2907 Quiz 1 (ch 25)

How many nurses struggle with SUD? The Recovery Village (2022) estimates that approximately 10% to 15% of nurses are impaired by or recovering from SUD, including alcohol addiction, a figure commonly found in the literature. Similarly, Taylor (2020) notes that SUD is the principal cause of professional impairment for certified registered nurse anesthetists _____, with _____experiencing addiction to drugs or alcohol. Some researchers, however, suggest the numbers are higher.

(CRNAs) one of every 10

Because nurses with SUD recover at varying rates, predicting how long this process will take is difficult. Many experts believe that impaired employees must devote at least _____ to their recovery without the stresses of _____. Success in reentering the workforce depends on factors such as the extent of the recovery process and individual circumstances.

1 year drug availability, overtime, and shift rotation

The recovery process In the second phase, as denial subsides, the impaired employee begins to see that the addiction is having a negative impact on their life and begins to want to change. Frequently, people in this phase are buoyed with hope and commitment but lack maturity about the struggles they will face. This phase generally lasts for about ______

3 months.

_____ occurs when medication is redirected from its intended destination for personal use, sale, or distribution to others. Thus, it includes drug theft and use of tampering (adulteration or substitution). The risk of diversion to patients is unrelieved pain, inadequate care from impaired health care workers, and risk of infections such as _____ from contaminated syringes (Nyhus, 2021).

Drug diversion hepatitis C

The following steps should be followed in the termination conference: 1. _____The manager must not appear angry or defensive. Although managers may express regret that the outcome is termination of employment, they must not dwell on this or give the employee reason to think that the decision is not final. The manager should be prepared to give examples of the behavior in question. 2. _____. State the date on which employment is terminated as well as the employee's and organization's role in the process. 3. _____ Termination conferences are always tense; raw, spontaneous, emotional reactions are common. Listen to the employee but do not allow yourself to be drawn emotionally into their anger or sorrow. Always stay focused on the facts of the case and attempt to respond without reacting. 4. _____ The manager should inform the employee what, if any, references will be supplied to prospective employers. Finally, 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.

Calmly state the reasons for dismissal. Explain the employment termination process Ask for employee input. Identify any follow-up that will occur.

_____ involves training or molding the mind or character to bring about desired behaviors. Discipline is often considered a form of punishment but is not quite the same thing as punishment. _____ is an undesirable event that follows unacceptable behavior

Discipline Punishment

MCGREGOR'S HOT STOVE RULES FOR FAIR AND EFFECTIVE DISCIPLINE Four elements must be present to make discipline as fair and growth producing as possible:

Forewarning Immediate consequences Consistency Impartiality

The contract language used by unions regarding discipline may be quite specific or quite general. Most contracts recognize the right of management to discipline, suspend, or dismiss employees for just cause. _____ can be defined as having appropriate rationale for the actions taken. For just cause to exist, the manager must be able to prove that the employee violated established rules, that corrective action or penalty was warranted, and that the penalty was appropriate for the offense. These contracts also generally recognize the right of the employee to submit grievances when they believe that these actions have been taken unfairly or are discriminatory in some way.

Just cause

In contrast, discipline can also be a powerful motivator for behavior change because it has an educational component as well as a corrective one. _____seeks to explain to the employee what positive actions the employer is looking for, opting to focus on the wanted behaviors and outcomes instead of the problems. The idea is to provide motivation for employees to improve.

Positive or constructive discipline

_____ are another type of problem employee; however, traditional discipline is generally not constructive in modifying their behavior. This is because marginal employees often make tremendous efforts to meet competencies yet usually manage to meet only minimal standards at best. All organizations have at least a few such employees. Managing these employees then is often a frustrating and tiring task.

Marginal employees

This chapter also focuses on two types of employees with special needs: the marginal employee and the employee with substance use disorder (SUD). _____ are those employees who disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards at best. Employees with _____ use nicotine, alcohol, or other illicit substances to an excess that leads to social, academic, and occupational impairment (Jahan & Burgess, 2022). _____ is not effective in addressing either of these types of employees

Marginal employees SUD Traditional discipline

These _____ generally allow someone to receive a similar salary but with a reduction in energy expenditure. For example, a long-time employee might be given a position as ombudsperson to use their expertise and knowledge of the organization and at the same time assume a status position that is less physically demanding. Finally, there is the _____ Some managers solve unit personnel problems by transferring problem employees to another unsuspecting department. Such transfers are harmful in many ways. They contribute to decreased productivity, are demotivating for all employees, and are especially destructive for the employee who is transferred.

accommodating transfers inappropriate transfer.

Although _____ is the most frequently misused substance, _____ are the three classes of prescription drugs mostly commonly misused (National Institute on Drug Abuse, 2020). _____ may also replace alcohol in the workplace so that the employee may feel a similar effect without having alcohol detectable on their breath. Indeed, nearly 7% of nurses use prescription drugs for nonmedical purposes, a rate higher than the national average

alcohol opioid pain relievers, such as Vicodin or OxyContin; stimulants for treating attention deficit hyperactivity disorder, such as Adderall, Concerta, or Ritalin; and central nervous system depressants for relieving anxiety, such as Valium or Xanax, Barbiturates

if a Board of Nursing finds that an employee's impairment was well known to other licensees and no report was made, the Board may move to also investigate the compliance to the Nurse Practice Act of _____In addition, the American Nurses Association (2015) Code of Ethics (Code 3.6) suggests that the nurse must be vigilant in protecting the public and intervening when a colleague's practice appears to be impaired.

all those who knew but did not come forward to protect the public.

If the differences cannot be settled through a formal grievance process, the matter may finally be resolved in a process known as arbitration. In _____both sides agree on the selection of a _____ who will review the grievance, complete fact finding, and interview witnesses before coming to a decision. Although grievance procedures extract a great deal of time and energy from both employees and managers, they serve several valuable purposes. Grievance procedures can settle some problems before they escalate into even larger ones. The procedures are also a source of data to focus attention on ambiguous contract language for labor-management negotiation later.

arbitration, professional mediator

Another common difference between unionized and nonunionized employees is that most nonunion employees are classified as _____, meaning that they are subject to dismissal "at the will" of the employer. The at-will doctrine, which is applicable in many states, permits an employer to terminate employment for any or no reason and at the discretion of the supervisor. In states that do not subscribe to the employment-at-will doctrine or in organizations that have union representation for employees, employers must have good and legal cause to dismiss an employee.

at-will

Timing and Conference Length All formal disciplinary conferences should be scheduled in advance at a time agreeable to _____Both will want time to reflect on the situation that has occurred. _____ should reduce the situation's emotionalism and promote employee self-discipline because employees often identify their own plan for keeping the behavior from recurring. In addition to privacy and advance scheduling, the length of the disciplinary conference is important. It should not be so long that it degenerates into a debate nor so short that both the employee and the manager cannot provide input. If the employee seems overly emotional or if great discrepancies exist between the manager and the employee's perceptions, an additional conference can be scheduled. Employees often need time to absorb what they have been told and to develop a plan that is not defensive.

both the employee and the manager. Allowing time for reflection

Another difference between unionized and nonunionized employee discipline lies in the _____ 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. This means that managers who discipline union employees must keep detailed records regarding misconduct and counseling attempts.

burden of proof

To protect themselves from charges of willful or discriminatory termination, managers should _____ The accuracy of your documentation can mean the difference between time in the courtroom and a good, clean break from a poor employee. Managers also must be careful not to discuss with one employee the reasons for discharging another employee or to make negative comments about past employees, which may discourage other employees or reduce their trust in the manager.

carefully document the behavior that occurred and any attempts to counsel the employee.

The most time-intensive option in dealing with marginal employees is _____With this strategy, the manager attempts to improve the marginal employee's performance through active coaching and counseling. Although this strategy holds the greatest promise for personal growth in the marginal employee, there is no guarantee that the employee's performance will improve or that the end results will justify the time and energy costs to the manager. The strategy chosen for dealing with the marginal employee often varies with the level of the manager. Ignoring the problem is a passive response and is more frequently used by _____ High-level managers tend to employ the more active measures of _____

coaching. low-level managers. coaching, transferring, and dismissal.

When discipline is _____, it can assist employee growth. In fact, the word discipline comes from the Latin term disciplina, which means teaching, learning, and growing. In constructive discipline, punishment may be applied for improper behavior, but it is carried out in a _____ Employees are reassured that the punishment given is because of their actions and not because of who they are. This can have the effect of improving employee morale, even in the face of needing to improve performance.

constructive supportive and corrective manner.

Closure On ending the disciplinary conference, provide the employee with a _____and place a copy of the documentation in the personnel file. Inform the employee about company policy concerning disciplinary action and the length of time disciplinary action forms remain in an employee's file before they can be removed (Mayhew, 2022).

copy of the disciplinary action

The first step in dealing with the impaired employee actually occurs before the confrontation process. In the _____the manager collects as much hard evidence as possible to document suspicions of SUD in the employee. All behavior, work performance, and time and attendance changes presented in the displays in this chapter should be noted objectively and recorded in writing. If possible, _____ should be asked to validate the manager's observations. In suspected drug addiction, the manager also may examine _____and check to see that the amount of narcotic the nurse signed out for each patient is the same as the amount ordered for that patient.

data- or evidence-gathering phase a second person unit narcotic records for inconsistencies

The recovery process In the first phase, the impaired employee continues to _____ the significance or severity of the SUD but does reduce or suspend substance use to appease family, peers, or managers. These employees hope to reestablish their substance use in the future.

deny

Nurses turn to drugs or alcohol for many reasons. Co-occurring disorders, such as _____ contribute to substance use as do fatigue and stress (Gonzales, 2020). Some nurses are subject to _____contributing to stress and feelings of powerlessness. All these issues place nurses at greater risk. In addition, some nurses believe they are invulnerable; that as caregivers, they can safely self-diagnose and self-medicate. Compounding the problem is that health care providers have relatively easy access to controlled substances and other drugs of abuse.

depression and posttraumatic stress disorder, and genetics workplace bullying and verbal abuse,

When coaching is unsuccessful in modifying problem behavior, the manager must take more aggressive steps and use more formal measures, such as a _____

disciplinary conference.

Another strategy that the manager should use is to always consult with either a supervisor or the Human Resources department before _____Most organizations have very clear policies about which actions constitute grounds for dismissal and how that dismissal should be handled.

dismissing an employee.

Although SUD can impair nurses' physical, psychological, social, and professional functioning, the problem was largely ignored until the late 1970s and early 1980s. Since that time, assistance occurs primarily in the form of _____

diversion programs (also called intervention or peer assistance programs). A diversion program is generally a voluntary, confidential program for nurses whose practice may be impaired due to SUD

Because few nurses drink alcohol while on duty, managers must observe for more subtle clues, such as the smell of alcohol on the employee's breath. If the organization's policy allows for it, the manager may wish to require an employee suspected of SUD to undergo immediate _____. If the employee refuses to cooperate, the organization's policy for documenting and reporting this incident should be followed.

drug or alcohol testing

Another aspect of discipline that may differ between unionized and nonunionized employees is following _____ in disciplining union employees. Due process means that management must provide union employees with a written statement outlining disciplinary charges, the resulting penalty, and the reasons for the penalty. Employees then have the right to defend themselves against such charges and to settle any disagreement through formal grievance hearings.

due process

Because of the general nature of nursing, many managers find themselves wanting to nurture the impaired employee, much as they would any other person who is sick. However, this nurturing can quickly become _____. The employee who already has a greatly diminished sense of self-esteem and a perceived loss of self-control may ask the manager to participate actively in their recovery. This is one of the most difficult aspects of working with the impaired employee. Others who have greater expertise and objectivity should assume this role.

enabling

An organization should, however, have as _____ A leadership role involves regularly reviewing all rules, regulations, and policies to see if they should be discarded or modified in some way. If managers find themselves spending much of their time enforcing one rule, it would be wise to reexamine the rule and consider whether there is something wrong with the rule or how it is communicated.

few rules and regulations as possible.

Clarification of Expectations for Change Present a performance improvement plan to be sure employee expectations for remediation are clear. This plan should include the expected behavioral change as well as the steps needed to achieve this change. Be clear whether the employee and the supervisor share responsibility for improving the employee's work performance (Mayhew, 2022). For example, if the employee's poor performance is based on not having proper training or skills, share what resources will be provided to help the employee improve. Also explain the consequences of failure to change. Again, do not be apologetic or hesitant; otherwise, the employee will be confused about the seriousness of the issue. Because they may lack self-control, employees who have repeatedly broken rules need _____ It must be very clear to the employee that timely follow-up will occur. Finally, it is important to make sure you've been understood. Have the employee _____

firm direction. repeat back to you what you've said, what needs to change, why, by when, and what will happen if the poor performance or the specific behavior continues (Hills, 2021).

1. All employees must be _____that if they touch the hot stove (break a rule), they will be burned (punished or disciplined). They must know the rule beforehand and be aware of the punishment. 2. If the person touches the stove (breaks a rule), there will be _____ (getting burned). All discipline should be administered immediately after rules are broken. 3. If the person touches the stove again, they will again be burned. Therefore, there is _____ each time the rule is broken, there are immediate and consistent consequences. 4. If any other person touches the hot stove, they also will get burned. Discipline must be _____, and everyone must be treated in the same manner when the rule is broken.

forewarned immediate consequences consistency impartial

Employees lack the security to have self-discipline if they do not trust their managers' motives. Finally, for self-discipline to develop, formal authority must be used judiciously. If _____ is quickly and widely used, subordinates do not have the opportunity to invoke self-discipline.

formal discipline

If the employee and management cannot resolve their differences informally, a _____ begins. The steps of the formal grievance process are generally outlined in all union contracts or administrative policy and procedure manuals. In general, these steps include the progressive lodging of formal complaints up the chain of command. If resolution does not occur at any of these levels, a formal hearing is usually held. A group of people is impaneled—much in the same way as a jury—to decide what should be done. Such groups are often at risk for favoring the individual employee over the all-powerful institution. This tendency reinforces the need for the manager to have clear, objective, and comprehensive written records regarding the problem employee's behavior and attempts to counsel.

formal grievance process

Several factors have led state boards to adopt diversion programs. First, a punitive system creates barriers to reporting and keeps impaired nurses from _____ Nurse colleagues or practitioners who suspect a nurse is impaired may well hesitate to report something that _____. In addition, from an employer's standpoint, the fear of litigation often makes it easier to dismiss a nurse without charges of misconduct. But this practice leaves the nurse, who is at risk for self-harm and for harming patients, free to seek work elsewhere. A board investigation can take months to 2 years, during which time the nurse in question may be able to continue working without restraint. Moving to another state will not, however, allow the nurse to avoid disciplinary action, and states typically consider this in granting license reciprocity.

getting help. could cost a nurse their job and license

Growth can only occur when employees perceive that feedback and discipline are fair and just. When employees and managers perceive "fair" and "just" differently, the discrepancy can usually be resolved by a more formal means called a _____ The grievance procedure is essentially a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed. This procedure is not limited to resolving discipline discrepancies; employees can use it any time they believe that they have not been treated fairly by management.

grievance procedure.

Ideally, all employees have adequate self-control and are self-directed in their pursuit of organizational goals. However, this is not always the case. Instead, _____ often influence individual behavior and make self-discipline difficult. The leader, who understands group norms, can work within those norms to mold group behavior. This modification of group norms, in turn, affects individual behavior and thus self-discipline

group norms (group-established standards of expected behavior that are enforced by social pressure)

Constructive discipline uses discipline as a means of helping the employee _____

grow, not as a punitive measure.

when a suspicion is reported, the leader-manager may also choose to follow up with coworkers and obtain separate witness statements from those who interacted with the nurse during the alleged impairment. Additional details may be given regarding the nurse's physical appearance or behaviors indicative of SUD. These witnesses should submit their own statements, either _____, describing their observations as close to the event as possible. If handwritten, the witness statement should be legible, dated, and signed with their name printed on the document. In addition, patients may be interviewed regarding their _____In addition, the leader-manager may want to inspect surrounding areas, such as bathrooms and wastebaskets, where the nurse was at the time and document any abnormal findings.

handwritten or by e-mail pain management and potential receipt of medications, and this information should be compared to the documentation in the medical record.

disciplinary conference Begin by clearly specifying why the employee is being disciplined. Do not bring hearsay or judgments into the conversation or you can find yourself squabbling over details, no matter how big or small (Hills, 2021). Point to data and quantify when you can. In addition, the manager must not be_____ about the need for discipline because the role of the manager includes both the authority and the responsibility for evaluating employee performance and suggesting appropriate action for improved or acceptable performance. Despite this, novice managers, however, often feel uncomfortable with the disciplinary process and may provide unclear or mixed messages to the employee regarding the nature or seriousness of a disciplinary problem.

hesitant or apologetic

impairment in nursing refers to the nurse being unable to perform their professional responsibilities and duties consistent with expected nursing standards. This chapter focuses on nurses who are impaired due to SUD. Nursing administrators may face no management problem more costly or emotionally draining than that of nurses whose practice is _____

impaired by substance use disorder.

Progressive discipline is _____, however, for employees who are impaired due to disease or degree of ability. These employees have special needs that require active coaching, support, and, often, professional counseling to maintain productivity. For employees to be managed most appropriately, managers must be able to distinguish between employees in need of _____

inappropriate discipline and those who are impaired

What are the 4 steps in the progressive discipline process?

informal reprimand or verbal admonishment formal reprimand or written admonishment suspension from work involuntary termination/dismissal

For the employee, return to work usually entails a comprehensive return-to-work agreement or contract with the organization. These_____ outline the terms and conditions under which the nurse can return to work.

last chance agreements (LCAs) Most state [boards] will honor the LCA and allow the nurse to continue to practice if there is compliance with all recommendations."

A _____ describes one staff person moving to another unit, to a position with a similar scope of responsibilities, within the same organization. A _____occurs when someone takes a position within the organization that is below their previous level. It may be in a nurse's interest to consider a downward transfer because it can increase the chances of long-term career success

lateral transfer downward transfer

One common difference, however, between health professionals with SUD and other people with addictions is that health professionals often obtain their drugs of choice through channels such as_____rather than purchasing them illegally on the street. This is because health professionals have greater access to undiverted medications themselves.

legitimate prescriptions that were written for them or diversionary measures on the job

Diversion programs are voluntary and confidential. Besides helping the nurse with recovery, the programs aid the employers and staff in coping with employee substance use. Impaired nurses who refuse participation in diversion programs are subject to disciplinary review by their State Board of Nursing and possible _____Nurse leader-managers should advocate for those who are impaired so that they receive appropriate assistance, treatment, and access to fair institutional and legal processes.

license revocation.

Both the manager and the employee must show goodwill in resolving grievances. This means that both parties must be open to discussing, negotiating, and compromising and must attempt to resolve grievances as soon as possible. The most significant goal of the grievance resolution should _____

not be to win but to seek a resolution that satisfies both the person and the organization.

Mayhew (2022) recommends that in preparing to discipline employees, the manager's first step should be to _____ Determine whether the employee has demonstrated similar behavior in the past, who addressed the previous issues, and how they were resolved. Also be alert for any personal bias you or others may have that is influencing the determination of whether discipline is needed. Hills (2021) concurs, noting if accusers are biased against an employee, a chain of attitudes and actions can be set into motion that unintentionally cause the poor job performance you want to avoid.

obtain the employee's personnel file materials and review the file documents for a better understanding of past performance and workplace behavior.

It is the overuse of _____ however, that has become a leading cause of injury and death due to drug overdose in the United States. The National Institute on Drug Abuse (2021) notes that in 2019, nearly 50,000 people in the United States died from opioid-involved overdoses. In addition, roughly 21% to 29% of patients prescribed opioids for chronic pain misuse them and between 8% and 12% develop an opioid use disorder (National Institute on Drug Abuse, 2021). In addition, over the past few years, the opioid death toll has been exacerbated by other synthetic opioids, most notably illicit _____About 80% of people who use heroin first misused prescription opioids (National Institute on Drug Abuse, 2021). Clearly, the misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare (National Institute on Drug Abuse, 2021).

opioids, fentanyl and heroin.

The last phase of the confrontation process is _____. This plan is like the disciplinary contract in that it is usually written down and clearly outlines the rehabilitative measures that should be undertaken by the employee and consequences if remedial action is not sought. Although the employee is generally referred informally by the manager to outside sources to help deal with the impairment, the employee is responsible for correcting their work deficiencies. Timelines are included in the plan, and the manager and employee must agree on and sign a copy of the contract.

outlining the organization's plan or expectations for the employee in overcoming SUD

In _____ the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with them to establish a plan to correct deficiencies. Because the role of a coach is less threatening than that of an enforcer, the manager becomes a supporter and a helper. Performance deficiency coaching helps employees, over time, to improve their performance to the highest level of which they are capable. As such, the development, use, and mastery of performance deficiency coaching should result in improved performance for all.

performance deficiency coaching

When using progressive discipline in all but the most serious infractions, the slate should be wiped clean at the end of a _____

predesignated period.

unionized employees generally must be disciplined according to specific, _____ within an established time frame. For example, the union contract may be very clear that excessive unexcused absences from work must be disciplined first by a written reprimand, then a 3-day work suspension, and then termination. This type of discipline structure is generally fairer to the employee but allows the manager less flexibility in evaluating each case's extenuating circumstances.

preestablished steps and penalties

All discipline, even informal admonishments, should be conducted in _____

private

What are the steps in a disciplinary conference?

reason for disciplinary action employee's response to disciplinary action rationale for disciplinary action clarification of expectations for change agreement and acceptance of action plan the environment for discipline timing and conference length closure

If at any time the manager suspects that an employee is impaired and thus presents a potential hazard to patient safety, the employee must be immediately _____ The manager should decisively and unemotionally tell the employee that they will not be allowed to return to the work area because of the manager's perception that the employee is impaired. The manager should arrange for the employee to be _____ A formal meeting to discuss this incident should be scheduled within the next _____

removed from the work environment. taken home so that they do not drive while impaired. 24 hours.

Other managers choose to dismiss marginal employees or attempt to talk them into early retirement or resignation. Again, this does little to help the marginal employee succeed. Other managers simply choose to ignore the problem and attempt to "work around" the employee. This is not always possible, however, and the result is frequently _____

resentment from coworkers who must carry the burden of finishing work the marginal employee was unable to accomplish

Self-discipline is possible only if subordinates know the _____

rules and accept them as valid.

This type of direct confrontation between the manager and the employee is the _____ in dealing with the employee suspected of SUD. Although some employees admit their problem when directly confronted, most use defense mechanisms (including denial) because they may not have admitted the problem to themselves. Indeed, individuals with a history of substance use have often become quite good at deception regarding their drug use.

second phase

Organizations need people who are self-disciplined for excellence, not punished into compliance. Indeed, the highest level and most effective form of discipline is _____ When employees feel secure, validated, and affirmed in their essential worth, identity, and integrity, self-discipline is forthcoming.

self-discipline.

Downward transfers also should be considered when nurses are experiencing periods of_____ Self-aware nurses often request such transfers. In some circumstances, the manager may need to intervene and use a downward transfer to alleviate temporarily a nurse's overwhelming stress. Another type of downward transfer may accommodate employees in the later stages of their career. In many cases, valued employees who wish to reduce their career roles may be accommodated by a manager's assistance with locating a suitable position for their talent and stature in the profession.

stress or role overload.

The recovery process During the third phase, the person examines their values and coping skills and works to develop more effective coping skills. Frequently, this is done by aligning themselves with _____ that reinforce a substance-free lifestyle. In this stage, the person realizes how sick they were in the active stage of the disease and is often fraught with feelings of humiliation and shame. In the last phase, people gain self-awareness regarding why they developed SUD, and they develop coping skills that will help them deal more effectively with stressors. As a result of this, self-awareness, self-esteem, and self-respect increase. When this happens, the person can decide consciously whether they wish to or should return to the workplace.

support groups

The goal of a diversion program is to protect the public by early identification of impaired nurses and by providing these nurses access to appropriate intervention programs and treatment services. Public safety is protected by immediate _____, when needed, and by ongoing careful monitoring of the nurse.

suspension of practice

When it is apparent that a progressive disciplinary approach has failed and that the necessary change in behavior has not been achieved, managers often need to terminate the employee. At this point, the disciplinary conference becomes a_____ Although many of the principles are the same, the termination conference differs from a disciplinary conference in that planning for future improvement is eliminated.

termination conference.

Strategies to address the problem of drug diversion include strict adherence to best practices regarding _____ In addition, providers should avoid wide range orders for controlled substances that can _____

the observed wasting of controlled substances and using controlled substances in doses that minimize the need to waste at all. promote waste and be alert for recurrent documentation that suggests a provider is wasting large amounts of narcotics.

Then the manager must _____ A supervisor must investigate all allegations of misconduct even if the misconduct is anonymously reported or initially appears to have no basis. The manager might ask the following questions: Was the rule clear? Did this employee know that they were breaking a rule? Is culture a factor in this rule breaking? Has this employee been involved in a situation like this before? Were they disciplined for this behavior? What was their response to the corrective action? How serious or potentially serious is the current problem or infraction? Who else was involved in the situation? Does this employee have a history of other types of disciplinary problems? What is the quality of this employee's performance in the work setting? Have other employees in the organization also experienced the problem? How were they disciplined? Could there be a problem with the rule or policy? Were there any special circumstances that could have contributed to the problem in this situation? What disciplinary action is suggested by organization policies for this type of offense? Has precedent been established? Will this type of disciplinary action keep the infraction from recurring? The wise

thoroughly investigate the situation that has prompted the employee discipline.

A _____ may be defined as a reassignment to another job within the organization. In a strict business sense, a transfer usually implies similar pay, status, and responsibility. Because of the variety of positions available for nurses in any health care organization, coupled with the lack of sufficient higher-level positions available, two additional terms have come into use: lateral transfer and downward transfer.

transfer

Managers typically try multiple strategies to deal with marginal employees. One common strategy is simply to _____Although some marginal employees may be more successful on one unit than another, more commonly, the problem is simply transferred from one unit to another, and the marginal employee experiences yet another failure

transfer the employee to another department, section, or unit.