Leadership Case: Incivility: The Problem with Huddles

A new graduate nurse has successfully completed orientation and has also been successfully oriented to the role of charge nurse. Over the course of several weeks, she has noticed that tasks she has delegated to a long-term, experienced certified nursing assistant (CNA) have not been completed by the end of the shift, leaving her to complete them. Which action by the new charge nurse is best? A. Approach the CNA in private to discuss the tasks that were not completed. B. Write up a counseling form to give to the nurse manager, citing specific tasks that were not completed. C. Continue to complete the tasks that were assigned to the CNA while attempting to build a relationship of trust with the CNA. D. Inform the nurse manager that the CNA has not completed the tasks assigned to her.

A. Approach the CNA in private to discuss the tasks that were not completed.

The nurse overhears two nursing assistants in the breakroom discussing their plans to call in sick to work on an upcoming Friday in order to attend a family party. Which action by the nurse is best? A. Privately ask to speak to them and let them know you overheard their plans and are concerned about the impact on staffing since you will be working that shift. B. Notify the nurse manager of what you have overheard. C. Offer to assist the nursing assistants in finding coverage for their scheduled shift so they will not have to call in sick. D. Do nothing unless they do call in sick to work that day, and then notify the nurse manager of what was overheard.

A. Privately ask to speak to them and let them know you overheard their plans and are concerned about the impact on staffing since you will be working that shift.

Which response by the nurse would be correctly identified by the nurse manager as insubordination? A. You're asking me to ambulate that patient? She hit me yesterday, so sorry, no way! B. This isn't something I think we should be doing, but I'll do it just this once. C. I can do that bed change, but I'm going to have to ask someone else to help me. D. I'm not qualified to perform that procedure. I can't do it.

A. You're asking me to ambulate that patient? She hit me yesterday, so sorry, no way!

Which statement is the most appropriate for a nurse manager to use when counseling an employee about repeated absences for the first time? A. I have to address your frequent absences because our unit policy is that two absences in one month requires a verbal warning. B. I am concerned about your attendance because you have called in sick every Monday for the last few weeks. C. If you can you promise me that you will not call in sick on Mondays anymore, I will not have to give you a written warning. D. If there something going on in your life that is making it difficult for you to work on Mondays, I can work with you to give you that day off.

B. I am concerned about your attendance because you have called in sick every Monday for the last few weeks.

Which action by a nurse can result in disciplinary action by a State Board of Nursing? (Select all that apply.) A. Administration of a prescribed medication from which the client experienced an anaphylactic reaction B. Refusal to care for a pediatric client who has not been immunized C. Release of a client's diagnosis to a neighbor D. Refusal of a nurse to work on Sundays due to religious reasons E. Caring for patients in an intoxicated state

B. Refusal to care for a pediatric client who has not been immunized C. Release of a client's diagnosis to a neighbor E. Caring for patients in an intoxicated state

A nursing student is discussing incivility in a leadership class. Which behaviors or statements, if demonstrated by students, would be considered incivility in a classroom setting? (Select all that apply.) A. Asking the instructor, "You've got to repeat that. I don't understand." B. Rolling eyes when the instructor praises another student for a task done well. C. Stating, "I don't know and I don't care," when asked a question about the assigned reading. D. Telling the instructor, "I've never failed a test before, so it must be your fault for not covering the material better." E. Telling the instructor, "These are awful exam questions. I can't believe someone would actually write them!"

B. Rolling eyes when the instructor praises another student for a task done well. C. Stating, "I don't know and I don't care," when asked a question about the assigned reading. D. Telling the instructor, "I've never failed a test before, so it must be your fault for not covering the material better." E. Telling the instructor, "These are awful exam questions. I can't believe someone would actually write them!"

Which response by the nurse manager is expected when an employee continuously reports late for work? A. You're outta here if you come in late even one more time - no exceptions! B. I've been hearing complaints about you coming into work late. You promised me you were going to fix it. I'm going to have to dock you half a shift's pay, since it happened before. C. Coming in late to work has got to stop. Please schedule an appointment with me so we can sit down and discuss why it's happening and what you can do to correct it. D. Please apologize to your team standing here waiting for you to get to work so they can start on time.

C. Coming in late to work has got to stop. Please schedule an appointment with me so we can sit down and discuss why it's happening and what you can do to correct it.

A new graduate nurse believes that a work schedule developed by the nurse manager is unfair, with more weekend shifts assigned to the new nurse than any of the other nurses. The nurse has mentioned these concerns to the manager several times, but the schedule has not changed. Which is the most appropriate action for the RN to take? A. Wait to address this issue until upcoming schedules are posted, to see if they also have the excessive weekend shifts still assigned. B. Ask another senior nurse to review the work schedule and advise if the work schedule is unfair. C. Ask the Director of Nursing to meet with the nurse manager and the new graduate nurse to resolve this issue. D. Make an appointment to formally discuss this with the nurse manager, bringing previous and current examples of concerning work schedules.

D. Make an appointment to formally discuss this with the nurse manager, bringing previous and current examples of concerning work schedules.

Which statement best defines insubordination? A. The refusal to "float" to another unit because the nurse has not been oriented to that unit. B. The refusal to work additional hours if the nurse is fatigued and is concerned about the ability to deliver safe patient care. C. The refusal to administer a medication order that the nurse feels is unclear or incomplete. D. The refusal to comply with a directive of a superior or manager.

D. The refusal to comply with a directive of a superior or manager.

Which verbal response by the nurse manager is most appropriate when working with an employee whose communication skills are consistently identified as uncivil? A. I'm telling you to take some time off to cool down. When you come back, I will send you to classes on dealing with difficult patients. B. I'm sorry, but your behavior has not changed as you promised me it would. I am going to move you to a different unit. C. I have had numerous complaints about your poor communication style. Even though I haven't mentioned it to you, I am going to have to let you go. D. We need to sit down privately in my office so we can talk about this inappropriate work behavior.

D. We need to sit down privately in my office so we can talk about this inappropriate work behavior.