Problem Employees: Chapter 25 for Leadership Test 3

What are 4 common steps in progressive discipline?

1. verbal admonishment 2. formal reprimand or written admonishment 3. suspension from work with or without pay 4. involuntary termination or dismissal

What is involuntary termination or dismissal?

Last resort; many will resign before it gets to this point

With union employees, the burden of proof for the wrongdoing and need for subsequent discipline falls on _________________________

Management

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

Unionized employees generally must be disciplined according to...?

Unionized employees generally must be disciplined according to specific pre established steps and penalties within an established time frame.

What is destructive discipline?

Use of threats and fear to control behavior Employee always alert to impending penalty or termination Arbitrarily administered and either unfair in the application of rules or in the resulting punishment (We have seen this in a lot of movies using threats or fears to control behaviors; it is not acceptable)

What is formal reprimand or written admonishment (written warning)?

Written warning.... Very specific about what has occurred and consequences and plan of action. Both the employee and manager should sign.

Is discipline a form of punishment?

Yes, it is often considered a form of punishment but is not quite the same thing as punishment

Do we need to know that someone is impaired?

You do not need to know that someone is impaired; you must only have a reasonable suspicion that the behavior you are witnessing or has been reported to you does not meet the standards of safe practice.

How would you confront the chemically impaired employee?

Gather as much evidence as possible of employee's impairment Immediate confrontation is necessary if manager suspects employee may be impaired and thus poses a risk to clients The manager should outline the plan for the employee to overcome chemical impairment

What does it mean when union is present?

Generally entails more procedural, legalistic safeguards for administering discipline and a well-defined grievance process for employees who believe that they have been disciplined unfairly (they believe they are not treated well).

What is constructive discipline?

Helps the employee to grow Is carried out in a supportive, corrective manner Employee is reassured that punishment is given because of actions and not because of who he or she is as a person Primary focus is to assist employees to be self-directed in meeting organizational goals

What is chemical impairment?

Impairment resulting from drug or alcohol addiction

Punishment may be applied for improper behavior.... but how is it carried out?

In a supportive and corrective manner

What is verbal admonishment?

Includes an informal meeting between the employee and the manager to discuss the broken rule or performance deficiency. Suggest ways to fix the behavior. *Managers must be impartial - all employees get warned for the same breech (frequently late; tardiness). Discipline must be impartial and everyone must be treated in the same manner when a rule is broken*

What is suspension from work with or without pay?

Suspension may give the employee an opportunity to think about the behavior

What are strategies to create an environment of self-discipline?

*CLEARLY written and communicated rules and regulations* Atmosphere of mutual trust Judicious use of formal authority- can we manage it at this level first? Employee identification with organizational goals- do we identify as the organization goals?

*What happens if disciplinary problems go unrecognized or ignored?*

*Disciplinary problems, if unrecognized or ignored, generally do not go away, they only get worse. Document!*

*What does impartial consequence mean?*

*Everyone must be treated in the same manner when the rule is broken - impartial consequences. Impartial consequences; what happens for nurse A should happen for nurse B.*

*What do we as nurses want to become proficient in?*

*Get proficient at SBAR - situation, background, assessment, & recommendation. Background includes patient's nursing diagnosis, admission date, medical diagnosis, & treatment to date.*

*What do marginal employees disrupt?*

*Marginal employees are those who disrupt functioning because quantity or quality of their work consistently meets minimum standards.*

*Should managers show compassion & apologize when delivering disciplinary action to an employee breaking the rules or always pushing the envelope on the brink of breaking the rules?*

*NO! The manager must not be hesitant or apologetic about the need for discipline because the role of the manager includes authority for managing the environment on the unit. Protecting everyone else on the unit* *-Do not apologize and do not be hesitant*

*What is an example of a rule?*

*Patient confidentiality can be breeched legally only when one provider must share information about a patient so that another provider can assume care (hand-off report).*

*Who is at most risk for bullying?*

*The Novice Nurse*

Likely that at least _____ out or ______ nurses you work with will struggle with a substance use problem.

1 out of 10

What is discipline?

Involves training or molding the mind or character to bring about desired behaviors

When rule breaking is allowed to go unpunished, groups generally do what?

Adjust to and replicate the low-level performance of the rule breaker

What are chemicals most commonly abused by nurses?

Alcohol (most frequently used) Opiates Stimulants (drugs for ADHD) Benzos

When should disciplines be implemented?

All discipline should be administered immediately after rules are broken Each time the rule is broken, there are immediate and consistent consequences

What should happen regularly to rules, regulations, and policies?

All rules, regulations, and policies should be regularly reviewed to see if they should be deleted or modified in some way

Although punishment can have negative consequences..... it can be....

Although punishment can have negative consequences, it can be a powerful motivator for positive change because it has an educational component as well as a corrective one.

What is punishment?

An undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change

Do we want a lot of rules and regulations as possible in an organization or a few?

As few rules and regulations as possible should exist in the organization

What are changes that may be indicative of substance abuse?

Irritability, forgetfulness, social isolation, and/or change in physical appearance.

What is a leaders job?

Be supportive and motivating in the climate and coach

What do we as nurses need to make sure we are doing after taking out our meds for out pt.'s?

Be sure to click the exit icon on the Pyxis or Omnicell. There is risk of abuse or diversion of opiates, stimulants, & benzodiazepine medications.

How do managers meet organizational goals?

By enforcing established rules, policies, and procedures

Where are problem employees?

Everywhere!

These employees often make tremendous efforts to meet...?

Competencies yet usually manage to meet only minimal standard at best

What are defense mechanisms that should be expected when confronting an employee who is chemically impaired?

Denial of the impairment or use of defense mechanisms should be expected; manager should not nurture or counsel the employee

What does the word discipline stem from?

Disciplina which means teaching, learning and growing

In disciplinary situations with non unionized employees, the burden of proof typically falls on the __________________

Employee

What do employees lack if they do not trust their manager's opinoins?

Employees lack the security

What must employees do?

Employees must respect their managers and perceive them as honest and trustworthy.

If a rule or regulation is worth having, it should be ________________

Enforced

What must managers believe?

Managers must believe that employees are capable of and actively seek self-discipline

What must managers do to ensure self-discipline is being done?

Managers must discuss clearly all written rules and policies with subordinates, explain the rationale for the existence of the rules and policies, and encourage questions. Providing an environment for an individual to self discipline themselves on these issues. Ex. is a nurse going to be on time?

These employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards OR Identify what it is that is minimum standard and they make sure they meet this minimum standard... WHAT KIND OF EMPLOYEE IS THIS?

Marginal Employee

What does the profile look like for an impaired nurse?

May vary greatly Typically, behavior changes are seen in the following three areas: 1. Personality/behavior changes 2. Job performance changes 3. Time and attendance changes

The majority of disciplinary actions by licensing boards are related to....?

Misconduct resulting from chemical impairment, including the misappropriation of drugs for personal use and the sale of drugs and drug paraphernalia to support the nurse's addiction.

What is the manager role in controlling subordinates?

Must be able to distinguish between employees who need progressive discipline and those who are chemically impaired, psychologically impaired, or marginal employees so that the employee can be managed in the most appropriate manner.

Can the manager be hesitant and apologetic?

NO!

Do we want to go to the formal authority right away?

NO! Give people the opportunity for self-discipline

Do issues associated with problem employees go away?

No, they do not. They only get worse

What happens if you as the manager don't discipline an employee who should be disciplined?

Not disciplining an employee who should be disciplined jeopardizes an organization's morale

Marginal employees contribute very little to...?

Overall organizational efficiency Usually don't warrant dismissal

What do we want to present as a manager?

Present a PIP (performance improvement plan) being specific, measurable, timed expectations. Present consequences of failure to change. Conducted in PRIVATE. Managers are not to discuss with other employees.

What do problem employees limit?

Productivity

What do we need to do if an employee is having a behavior issue?

Review employee's file..... Has this behavior been documented before? Give the employee an opportunity to explain why the rule was broken

In the disciplinary conference, managers must assume the authority given to them by their __________

Role

What is an example of self discipline?

Self discipline is telling yourself you are going to bed every night at 9:30pm

What are risk factors for nursing?

Staff shortages Rotating shifts Long hours (body is stressed) Bullying (novice nurses get bullied the most) Easy Access (lock up that pixis- you wouldn't want someone who has a tendency to abuse be using your pixis log in to steal meds)

What is the disciplinary conference consist of?

State the problem clearly Ask the employee why there has been no improvement in managing this problem Explain the disciplinary action to be taken Describe the expected behavioral change Get agreement to and acceptance of the plan

What happens if formal discipline is quickly and widely used?

Subordinates do not have the opportunity to invoke self-discipline.

What is the definition of substance misuse?

Substance misuse is usually defined as maladaptive patterns of psychoactive substance abuse indicated by continued use even when faced with recurrent occupational, social, psychological, or physical problems as well as use in dangerous situations

What is McGregor's (Hot stove rule)?

The following four elements must be present to make discipline as fair and growth-producing as possible: 1. Forewarning: let someone know they are on shaky grounds 2. Immediate Consequences 3. Consistency: unfair if a parent isn't consistent with all of their kids 4. *Impartiality: what happens for Nurse A should happen for Nurse B*

What is self discipline?

The process by which rules are internalized and become part of the person's personality *Highest and most effective form of discipline*= self discipline Self-discipline is possible only if subordinates know the rules and accept them as valid

What must employees know?

The rule beforehand and be aware of the punishment

What can problem employees be a threat to?

The work environment

What is a marginal employee?

Their quantity or quality of work consistently meets minimal standards (they do just enough).

Is traditional discipline enough for marginal employees?

Traditional discipline is generally not constructive in modifying their behavior

What can discipline be defined as?

Training, educating or molding into their role