Chapter 25 Flashcards
Exam 4 (Final)
Problem Employees: Rule Breakers, Marginal Employees, and Those with Substance Use Disorder
What must managers be able to distinguish? Why?
Managers must be able to distinguish between employees who need progressive discipline, those who are marginal employees, and those who have substance use disorder so that the employee can be addressed in the most appropriate manner.
Rules #1
How should rules and regulations exist in the organization?
As few rules and regulations as possible should exist in the organization.
Rules #1
What should regularly be happening to rules, regulations and policies within an organization?
All rules, regulations, and policies should be regularly reviewed to see if they should be deleted or modified in some way.
Rules #1
What should you make sure employees know?
Make sure all employees know that rule violations will result in discipline
Rules #2
If a rule or regulation is worth having, how should it be?
If a rule or regulation is worth having, it should be enforced.
Rules #2
What happens when rule breaking is allowed to go unpunished?
When rule breaking is allowed to go unpunished, groups generally adjust to and replicate the low-level performance of the rule breaker.
Rules #2
Who is above rules?
No one is above the rules , it applies to everyone
Rules #2
What happens if you do not discipline an employee who should be disciplined?
Not disciplining an employee who should be disciplined jeopardizes an organization’s morale.
Discipline Versus Punishment
Discipline: What does it involve?
Involves training or molding the mind or character to bring about desired behaviors
Discipline Versus Punishment
Discipline: What is it often considered?
Is often considered a form of punishment but is not quite the same thing as punishment
Discipline Versus Punishment
Punishment: What is it?
An undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change
Constructive Discipline
How does it help the employee?
Helps the employee to grow
Constructive Discipline
How is it carried out?
Is carried out in a supportive, corrective manner
Constructive Discipline
What is the employee reassured about?
Employee is reassured that punishment is given because of actions and not because of who they are as a person
Constructive Discipline
What is the primary focus of this?
Primary focus is to assist employees to be self-directed in meeting organizational goals
Constructive Discipline
Focus is on employee growth; what does this help with?
Focus is employee growth, helps the employee grow to meet organizations goals
Constructive Discipline
What is it not in nature?
It is not punitive in nature.
Destructive Discipline
What is it?
Use of threats and fear to control behavior
Destructive Discipline
When this happens, how is the employee?
Employee always alert to impending penalty or termination
Destructive Discipline
How is it administered?
Arbitrarily administered and either unfair in the application of rules or in the resulting punishment
Self-Discipline
The process by which rules are internalized and become part of the person’s personality
What is the highest and most effective form of discipline? When is it forthcoming?
Highest and most effective form of discipline
is self discipline.
(employees who feel secure, validated and affirmed in their worth self discipline is forthcoming)
Self discipline:
When is self discipline only possible?
Self-discipline is possible only if subordinates know the rules and accept them as valid.
Self discipline:
What do managers need to do with employees?
Mangers need to clearly discuss all written rules and policies with employees
Self discipline:
Organizations need what kind of employees?
Organizations need people who are self disciplined for excellence, not punished into compliance.
McGregor’s (Hot Stove) Rule:
What is it?
The following four elements must be present to make discipline as fair and growth-producing as possible:
McGregor’s (Hot Stove) Rule:
The following four elements must be present to make discipline as fair and growth-producing as possible:
Forewarning
Immediate consequences
Consistency
Impartiality
Several guidelines must be followed if discipline is to be perceived by subordinates as growth producing.
What does this not imply?
This does not imply that subordinates enjoy being disciplined or their discipline should be a regular means of producing employee growth.
If implemented correctly, how should discipline not be?
However, if implemented correctly discipline should not permanently alienate or demoralize subordinates.
McGregor’s (Hot Stove) Rule
Why is it called this?
these rules are called hot stove rules because they can be applied to someone touching a hot stove.
Strategies to Create an Environment of Self-Discipline
How are rules and regulations?
Clearly written and communicated rules and regulations
Strategies to Create an Environment of Self-Discipline
How is the atmosphere?
Atmosphere of mutual trust
Strategies to Create an Environment of Self-Discipline
How should authority be used?
Judicious use of formal authority
Strategies to Create an Environment of Self-Discipline
What should there be identification of?
Employee identification with organizational goals
Progressive Discipline #1
Four Common Steps:
Verbal admonishment
Formal written admonishment
Suspension from work without pay
Dismissal
Progressive Discipline #2
When using progressive discipline, what should happen?
When using progressive discipline, for all but the most serious infractions, the slate should be wiped clean at the conclusion of a predesignated period.
Performance Deficiency Coaching
What do managers do?
Manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with them to establish a short-term plan to correct deficiencies.
Performance Deficiency Coaching
What is it?
Performance deficiency coaching is a strategy to the manager can use to create a disciplined work environment.
Performance Deficiency Coaching
How is this type of coaching?
This type of coaching may be ongoing or program centered.
The Disciplinary Process for Unionized Employees
What does it entail?
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
The Disciplinary Process for Unionized Employees
What must be done?
Follow specific steps and penalties within an established time frame
The Disciplinary Process for Unionized Employees
What happens in disciplinary situations with non unionized employees? How does this differ from union employees?
In disciplinary situations with non unionized employees, the burden of proof typically falls on the employee.
With union employees, the burden of proof for the wrongdoing and the need for subsequent discipline generally falls on management.
The Disciplinary Conference
What should be done? (5 steps)
State the problem clearly.
Ask the employee why there has been no improvement.
Explain the disciplinary action to be taken.
Describe the expected behavioral change.
Get agreement to and acceptance of the plan.
The Disciplinary Conference
How should this be conducted?
All discipline, even in formal admonishments, should be conducted in private.
Termination:
When should termination occur?
Termination should always be the last resort when dealing with poor performance but is necessary for employees who continue to break rules despite repeated warnings.
Termination:
Who is it difficult for? But what are the problems of keeping an employee?
Termination is always difficult for the employee, manager, and unit;
however, the cost in terms of managerial/employee time and unit morale of keeping such an employee is enormous.
The Termination Conference
What should be stated?
- State the facts of the case and the reason for termination.
The Termination Conference
What should be explained?
- Explain the termination process.
The Termination Conference
What should be asked of the employee?
- Ask for the employee’s input and respond calmly and openly.
The Termination Conference
How should the meeting be ended?
- End the meeting on a positive note, if possible.
Termination
When should termination occur? What is it best to do?
Terminate occurs immediately, there is no termination period.
Best to allow employee to leave the organization immediately.
Termination
When should security become involved?
security should become involved ONLY if there is a plausible security risk
Termination
When should addressed with termination?
Address whether references will be supplied for future employers.
Formal Grievance Process #1
What is it?
The grievance procedure is essentially a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed (that they have been disciplined unjustly.)
Formal Grievance Process #1
What do all employees have the right to do?
All employees should have the right to file grievances about disciplinary action that they believe has been arbitrary or unfair in some way.
Formal Grievance Process #2
Where are the steps for making a formal grievance available?
The steps are generally outlined in union contracts or administrative policies.
Formal Grievance Process #2
What does formal grievance typically entail?
It typically entails progressive lodging of complaints up the chain of command.
Formal Grievance Process #2
If differences are not settled in formal grievance process, what happens?
If differences are not settled in formal grievance process, the dispute generally proceeds to arbitration.
Formal Grievance Process #2
What is arbitration?
Arbitration Professional mediator reviews the grievance, and makes a binding decision
Marginal Employees
What do these employees do?
These employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards.
Marginal Employees
How do these employees try to work?
These employees often make tremendous efforts to meet competencies yet usually manage to meet only minimal standards at best.
Marginal Employees
What is not effective for these employees?
Traditional discipline is generally not constructive in modifying their behavior.
Marginal Employees
What do these employees not warrant? How do they contribute to overall organizational efficiency?
Marginal employees usually do not warrant dismissal, but they contribute very little to overall organizational efficiency.
Prevalence of Substance Use Disorder (SUD) in Nursing
What is the rate of SUD in health professionals compared to general public?
The rate of SUD in health professionals is generally acknowledged as mirroring or being slightly greater than that of the general public.
Prevalence of Substance Use Disorder (SUD) in Nursing
The majority of disciplinary actions by licensing boards are related to what?
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.
Prevalence of Substance Use Disorder (SUD) in Nursing
Substance misuse is usually defined as what?
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.
Prevalence of Substance Use Disorder (SUD) in Nursing
What is most costly and emotionally draining for managers?
Nursing administrators may face no management problem more costly or emotionally draining than that of nurses whose practice is impaired by substance use disorder.
Drug Diversion #1
When does it occur?
Occurs when medication is redirected from its intended destination for personal use, sale, or distribution to others
Drug Diversion #1
What does it include?
Includes drug theft and use of tampering (adulteration or substitution)
Drug Diversion #1
Common methods of drug diversion include:
Removing medications of discharged patients
Taking medications from pumps, drips, or discarded vials in sharps containers
Removing larger doses of medication when a smaller dose is available
Not documenting administration or waste of medications
Drug Diversion #1
The risk of diversion to patients is:
The risk of diversion to patients is:
unrelieved pain,
inadequate care from an impaired healthcare worker,
and risk of infection such as hepatitis C from contaminated syringes.
Drug Diversion #2
Common methods of drug diversion include:
Utilizing unnecessary overrides to obtain medications
Stealing medications for personal use from a lockbox or cabinet, never intending to administer them to patients
Theft of home medications
Drug Diversion #2
Common methods of drug diversion include:
What else?
Removal of a medication under a colleague’s sign-in
Diluting a dose with water or saline
Removal of duplicate doses
Substitution of a dose with other medication, water, or saline
Most Commonly Misused Prescription Drugs
Opioid pain relievers, such as Vicodin or OxyContin
Stimulants for treating attention deficit hyperactivity disorder, such as Adderall, Concerta, or Ritalin
Central nervous system depressants for relieving anxiety, such as Valium or Xanax
Alcohol
Most Commonly Misused Prescription Drugs
What is more difficult to prove? Why?
Proving alcohol impairment is often more difficult than detecting drug impairment, as an employee may be able to hide alcoholism more easily than drug addiction.
Most Commonly Misused Prescription Drugs
What is prioritized over other factors when it comes to drug use?
Safety of clients and families is prioritized over other factors
Profile of Impaired Nurse
How does it vary?
May vary greatly
Profile of Impaired Nurse
Typically, behavior changes are seen in the following three areas:
Personality/behavior changes
Job performance changes
Time and attendance changes
Late-Stage Substance Use Disorder #1
How is tolerance to a drug?
Tolerance is developed by the employee to the chemical, and the individual needs the chemical in greater amounts and more often to achieve the same effect.
Late-Stage Substance Use Disorder #1
What does the individual characteristically exhibit?
The individual characteristically exhibits high defensiveness.
Late-Stage Substance Use Disorder #1
How is the employee continually?
The employee must continually use the substance even though they generally no longer gain pleasure from it.
Late-Stage Substance Use Disorder #2
What should the manager not do?
The manager should not assume the role of counselor or treatment provider or feel the need to diagnose the cause of the substance use disorder.
Late-Stage Substance Use Disorder #2
What is the manager’s role?
The manager’s role is to clearly identify performance expectations for the employee and to confront the employee when those expectations are not met.
Confronting the Employee with Substance Use Disorder
If at any time the manager suspects that an employee is impaired and thus presents a potential hazard to patient safety, what must occur?
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 removed from the work environment.
Confronting the Employee with Substance Use Disorder
What should be collected?
Gather as much evidence as possible of employee’s impairment.
Confronting the Employee with Substance Use Disorder
What may be necessary by the manager?
Immediate confrontation is necessary if the manager suspects employee may be impaired and thus poses a risk to clients.
Confronting the Employee with Substance Use Disorder
What should be expected of the employee when confronted? What should manager not do?
Denial of the impairment or use of defense mechanisms should be expected; manager should not nurture or counsel the employee.
Confronting the Employee with Substance Use Disorder
What should the manager outline?
The manager should outline the plan for the employee to overcome chemical impairment.
Confronting the Employee with Substance Use Disorder
As soon as chemical impairment is recognized, what should be done?
Employee should be confronted and removed as soon as possible after chemical impairment is recognized
State Board of Nursing Treatment Programs #1
What is the goal of a diversion program?
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.
State Board of Nursing Treatment Programs #2
What happens if the Board of Nursing finds that an employee’s impairment was well known to other licensees and no report was made?
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.
Reentry Guidelines for the Recovering Nurse
What will not be tolerated?
No psychoactive drug use is tolerated.
Reentry Guidelines for the Recovering Nurse
When should the employee be assigned?
The employee should be assigned to day shift for the first year.
Reentry Guidelines for the Recovering Nurse
Who should the employee be paired with?
The employee should be paired with a successfully recovering nurse whenever possible.
Reentry Guidelines for the Recovering Nurse
What should the employee be willing to do?
The employee should be willing to consent to random urine screening with toxicology or alcohol screens.
Reentry Guidelines for the Recovering Nurse
What must the employee give evidence of?
The employee must give evidence of continuing involvement with support groups such as Alcoholics Anonymous or Narcotics Anonymous. Employees should be encouraged to attend meetings several times each week.
Reentry Guidelines for the Recovering Nurse
What should the employee be encouraged to participate in?
The employee should be encouraged to participate in a structured aftercare program.
Reentry Guidelines for the Recovering Nurse
What should the employee be encouraged to seek as needed?
The employee should be encouraged to seek individual counseling or therapy as needed.
