LEARNING EXERCISE
25.9
Determining an Appropriate Action When Proof Is Unavailable
Y
ou are the supervisor of a pediatric acute care unit. One of your patients, Joey, is a 5-year-old boy who sustained 30% third-degree burns, which have been grafted and are now healing. He has been a patient in the unit for approximately 2 months. His mother stays with him nearly all the waking hours and generally is supportive of both him and the staff.In the last few weeks, Joey has begun expressing increasing frustration with basic nursing tasks, has frequently been uncooperative, and, in your staff’s opinion, has become very manipulative. His mother is frustrated with Joey’s behavior but believes that it is understandable given the trauma he has experienced.
She has begun working with the staff on a mutually acceptable behavior modification program.
Although you have attempted to assign the same nurses to care for Joey as often as possible, it is not possible today. This lack of continuity is especially frustrating because the night shift has reported frequent tantrums and uncooperative behavior. The nurse whom you have assigned to Joey is Monica. She is a good nurse but has lacked patience in the past with uncooperative patients. During the morning, you are aware that Joey is continuing to act out. Although Monica begins to look more and more harried, she states that she is handling the situation appropriately.
When you return from lunch, Joey’s mother is waiting at your office. She furiously reports that Joey told her that Monica hit him and told him he was “a very bad boy” after his mother had gone to lunch. His mother believes that physical punishment was totally inappropriate, and she wants this nurse to be fired.
She also states that she has contacted Joey’s physician and that he is on his way over.
You call Monica to your office where she emphatically denies all the allegations. Monica states that during the lunch hour, Joey refused to allow her to check his dressings and that she followed the behavior modification plan and discontinued his television privileges. She believes that his accusations further reflect his manipulative behavior. You then approach Joey, who tearfully and emphatically repeats the story that he told to his mother. He is consistent about the details and swears to his mother that he is telling the truth.
None of your staff was within hearing range of Joey’s room at the time of the alleged incident. When Joey’s doctor arrives, he demands that action be taken.
A S S I G N M E N T:
Determine your action. You do not have proof to substantiate either Monica’s or Joey’s story. You believe that Monica is capable of the charges but are reluctant to implement any type of discipline without proof. What factors contribute the most to your decision?
LEARNING EXERCISE
25.10
What Type of Discipline Is Appropriate?
S
usie has been an RN on your medical–surgical unit for 18 months. During that time, she has been competent in terms of her assessment and organizational skills and her skills mastery. Her work habits, however, need improvement. She frequently arrives 5 to 10 minutes late for work and disrupts report when she arrives. She also frequently extends her lunch break 10 minutes beyond the allotted 30 minutes. Her absence rate is twice that of most of your other employees. You have informally counseled Susie about her work habits on numerous past occasions. Last month, you issued a written reprimand about these work deficiencies and placed it in Susie’s personnel file. Susie acknowledged at that time that she needed to work on these areas but that her responsibilities as a single parent were overwhelming at times and that she felt demotivated at work. Every day this week, Susie has arrived 15 minutes late. The staff are complainingabout Susie’s poor attitude and have asked that you take action.
You contemplate what additional action you might take. The next step in progressive discipline would be a suspension without pay. You believe that this action could be supported given the previous attempts to counsel the employee without improvement. You also realize that many of your staff are closely watching your actions to see how you will handle this situation. You also recognize that suspending Susie would leave her with no other means of financial support and that this penalty is somewhat uncommon for the offenses described. In addition, you are unsure if this penalty will make any difference in modifying Susie’s behavior.
A S S I G N M E N T:
Decide what type of discipline, if any, is appropriate for Susie. Support your decision with appropriate rationale. Discuss your actions in terms of the effects on you, Susie, and the department.
LEARNING EXERCISE
25.11
Discipline and Insubordination
Y
ou are the coordinator of a small, specialized respiratory rehabilitation unit. Two other nurses work with you. Because all of the staff are professionals, you have used a very democratic approach to management and leadership. This approach has worked well, and productivity has always been high. The nurses work out schedules so that there are always two nurses on duty during the week, and they take turns covering the weekends, at which time there is only one RN on duty. With this arrangement, it is possible for three nurses to be on duty 1 day during the week, if there is no holiday or other time off scheduled by either of the other two RNs.Several months ago, you told the other RNs that the state licensing board was arriving on Wednesday, October 16, to review the unit. It would, therefore, be necessary for both of them to be on duty because you would be staying with the inspectors all day. You have reminded them several times since that time and checked the schedule just 4 days ago to make sure everything was covered.
Today is Tuesday, October 15, and you are staying late preparing files for the impending inspection.
Suddenly, you notice that one of your staff has changed the schedule in the last day or two and that only one of the RNs is scheduled to work on Wednesday. Alarmed, you phone Mike, the RN who is scheduled to be off. You remind him about the inspection and state that it will be necessary for him to come to work.
He says that he is sorry that he forgot about the inspection but that he has scheduled a 3-day cruise and has paid a large, nonrefundable deposit. After a long talk, it becomes obvious to you that Mike is unwilling to change his plans. You say to him, “Mike, I feel this borders on insubordination. I really need you on the 16th, and I am requesting that you come in. If you do not come to work, I will need to take appropriate action.” Mike replies, “I’m sorry to let you down. Do what you have to do. I need to take this trip, and I will not cancel my plans.”
A S S I G N M E N T:
What action could you take? What action should you take? Outline some alternatives. Assume that it is not possible to float in additional staff because of the specialty expertise required to work in this department. Decide what you should do. Give rationale for your decision. Did ego play a part in your decision?
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