Chp 21: Discipline and Coaching Techniques

what is punishment?

an undesirable event that follows unacceptable behavior.

disciplinary conference: clarification of expectations for change

describe the expected behavior change; list steps needed to achieve the change and explain the consequences for failure to change.

what is an impaired employee?

employees unable to accomplish their work due to chemical (drugs, alcohol) or psychological disease

what is a marginal employee?

employees who disrupt unit functioning because the quantity or quality or their work consistently meets only minimal standards

disciplinary conference: rationale for disciplinary action

explain the action you are taking and why

disciplinary conference: employee's response to action

give the employee the opportunity to explain; ensures recognition and that your ultimate goal is to be fair.

group norms

group-established standards of expected behavior that are enforced by social pressure. Can either promote self-discipline or make it difficult.

what is self-discipline?

highest level and most effective form of discipline

manager's role in helping the chemically dependent employee

-Don't mistake nurturing for enabling. See that the employee gets help & can become functional again. -Employee may ask the manager to participate actively in their recovery. This must be done with those who have expertise in this field. -Manager can't diagnose the cause of the addiction or to justify its existence. Protecting patients must be top priority. -Manager's role is to identify performance expectations and confront the employee when they aren't met. -Create an environment that decreases chances of chemical impairment (education, policies, reduce stressors)

work reentry guidelines for recovering nurse

-depends on several factors (length of recovery process and the individual) -experts say employee must devote at least 1 year -no psychoactive drug use tolerated -employee should be assigned day shift for the 1st year -should be paired w/ a successful recovering nurse whenever possible -have to consent to random drug testing/alcohol screenings -must give evidence of continued involvement -encourage employee to participate in structured aftercare programs -encourage employee to seek individual counseling/therapy as needed.

Confronting the chemically impaired employee

-first step: occurs before the confrontation process. Gather evidence phase. Manager collects as much hard evidence. -2nd person should validate manager's observations. Manager can examine narcotics records for inconsistencies (if done with the same person) -observe for subtle clues: smell on breath, blood test -if suspected, employee must be removed if they present a potential hazard to patient safety; manager must be unemotional -manager should make arrangements (formal meeting, transportation home) -second phase: direct confrontation. many use defense mechanisms. If employee denies, present evidence. manager must focus on PERFORMANCE DEFICITS and not the cause of the problem. Don't preach, scold, or blame -confront before it escalates too far. -last phase: outlining the organization's plan/expectations for the employee to overcome the dependency. Refer to outside sources, need a written plan and timeline; employee is responsible for correction of work deficiencies.

McGegor's Hot Stove Rules for Fair and Effective Discipline

1. All employees forewarned if they touch hot stove; be aware of punishment and follow the rules. 2. Immediate consequences if touched; discipline administered immediately. 3. Touch the stove again, burned again. Consistency each time rule is broken (immediate consequences). 4. If another person touches, they will get burned; impartial discipline.

Disciplinary strategies for nurse-manager

1. Investigate the situation thoroughly that prompted the employee discipline. Ask lots of questions. 2. Always consult with either a superior or human resources department before dismissing the employee. Most organizations have clear policies about which actions cause grounds for dismissal. 3. Managers should carefully document behavior that occurred and any attempts to counsel the employee. Need to protect self from willful or discriminatory termination.

The disciplinary conference

1. Reason for disciplinary action 2. Employee's response to action 3. Rationale for disciplinary action 4. Clarification of expectations for change. 5. Agreement and acceptance of the plan

The Termination Conference

1. calmly state the reasons for dismissal; be prepared to give examples of behavior 2. explain the employment termination process 3. ask for employee input, listen to the employee, stay focused on facts of the case 4. end meeting on positive note, if possible. Inform employee what, if any references will be supplied to prospective employers; allow employee to leave the organization immediately.

Disciplinary strategies for the nurse-manager

1. investigate the situation thoroughly that prompted the employee discipline. Everything must be questioned. 2. always consult with either a superior or HR department before dismissing an employee. Organization should have clear policies. 3. carefully document the behavior and any attempts to counsel the employee.

Recognizing behavior changes in chemically impaired employees (3 main areas)

1. personality/behavior changes (irritability, isolation, mood swings, forgetfulness, change in appearance) 2. job performance changes (sloppy charting, med errors, complaints from patients, employee dozing off on duty) 3. time and attendance changes (long lunch, excessive sick leave, consistently late, disappears without explanation) *more on pg 447

what are the steps to the disciplinary conference?

1. reason for disciplinary action 2. Employee's response to action 3. Rationale for disciplinary action 4. Clarification of expectations for change 5. Agreement and acceptance of action plan

informal reprimand or verbal admonishment

1st step in progressive discipline. Informal meeting between employee and manager to discuss the broken rule. manager suggest ways to alter behavior. Often all that's needed for behavior modification.

formal reprimand or written admonishment

2nd step. Rule breaking recurs after verbal admonishment. Written warning issued about what's been violated and consequences if not altered.

suspension from work

3rd step in discipline. Manager should remove the employee from their job for a brief time. Gives the employee the opportunity to reflect on the behavior and plan how he might modify the behavior in the future.

Difference between chemically impaired health professionals and other addicts

Chemically impaired nurses and physicians tend to obtain their drugs of choice through legitimate prescriptions that were written for them or diversionary measures on the job vs purchasing them illegally. Greater access to meds and highly experienced at administering meds, they sometimes believe that they can control their own use.

disciplinary conference: reason for disciplinary action

Clearly specify why the employee is being disciplined. Major role to evaluate and suggest appropriate action for improved or acceptable performance

Problem-centered coaching differs from performance deficiency coaching

Problem-centered is less spontaneous

Performance deficiency coaching

Strategy that can be used to create a disciplined work environment.

involuntary termination or dismissal

last step in progressive discipline. Should always be the last resort.

what is substance misuse?

maladaptive patterns of psychoactive substance abuse, with the substance user continuing to use in the face of recurrent occupational, social, psychological or physical problems, and/or dangerous situations.

what is performance deficiency coaching?

manager actively bringing areas of unacceptable behavior or performance to the attention of the employee. The role is less threatening and helps the employee improve their performance over time.

why nurses & managers are slow to recognize and respond to chemically impaired colleagues?

may be less sensitive to behaviors and actions that may signal impairment -profile varies greatly -earliest stages of chemical dependency employee uses substances for pleasure/social, which means usually doesn't occur during work hours -employee develops a tolerance as chemical dependency deepens = need for greater quantities = conscious lifestyle decision = high defense of justifying use of substance -work performance then begins to decline (attendance, judgement, quality, relationships w/ coworkers) -final stage employee continues use & may longer have pleasure or gratification. They are addicted. Personal and professional life is affected; signs may now be seen at work (missing drugs, med errors, mood swings, etc.) -employee must be removed but managers have responsibility to help employee deal with disease

difference between punishment (destructive discipline) and constructive discipline

punishment is usually demotivating and reduces long term productivity. People will do the minimum to avoid punishment. Destructive discipline is often unfair in either the application of rules or in results. Discipline is constructive and assists with growth, teaching, molding. Punishment may be applied but is done in a supportive manner. The punishment is because of the employees actions and not who they are.

what is discipline?

training or molding of the mind or character to bring about desired behaviors. Necessary and positive tool in promoting subordinate growth.

Progressive steps of discipline

verbal admonishment written admonishment suspension dismissal/termination *exception is for the most serious infractions

what is a diversion program

voluntary, confidential program for nurses whose practice may be impaired due to chemical dependency or mental illness. Goal is to protect the public by early identification of impaired nurses and provide them with access to participate in intervention programs/treatments.

what is the disciplinary conference?

when coaching is unsuccessful in modifying problem behavior; manager must make more aggressive steps and use more formal measures. Confront employee with their findings in the form of a conference.