any history of violence. B) Review the employee's available personnel records and files. C) Contact the client and family and apologize for the nurse's action. D) Inform the client's health-care provider about this incident.

Ans: B Feedback: In preparing to discipline employees, the manager's first step should be to obtain the employee's personnel file materials and review the file documents for a better understanding of past performance and workplace behavior. Canvasing other employees may be a violation of the nurse's right to privacy. The manager should be careful not to "own" the nurse's behavior by apologizing to the client and should gather more facts first. There is no obvious reason to inform the health-care provider if this event happened several days ago.

15. When monitoring medication inventories for possible diversion or theft by nurses with a substance use disorder, what medication classifications should the manager monitor most closely? Select all that apply. A) Anticholinergics B) Opioid analgesics C) Central nervous system stimulants D) Antidepressants E) Benzodiazepines F) Nonsteroidal anti-inflammatories

Ans: B, C, E Feedback: CNS stimulants, opioids, and benzodiazepines are among the most commonly used medications by nurses with substance use disorders. Anticholinergics, NSAIDs, and antidepressants are much less commonly used by these nurses.

22. How should the nurse-manager implement McGregor's hot stove rules when setting standards for employee behavior on the unit? A) Any rule that is outdated or irrelevant must be eliminated promptly. B) Rules should be called "norms" in an effort to make them less authoritarian. C) All employees should be made aware of the rules and associated punishments beforehand. D) Rules should be reviewed on a regular basis to ensure they are necessary.

Ans: C Feedback: All employees must be forewarned that if they break a rule, they will be punished or disciplined. McGregor did not emphasize the need to review rules and eliminate unnecessary ones, although these are both appropriate actions. There is no need to reframe rules as "norms," although some individuals and organizations do so.

21. A nurse became frustrated with a client and deliberately damaged the medication cart in a subsequent outburst. How should the manager discipline this employee? A) Dismissal B) Suspension C) Written admonishment D) Verbal warning

Ans: C Feedback: An employee caught willfully damaging property is initially presented with a written admonishment.

5. An employee is found to have grossly mistreated a client, which the employee has never done before. What consequence should be administered to the employee? A) Suspension with pay B) Suspension without pay C) Termination D) Written admonishment

Ans: C Feedback: For a first infraction of gross mistreatment of a client, the most appropriate level of employee discipline would probably be termination. The organization's first responsibility is in the protection of patients.

16. A nurse is uncharacteristically extroverted on today's shift, with an unsteady gait. The manager suspects that the nurse may be chemically impaired. What is the manager's most appropriate action? A) Document this finding and communicate with the personnel department. B) Monitor the nurse's behavior closely for the remainder of the shift. C) Promptly confront the nurse to discuss this suspicion. D) Ask the other nurses and staff members on the unit if they have noticed the same thing.

Ans: C Feedback: For safety reasons and to protect clients, employees should be confronted as soon as possible after chemical impairment is recognized. Delaying could be unsafe for clients. The manager has a responsibility to collect data, but this should not take precedence if the nurse is impaired at this point in time.

19. What consideration should the nurse-manager prioritize when creating a program to deal with the issue of employees with substance use disorders? A) The program should emphasize punishment due to the safety risk posed by impaired employees. B) The program may be unnecessary because state boards of nursing have authority over this issue. C) The program should emphasize screening, prevention, and early intervention. D) For confidentiality reasons, the program should be planned and executed by the personnel department.

Ans: C Feedback: Prevention and early detection should be cornerstones of any substance use disorder program in the workplace. The focus should not be primarily punitive. State boards of nursing have purview over this issue, but this does not mean that organizational programs are unnecessary. Such programs do not need to be limited to the personnel department.

2. How can the nurse-manager best promote the development of self-discipline in employees? A) Eliminate punishment from the unit's culture and procedures. B) Allow employees full autonomy in choosing tasks and the means for carrying out those tasks. C) Clearly communicate expectations, rules, and policies to employees. D) Hire employees who have a history of being compliant and collaborative.

Ans: C Feedback: The highest level and most effective form of discipline is self-discipline. When employees know expectations, rules, policies, and procedures, self-discipline is enhanced. The presence of self-discipline does not wholly eliminate the possibility of punishment. Granting employees full autonomy erodes the sense of structure and boundaries that promotes self-discipline. There is no guarantee that employees who are compliant will possess high levels of self-discipline.

11. What action should the manager take when implementing the second step in the progressive disciplinary process? A) Suspend the employee from work for a specified period of time. B) Explain in detail the nature of the inappropriate behavior. C) Complete a formal written reprimand. D) Verbally instruct the employee not to repeat the infraction.

Ans: C Feedback: The second step in the progressive disciplinary process is for the manager to complete a formal written reprimand signed by the employee and the manager. The second step in the progressive disciplinary process does not involve any of the other options.

28. The nurse-manager has had difficulty improving the performance of a registered nurse who is a marginal employee on the hospital medical unit. The manager no longer wishes to work with the employee and has arranged a transfer to the postsurgical unit of the hospital. What type of transfer has the manager arranged? A) Lateral B) Downward C) Inappropriate D) Accommodating

Ans: C Feedback: Transferring an employee to another department for the sole reason of "getting rid of" the employee is an inappropriate transfer. The manager's motivation makes this an inappropriate, rather than lateral, transfer.

7. The nurse-manager is preparing to terminate an employee for continuous rule breaking. What is the manager's best action? A) Arrange for the employee to be escorted from the building by security staff. B) Collaborate with the employee to work out a 2-week termination period. C) Describe what, if any, references will be supplied to future employers. D) Arrange for a meeting between the employee and senior administration.

Ans: C Feedback: When a manager terminates an employee for continuous rule breaking, the manager should tell the employee what, if any, references will be supplied to future employers. Security should become involved only if there is a plausible security risk. It is usually best to allow the employee who has been dismissed to leave the organization immediately. If the employee continues to work on the unit after dismissal has been discussed, it can be demoralizing for all the employees who work on that unit.

26. The nurse-manager works at a unionized health-care facility and is preparing for a disciplinary conference for an employee with a history of unexcused absences. What activity should the manager prioritize in this conference? A) Promoting rapport with the employee in order to protect their future working relationship B) Requiring the employee to present compelling evidence to prove that he or she is innocent of rule breaking C) Presenting a grievance that summarizes the way that the employee has failed to meet organizational standards D) Presenting objective evidence that demonstrates the employee's deficient performance

Ans: D Feedback: A difference between unionized and nonunionized employee discipline lies in the burden of proof, which typically is the responsibility of the employee without union membership but is the responsibility of the manager of the employee who belongs to a union. Employees file grievances; managers do not. The need to preserve rapport is not prioritized over the need to fairly and directly address the employee's behavior.

10. What event is most likely to result in an employee filing a grievance? A) The manager and employee have a relationship that precedes an episode of discipline. B) An employee knowingly breaks an established rule. C) An employee wants to have an impartial third party impose a solution. D) The employee believes he or she has been disciplines unjustly.

Ans: D Feedback: A grievance is usually motivated by an employee's belief that he or she was dealt with unfairly. The presence or absence of a relationship between the employee and manager is not relevant. Not every episode of rule breaking results in a grievance. Involvement of a third party characterizes arbitration.

20. The nurse-manager oversees an experienced employee who is earnest and pleasant, but who struggles to maintain minimum performance standards. What is the manager's best initial approach to this employee? A) Arrange for the nurse to complete extra continuing education. B) Provide interventions that will increase the nurse's motivation. C) Affirm the nurse's strengths in an effort to encourage excellence. D) Provide coaching that addresses the employee's main deficiencies.

Ans: D Feedback: Coaching is a key approach to helping marginal employees improve. Affirming strengths may bolster confidence with no consequent improvement in performance. There is no evidence that the nurse's deficits are based on a lack of knowledge or motivation, so continuing education and motivational strategies may not be appropriate.

1. A nurse-manager needs to discipline an employee and wants to ensure that it leads to constructive outcomes. What is the primary difference between constructive and destructive discipline? A) The manager is more empathetic to the employee in constructive discipline than in destructive discipline, so that their relationship becomes closer. B) Constructive discipline excludes punishment, but destructive discipline is primarily focused on punishment. C) The person who has received constructive discipline always appreciates it, whereas destructive discipline is always resented. D) Constructive discipline helps the person grow to meet organizational goals; destructive discipline focuses more on punishment.

Ans: D Feedback: Constructive discipline focuses on helping the employee grow. Punishment can be included in constructive discipline, but it is the near-exclusive focus in destructive discipline. The difference between the two is not based on the presence or absence of empathy. Even if properly applied, there is no guarantee that an employee will appreciate constructive discipline.

25. The manager is working with a staff member who has twice arrived late for assigned shifts over the past few weeks. What is the fundamental rationale for conducting a disciplinary conference for this employee? A) This behavior disrupts the efficiency of the nursing team. B) The tardiness is costing the facility money. C) This behavior encourages other staff to disregard rules. D) The problem will get worse if it is ignored.

Ans: D Feedback: Disciplinary problems, if unrecognized or ignored, generally do not go away; they only get worse. The other options are likely outcomes of the staff member's unacceptable behavior but not the fundamental rational for the disciplinary action.

13. A novice nurse-manager admits to feeling nervous about the possibility of disciplining employees. How should the manager be encouraged by superiors to view discipline? A) As a necessary means for controlling an unmotivated and self-centered workforce B) As a "big stick" that management can use to eliminate behavior that conflicts with organizational goals C) As a means of narrowing the power-authority gap D) As a necessary part of fostering excellence in the organization

Ans: D Feedback: Discipline is an occasional, but necessary, part of creating excellence in an organization and growth in employees. It is not simply a tool to narrow the power- authority gap. Managers should adopt a strengths-based view of employees.

18. The nurse-manager is contributing to the plan for the workplace reentry of an employee with a history of substance use disorder. What should be included in the reentry plan? A) The nurse should have a 50% work assignment for the first several months. B) Clients and families should be made aware of the nurse's history. C) Reentry should not occur until the nurse has been chemical-free for at least 18 months. D) The employee should agree to random urine screening.

Ans: D Feedback: Most nurses successfully return to work following a treatment program, and this generally takes 1 year. Often, the conditions that the employee has successfully changed his or her lifestyle and will submit to random drug tests must be met before the employee can be allowed to return to work. Informing clients of the nurse's history would violate the nurse's right to confidentiality. A reduced work assignment is not typically required.

4. The nurse-manager is initiating the process of progressive discipline in response to an employee's tardiness. The manager should: A) write a brief letter of warning to the employee without providing a copy to the personnel department. B) write a brief letter of warning to the employee and send a copy to the personnel department. C) avoid confronting the employee but observe the employee's behavior closely in the near future. D) privately administer a verbal reprimand to the employee.

Ans: D Feedback: The first step of the progressive disciplinary process is an informal reprimand or verbal warning. This reprimand is followed by a formal reprimand or written warning when the behavior has not been changed. Progressive discipline begins with a direct warning, not just further observation.

14. What variable should the nurse-manager prioritize when dealing with employees who break the rules? A) Terminating employment when necessary B) Modelling empathy C) Counseling employees to promote their personal and professional growth D) Ensuring organizational goals are met

Ans: D Feedback: The larger organizational goals are prioritized over the personal interests of individual employees. Modeling empathy is not the main goal when addressing insubordination, and the manager should not adopt the role of counselor. Not all situations would result in termination.

9. The nurse-manager is working in a unionized health-care organization. When administering discipline to employees, the manager should: A) communicate with the union's attorneys rather than directly with employees. B) defer to the organization's personnel department rather than administering discipline directly. C) assist employees with filing grievances. D) follow specific steps and penalties within an established time frame.

Ans: D Feedback: Unionized employees must generally be disciplined according to specific, preestablished steps and penalties within an established time frame. This does not normally mean that the manager must liaise with an attorney or defer to the centralized personnel department. It is not the nurse-manager's responsibility to assist with filing grievances, although he or she must respond to them appropriately.