Performance Appraisal and Managing Employee Problems Flashcards
1
Q
Performance Apprasial
A
Work performance review where actual performance, NOT INTENT, is evaluated
Different from merit rating, performance evaluation, service rating, competency assessment, effectiveness reports as it implies an appraisal of how well employees perform the duties of their job as delineated by the job description or some other prespecified criteria
2
Q
Factors influence effective performance appraisal
A
Appraisal should be based on a standard.
The appraisal tool must adequately and accurately assess job performance.
Employee should have input into development of the standard.
Employee must know the standard in advance.
Employee must know the sources of data gathered for the appraisal.
Appraiser should be someone who has observed the employee’s work.
Appraiser should be someone who the employee trusts and respects.
Employer support and clarity of expectations are critical to the employee perceiving the appraisal as fair.
3
Q
What makes an employee view an appraisal as more relevant
A
if they believe their appraisal is based on job description rather than whether the manager approves of them personally.
They also view it more positively when it is perceived as fair and accurate
4
Q
What should the goal of performance appraisals be and not be
A
Not Be: To satisfy requirements of the organization - thats a waste of time
Do Be: involving ongoing communication, setting achievable goals with clear expectations and having a plan of action for the next period
Can provide opportunity to document specific criteria for salary increases promotions or disciplinary action
5
Q
A performance appraisal is a waste of time if…
A
it is merely an excuse to satisfy regulations and the goal is not employee growth
6
Q
Strategies for the Manager to make a More Fair and Accurate Performance Appraisal
A
- Appraiser should develop an awareness of his or her own biases and prejudices
- Consultation should be sought frequently
- Data should be gathered appropriately
- Accurate record keeping is another critical part of ensuring accuracy and fairness in the performance appraisal - notes avoid the recency effect and recording pos/neg things during the period is critical incident recording
- Collected assessments should contain positive examples of growth and achievement and areas where development is needed
- Some effort must be made to include the employees own appraisal of his or her work
- The appraiser needs to guard against three common pitfalls of assessment: Halo, Horns, and Central Tendency effects
- Reviewers need to guard against the biased Matthew Effect
- Performance appraisals should always include asking the employee how the organization or manager can make work easier to achieve better quality, greater volume, and improved outcomes
7
Q
When ongoing anecdotal notes are not maintained during the evaluation period…
A
the appraiser is more apt to experience the recency effect, where recent issues are weighed more heavily than past performance
8
Q
Halo Effect
A
When appraiser lets 1 or 2 positive aspects of the assessment or behavior of the employee unduly influence all other aspects of the employees performance
9
Q
Horns Effect
A
When appraiser lets some negative aspects of the employees performance to influence the assessment to such an extent that other levels of job performance are not accurately recorded
10
Q
Central Tendency Trap
A
Manager hesitant to risk true assessment and therefore rates all employees as average
11
Q
Matthew Effect
A
“The rich get richer and the poor get poorer”
Occurs when employees receive the same appraisal year after year - so those who performed well early in their employment are likely to do well and those that struggled will continue to struggle
So, no matter how hard an employee works to improve, his or her past appraisals prejudice any chance for future improvement
12
Q
Management Strategies for Successful Performance Appraisals
A
Develop self-awareness regarding own biases and prejudices.
Use appropriate consultation.
Gather data adequately over time.
Keep accurate anecdotal records for the length of the appraisal period.
Collect positive data and identify areas where improvement is needed.
Include employee’s own appraisal of his or her performance.
Guard against the halo effect, horns effect, central tendency trap, and Matthew effect.
Ask the employee how the organization or the manager can help the employee be successful.
13
Q
Competence Assessment
A
evaluates skill and knowledge
14
Q
Performance Evaluation
A
evaluates execution of a task or tasks
15
Q
How do competence assessments and performance evaluations differ
A
a competence assessment evaluates whether and individual has the knowledge, education, skills, or experience to perform the task, whereas performance evaluation examines how well that individual actually completes that task
16
Q
Trait Rating Scale
A
method of rating a person against a set standard, which may be the job description, desired behaviors, or personal traits
Rating scales however are subject to horn, halo, central tendency effects and are used less in modern day
Think the 1 to 5 rating scale for criteria for papers we write
17
Q
Job Dimension Scales
A
Require that a rating scale be constructed for each job classification - they share some trait scale weaknesses but focus on job requirements rather than on ambiguous terms like “quantity of work”
a more specific trait scale rating something like 1-5 on specific actions for that specific job
18
Q
Behaviorally Anchored Rating Scales
A
BARS
Overcome some weaknesses inherent in other rating systems
Uses a separate rating form for every job class but then many specific examples ranked 1-9 are used, but the highest ranked example of a job dimension being met is less important than a lower ranked example that is not
Disadvantage - time and expense - also only uses physically observable skills rather than conceptual skills
19
Q
Checklist Appraisal tools
A
ex: Weighted Scale
composed of behavioral statements that represent job behaviors that are desirable
each behavior has a score attached to it that’s weighted
total score can determine pay increases
20
Q
Forced Checklist
A
requires supervisor to select an undesirable and a desirable behavior for each employee with quantitative values attached
21
Q
Simple Checklist
A
Comprises numerous words or phrases describing various employee behaviors or traits and are clustered for different aspects of one behavior like assertiveness or interpersonal skills
22
Q
Weakness of Checklists
A
there are no set performance standards
specific components of behavior are not addressed.
23
Q
Essay Appraisal Method (Free Form Review)
A
Appraiser describes in narrative form strengths and weaknesses where improvement and growth is needed
can be unstructured but usually calls for certain items to be addressed
greater opportunity for personal bias exists!!!`
24
Q
Self Appraisals
A
Not easy
many do not see point in it
important part of reflective practice where it is a form of problem solving that is used to resolve issues in a practical context
by being specific about scope of success, involvement in work related activities, and by avoiding soft terms like great, good, and a lot the manager can better assess accuracy of self appraisal
allows employees to be proactive of development areas
25
Some employees look on their annual performance review as an opportunity for what
to receive positive feedback from their supervisor, especially if the employee receives infrequent praise on a day to day basis
26
Management by Objectives (MBO)
tool for determining an individual employees progress because it incorporates both the employees assessments and the organization
instead of assuming traits, it concentrates on actual outcomes
advantage: creates a vested interest in the employee to accomplish goals because employees are able to set their own goals - also defensive feelings are minimized and a spirit of teamwork prevails
disadvantage: highly directive and authoritarian managers have trouble leading this way - marginal employee frequently attempts to set easy goals - objectives can hinder innovation - collaboration is needed
27
What are some steps that delineate how MBO can be effectively used in performance appraisal
1. The employee and supervisor meet and agree on the principal duties and responsibilities of the employee’s job.
2. The employee sets short-term goals and target dates in cooperation with the supervisor or manager, and the manager guides the process so that it relates to the position’s duties. --- human beings tend to lack the skills needed to do their own “reality checking.” Nor are these skills easily conveyed by training.
3. It is important that the subordinate’s goals not conflict with the goals of the organization.
4. Both parties agree on the criteria that will be used for measuring and evaluating the accomplishment of goals.
5. Regularly, but more than once a year, the employee and supervisor meet to discuss progress
6. Some modifications can be made to the original goals if both parties agree.
7. The manager’s role is supportive, assisting the employee to reach goals by coaching and counseling.
8. During the appraisal process, the manager determines whether the employee has met the goals.
9. The entire process focuses on outcomes and results and not on personal traits.
28
Peer Review
When peers rather than supervisors carry out monitoring and assessing work performance
closely related to maintaining professional standards
29
Healthcare is slow to adopt peer review for what reasons
1. Staff are often poorly oriented to the peer review method and many first-level managers, including team leaders, have had little training on how to conduct a growth-producing performance appraisal.
2. Peer review is viewed as very threatening when inadequate time is spent orienting employees to the process and when necessary support is not provided throughout the process.
3. Peers often feel uncomfortable sharing feedback with people with whom they work closely. To avoid potential conflict, they omit needed suggestions for improving the employee’s performance. Thus, the review becomes more advocacy than evaluation.
4. Peer review is viewed by many as more time-consuming than traditional superior–subordinate performance appraisals.
5. Because much socialization takes place in the workplace, friendships often result in inflated evaluations, or interpersonal conflict may result in unfair appraisals.
6. Because peer review shifts the authority away from management, the insecure manager may feel threatened.
30
If peer review is to succeed, the organization must...
overcome its inherent difficulties by doing the following:
Peer review appraisal tools must reflect standards to be measured, such as the job description.
Staff must receive a thorough orientation to the process before its implementation. The role of the manager should be clearly defined.
Ongoing support, resources, and information must be made available to the staff during the process.
Data for peer review must be obtained from Predetermined sources, such as observations, charts, and patient care plans.
A decision must be made about whether anonymous feedback will be allowed. This is controversial and needs to be addressed in the procedure.
Decisions must be reached on whether the peer review will affect personnel decisions and, if so, in what manner.
31
Benefit of Peer Review
Can improve accuracy of performance appraisal
can provide many opportunities for increased professionalism and learning
32
Define Trait Rating Scales
rates an individual against some standard
33
Define Job Dimension Scales
rates the performance on job requirements
34
Define Behaviorally Anchored rating Scales
rates desired job expectations on a scale of importance to the posituion
35
Define Checklists
rates the performance against a set list of desirable job behaviors
36
Define Essays
a narrative appraisal of job performance
37
Define Self Appraisals
an appraisal of performance by the employee
38
Define Management by Objectives
employee and management agree on goals of performance to be reached
39
Define Peer Review
Assessment of Work performance carried out by peers
40
360 Degree Evaluation
includes an assessment by all individuals within the sphere of influence of the individual being appraised
biggest challenge is the concerns of confidentiality
41
The greatest tool for a manager for changing employee behavior
Feedback
42
Things to do Before the interview for overcoming appraisal interview difficulties
Make sure that the conditions mentioned previously have been met (e.g., the employee knows the standard by which his or her work will be evaluated), and he or she has a copy of the appraisal form.
Select an appropriate time for the appraisal conference. Do not choose a time when the employee has just had a traumatic personal event or is too busy at work to take the time needed for a meaningful conference.
Give the employee 2 to 3 days of advance notice of the scheduled appraisal conference so that he or she can prepare mentally and emotionally for the interview.
Be prepared mentally and emotionally for the conference yourself. If something should happen to interfere with your readiness for the interview, it should be canceled and rescheduled.
Schedule uninterrupted appraisal time. Hold the appraisal in a private, quiet, and comfortable place. Forward your telephone calls to another line and ask another manager to answer any pages that you may have during the performance appraisal.
Plan a seating arrangement that reflects collegiality rather than power. Having the person seated across a large desk from the appraiser denotes a power–status position; placing the chairs side by side denotes collegiality.
43
Things to do During the interview for overcoming appraisal interview difficulties
Greet the employee warmly, showing that the manager and the organization have a sincere interest in his or her growth.
image Begin the conference on a pleasant, informal note.
Conduct the conference in a nondirective and participatory manner. Input from the employee should be solicited throughout the interview; however, the manager must recognize that employees from some cultures may be hesitant to provide this type of input. In this situation, the manager must continually reassure the employee that such input is not only acceptable but also desired.
Ask the employee to comment on his or her progress since the last performance appraisal.
Although it’s important to be as positive as possible, it’s also essential to be honest (Team MyHub, 2018). If an employee is not performing well in an aspect of their job, you must tell them so; however, be constructive and identify specific ways that they can turn things around. Seek a balance of positives and negatives whenever possible.
Avoid surprises in the appraisal conference. The effective leader coaches and communicates informally with staff on a continual basis, so there should be little new information at an appraisal conference.
When dealing with an employee who has several problems—either new or long-standing—do not overwhelm him or her at the conference with excessive criticism. If there are too many problems to be addressed, select the major ones.
Use positive encouragement and affirmation as much as possible during the appraisal interview because they are crucial to improving worker performance. “Billikopf calls these ‘good-will deposits,’ and says without them, ‘withdrawals cannot be made’” (Kerr, 2019).
Listen carefully to what the employee has to say and give him or her your full attention.
Focus on the employee’s performance and not on his or her personal characteristics.
Avoid vague generalities, either positive or negative, such as “your skills need a little work” or “your performance is fine.” Be prepared with explicit performance examples. Be liberal in the positive examples of employee performance; use examples of poor performance sparingly. Use several examples only if the employee has difficulty with self-awareness and requests specific instances of a problem area.
When delivering performance feedback, be straightforward and state concerns directly so as not to retard communication or cloud the message.
Never threaten, intimidate, or use status in any manner. Differences in power and status interfere with the ability of professionals to form meaningful and constructive relationships. This is not to say that managers should not maintain an appropriate authority–power gap with their employees; it simply suggests that power and status issues should be minimized as much as possible so that the performance appraisal can appropriately focus on the subordinate’s performance and needs.
Let the employee know that the organization and the manager are aware of his or her uniqueness, special interests, and valuable contributions to the unit. Remember that all employees make some special contribution to the workplace.
Make every effort to ensure that there are no interruptions during the conference. It is important employees feel as though they are being listened to and their views matter (Team MyHub, 2018).
Use terms and language that are clearly understood and carry the same meaning for both parties. Avoid words that have a negative connotation. Do not talk down to employees or use language that is inappropriate for their level of education.
Mutually set realistic and achievable goals for further growth or improvement in the employee’s performance. Vague or unachievable goals are counterproductive (Team MyHub, 2018). Decide how goals will be accomplished and evaluated and what support is needed. Make sure it is clear how you as the manager and the organization can support the employee to achieve their personal development and career goals (Team MyHub, 2018).
Use coaching techniques throughout the conference.
Plan on being available for employees to return retrospectively to discuss the appraisal review further. There is frequently a need for the employee to return for elaboration if the conference did not go well or if the employee was given unexpected new information. This is especially true for the new employee.
44
Things to do After the interview for overcoming appraisal interview difficulties
Both the manager and the employee need to sign the appraisal form to document that the conference was held and that the employee received the appraisal information. This does not mean that the employee is agreeing to the information in the appraisal; it merely means that the employee has read the appraisal. An example of such a form is shown in Figure 24.1. There should be a place for comments by both the manager and the employee.
End the interview on a pleasant note.
Document the goals for further development that have been agreed on by both parties. The documentation should include target dates for accomplishment, support needed, and when goals are to be reviewed. This documentation is often part of the appraisal form.
If the interview reveals specific long-term coaching needs, the manager should develop a method of follow-up to ensure that such coaching takes place.
45
Performance MANAGEMENT
potential replacement for appraisals where they are eliminated and the manager places his/her efforts in ongoing coaching, mutual goal setting, and the leadership training of subordinates - requires the manager to spend more regularly scheduled face to face time with subordinates
46
Coaching
transfer of skills and knowledge by a coach to achieve agreed on outcomes
conveys the spirit of leaders and managers roles in informal day to day performance appraisals which promote improved work performance and team building
can lead to increased competence, commitment, and confidence and help employees anticipate options for making vitla connections between present and future plans
47
What is one of the best methods for improving work performance and building a team approach
day to day feedback regarding performance (coaching)
48
Coaching does not replace...
the need for self motivation on the part of the employee
49
What tactics assist managers in becoming more effective coaches
Be specific, not general, in describing behavior that needs improvement.
Be descriptive, not evaluative, when describing what was wrong with the work performance.
Be certain that the feedback is not self-serving but meets the needs of the employee.
Direct the feedback toward behavior that can be changed.
Use sensitivity in timing the feedback.
Make sure that the employee has clearly understood the feedback and that the employee’s communication has also been clearly heard.
50
What do the subordinates, leaders, and managers each do to create a productive work environment
subordinates use self control
managers enforce rules, policies, and procedures
leaders create a supportive and motivating climate and by coaching
51
Not disciplining an employee that should be disciplined does what
jeopardizes and organizations morale
52
Marginal Employees
employees that disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards at best
53
Impaired Employees
those who are unable to accomplish their work at the expected level as a result of chemical or psychological disease
54
Alongside chemical impairment, what else is a significant issue for employees
psychological impairment
55
Discipline
involves training or molding the mind or character to bring about desired characters
56
Is Discipline also punishment?
No, it may be considered that but it is not the same. Punishment is an undesirable event that follows unacceptable behavior
Discipline molds the person and punishment is shown not to work on people as it just helps them learn to comply rather than commit with vision
57
Positive/Constructive Discipline
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
want to provide motivation for employees to improve (carrot rather than the stick)
constructive - assist employee growth
58
How is punishment used in constructive discipline
it can be used and applied for improper behavior but it is carried out in a supportive and corrective manner and employees are reassured that the punishment given is because of their actions and not because of who they are
59
Constructive discipline uses discipline as...
a means of helping the employee grow, not as a punitive measure
60
Self Discipline also requires...
an atmosphere of mutual trust and formal authority used judiciously
61
What are "Hot Stove Rules"
4 rules to make discipline as fair and growth producing as possible
called thus because they can be applied to someone touching a hot stove
62
What are the 4 Hot Stove Rules
1. Forewarning
2. Immediate Consequences
3. Consistence
4. Impartiality
63
What is the rule of Forewarning
all employees must be forewarned 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
64
What is the rule of Immediate Consequences
If the person touches the stove (breaks a rule) there will be immediate consequences (getting burned)
all discipline should be administered immediately after rules are broken
65
What is the rule of Consistency
If the person touches the stove again, he or she will again be burned
therefore, there is consistency; each time the rule is broken there are immediate and consistent consequences
66
What is the rule of impartiality
If any other person touches the hot stove, they will also get burned
discipline must be impartial, and everyone must be treated in the same manner when a rule is broken
67
Are the 4 Hot Stove Rules always used to enforce rule breaking
not necessarily
for instance, people speed - they know the laws and see signs so forewarning is present - but there may be no immediacy, consistency, or impartiality
Some people exceed speed limits for a long time before punishment or maybe not at all etc
68
Discipline is generally done in a ___ way, except in limited circumstances, giving employees the opportunity to correct problems
progressive
69
Action must be taken when an employee...
continues undesirable conduct, either by breaking rules or by not performing their job duties adequately
70
Steps of Progressive Disciplinary Process
1. Informal reprimand or verbal admonishment
2. Formal reprimand or written admonishment
3. Suspension from work, with or without pay
4. Involuntary termination or dismissal
71
On a written admonishment/formal reprimand the employee's signature...
does not imply that the employee agrees with everything on the report, only that it has been discussed
72
Does progressive discipline apply to every infraction?
No, depending on what you did you could skip steps
73
When using progressive discipline in all, but the most serious infractions, ...
the slate should be wiped clean at the end of a predesignated period
74
What is progressive discipline like for gross mistreatment of a patient
Immediate Dismissal
75
What is progressive discipline like for discourtesy of a patient
1st time = Verbal --> Written --> Suspension --> 4th time = Dismissal
76
What is progressive discipline like for insubordination
1st: Written --> Suspension --> 3rd: Dismissal
77
What is progressive discipline like for use of intoxicants while on duty
Immediate Dismissal
78
What is progressive discipline like for neglect of duty
1st: Verbal --> Written --> Suspension --> 4th: Dismissal
79
What is progressive discipline like for theft or willful damage of property
1st: Written --> 2nd Dismissal
80
What is progressive discipline like for falsehood
verbal --> written --> Dismissal
81
What is progressive discipline like for unauthorized absence
verbal --> written --> Dismissal
82
What is progressive discipline like for abuse of leave
verbal --> written --> suspension --> Dismissal
83
What is progressive discipline like for violation of safety rules
written --> suspension --> dismissal
84
What is progressive discipline like for inability to maintain work standards
written --> suspension --> dismissal
85
What is progressive discipline like for excessive unexcused tardiness
verbal --> written --> suspension
86
Disciplinary problems if unrecognized or ignored...
generally do not go away, they only get worse
87
Performance Deficiency Coaching / Ongoing Coaching
a strategy to create a disciplined work environment
More spontaneous and needs less managerial planning than problem centered coaching
the manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a plan to correct deficiencies
88
How does discipline differ for unionized versus nonunionized employees
Managers of nonunionized employees has a greater latitude in selective which disciplinary measure is appropriate for a specific interaction - gives more flexibility in discipline --- but a unionized employee is covered by collective bargaining agreements for punishment and notification
Unionized employees get due process - written statement outlining disciplinary charges and they have the right to defend themselves
Employees without union membership have burden of proof - opposite for unionized ones
non-unionized employees are "at will"
89
Steps for a Disciplinary Conference
Here the manager assumes the authority given to them by their role and follow these steps/actions:
Given Reason for Disciplinary Actions
See employee's response to disciplinary action
give rationale for disciplinary action
given clarification of expectations for change and present a performance improvement plan
agreement and acceptance of action plan
give a private environment for any discipline even informal admonishment
schedule in advance good for both manager and employee and keep conference length appropriate
proper meeting closure
90
Termination Conference
A disciplinary conference where it has become apparent that a progressive disciplinary approach that has failed and that the necessary change in behavior has not been achieved, managers often need to terminate the employee
91
4 Steps for Termination Conference
1. Calmly state the reason for dismissal
2. Explain the employment termination process
3. Ask for employee input
4. End the meeting on a positive note, if possible
92
Grievance Procedures
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 disciplining discrepancies
employees can user it any time they believe that they have not been treated fairly by management
93
If the employee and management cannot resolve their differences....
then a formal grievance process begins
94
Arbitration
Final process done if differences cannot be settled after a formal grievance process
Both sides agree on selection of a PROFESSIONAL MEDIATOR who will review the grievance, complete fact finding, and interview witnesses before coming to a decision
95
What are the important valuable purposes of the grievance procedures despite it extracting a great deal of time and energy from both employees and managers
1. Can settle some problems before they escalate into even larger ones
2. also act as a source of data to focus attention on ambiguous contract language for labor management negotiation later
3. Most important - the legitimate opportunity that it provides for employees to resolve conflicts with their superiors
96
Transfer
reassignment to another job within the organization
can be lateral or downward, accommodating or inappropriate
97
Lateral Transfer
describes one staff person moving to another unit, to a position with a similar scope of responsibilities within the same organization
98
Downward Transfer
Occurs when someone takes a position within the organization that is below his or her previous level - may be considered for long term career success
99
Managers often assist employees who desire reduced/different role in their careers ...
to locate a position that will use their talents and still allow them a degree of status
100
Accommodating Transfers
generally allows someone to receive a similar salary but with a reduction in energy expenditure
a long time employee may be given this for less physical demand
101
Inappropriate Transfer
Transfers used to solve personnel problems for managers by moving them into an unsuspecting department
harmful transfer and contribute to decreased productivity
102
It is not uncommon for an employee to struggle in one department yet...
improve performance in a new department or unit
103
Do marginal employees warrant dismissal?
No but they contribute very little to overall organizational efficiency
104
Impaired Registered Nurse
defined as a licensee who is unable to practice with professional skill and safety by reason of habitual or excessive use or abuse of drugs, alcohol, or other substances that impair ability or by reason of a mental disorder or physical ability
105
About how many nurses may be impaired or in recovery from alcohol or drug addiction
1 in 10 or 10-15% of all nurses
106
Diversion
when nurses take drugs designated for patient use
107
How do chemically impaired health professionals differ from other addicts
Chem impaired nurses and physicians tend to obtain their drugs of choice through channels such as legitimate prescriptions that were written for them or diversionary measures on the job rather than purchasing them illegally on the street
108
While alcohol is most frequently abused substance, what are the 3 classes of prescription drugs most commonly misused by RNs
1. Opioid Pain Relievers - Vicodin/OxyContin
2. Stimulants (for treating things like ADHD) - Adderall, Concerta, Ritalin
3. CNS Depressants - for relieving anxiety - Valium, Xanax
109
What may replace alcohol in the workplace and why?
Barbiturates
So the employee can get a similar effect without having ROH detectable on their breath
110
What is the leading cause of injury and death due to drug overdose in the US
Overuse of opioids
111
Do you need to know if someone is impaired to report them for impairment?
No you just need to have REASONABLE SUSPICION that the behavior you are witnessing or has been reported to you does not meet the standards of safe practice
112
Can a non-impaired nurse get in trouble for an impaired nurses action
Potentially yes, if the Board of Nursing finds that the impairment was well known to others with no report being made they may investigate everyone's nurse practice act compliance
113
Changes in Personality/Behaviors of a Chemically Impaired Employee
Increased irritability with patients and colleagues, often followed by extreme calm
Social isolation; eats alone, avoids unit social functions
Extreme and rapid mood swings
Euphoric recall of events or elaborate excuses for behaviors
Unusually strong interest in narcotics or the narcotic cabinet
Sudden dramatic change in personal grooming or any other area
Forgetfulness ranging from simple short-term memory loss to blackouts
Change in physical appearance, which may include weight loss, flushed face, red or bleary eyes, unsteady gait, slurred speech, tremors, restlessness, diaphoresis, bruises and cigarette burns, jaundice, and ascites
Extreme defensiveness regarding medication errors
114
Changes in Job Performance of a Chemically Impaired Employee
Difficulty meeting schedules and deadlines
Illogical or sloppy charting
High frequency of medication errors or errors in judgment affecting patient care
Frequently volunteers to be medication nurse
Has a high number of assigned patients who complain that their pain medication is ineffective in relieving their pain
Consistently meeting work performance requirements at minimal levels or doing the minimum amount of work necessary
Judgment errors
Sleeping or dozing on duty
Complaints from other staff members about the quality and quantity of the employee’s work
Disappears from the work area for long periods of time or may spend long periods of time in the bathroom or around the medication cart
115
Changes in Attendance and Use of Tie of a Chemically Impaired Employee
Increasingly absent from work without adequate explanation or notification; most frequent absence on a Monday or Friday
Long lunch hours
Excessive use of sick leave or requests for sick leave after days off
Frequent calling in to request compensatory time
Arriving at work early or staying late for no apparent reason
Consistent lateness
Frequent disappearances from the unit without explanation
116
Stages of Chemical Dependency
1. Early - employees use the addictive substance primarily for pleasure and although the use of alcohol/drug use is excessive - it is primarily recreational and social
2. Deepening - employee develops tolerance to the chemical and must sue greater quantities more frequently to achieve the same effect - at this point the person has made a conscious lifestyle decision to use chemicals - begins using both at and away from work
3. Final stages - needs continuous use the chemical substance, even though he or she no longer gains pleasure or gratification - physically and psychologically addicted, the employee generally harbors a total disregard for self and others
117
Proving alcohol impairment is often more difficult than detecting drug impairment...
because an employee can generally hide alcoholism more easily than drug addiction
118
Phase of Confronting the Chemically Impaired Employee
1. Before Confrontation - data or evidence gathering phase
2. Direct confrontation- formal meeting scheduled and notifying them
3. Last Phase - outlining the organizations plan or expectations for the employee in overcoming the chemical impairment
119
The manager needs to be very careful to not do what when dealing with an impaired nurse
not assume the role of counselor or treatment provider for the impaired nurse
120
Recovery Process Steps
1. Impaired employee continues to deny significance or severity of the chemical impairment - but does reduce or suspend use to appease others
2. Denial Subsides - begins to see the addiction has a negative impact on their life and wants to change
3. Person examines his or her values and coping skills and works to develop more effective coping skills
4. Person gains self awareness regarding why they became chemically addicted, and they develop coping skills that will help them deal more effectively with stressors
121
Diversion Programs (Intervention or Peer Assistance Programs)
generally, a voluntary confidential program for nurses whose practice may be impaired due to chemical dependency or mental illness
a punitive system creates barriers to reporting and keeps impaired nurses from getting help usually - so this can provide better help
122
What are the generally accepted reentry guidelines for a recovering nurse
No psychoactive drug use will be tolerated.
The employee should be assigned to day shift for the first year.
The employee should be paired with a successfully recovering nurse whenever possible.
The employee should be willing to consent to random urine screening with toxicology or alcohol screens.
The employee must give evidence of continuing involvement with support groups such as Alcoholics Anonymous and Narcotics Anonymous. Employees should be encouraged to attend meetings several times each week.
The employee should be encouraged to participate in a structured aftercare program.
The employee should be encouraged to seek individual counseling or therapy as needed.
123
What are some ways to manage employee problems
understand personalities
communication is key
adequate employee training
regularly scheduled performance evaluations
be constructive v destructive
support mental health of the overworked
124
Important things to assess about the employee in order to manage problems
assess if employee understands expectations and manager meets them to develop skills/job performance
Self discipline - values, beliefs, self worth, integrity, emotional intelligence
does the employee fit in with the group, is there social pressure (can be good or bad)
mutual trust among colleagues, management, and administration
125
McGregor's Hot Stove Rules for Fair and Effective Discipline
FICI:
Forewarning - understand rules (policies) before, if they deviate, what the result will be
Immediate Consequences - when a rule is broken, there is a result; should be carried out quickly
Consistency - if the problem happens again, the same consequence (or more) will occur; progressive discipline
Impartiality - everyone is treated equally
126
What is leadership's duty to discipline
leadership must take action when employee does not change unwarranted behaviors, providing unsafe care, or does not follow rules
leadership has a duty to support not only each team member, but the whole team as well
127
Steps for Progressive Discipline
1. Informal Warning - written/verbal (what is more effective)
2. Formal Warning - written, specific, consequences, should be signed by both manager and employee
3. Release to think - suspension from work
4. Dismissal - removal of employee from the work setting
128
Challenging Situations for Discipline
termination of employment
filing grievances
transfers to another department
marginally performing employee
chemically impaired employee
need for mental health support / counseling
overworked, burned out staff
129
Important Considerations for Disciplinary Conference
Set the meeting in a quiet, private place, soon after the situation
make sure the employee understand what the meeting is about
state reasons clearly
give the employee time to tell their story
may need to call for support if emotions are elevated
explain next steps/what now
plan for a performance change
give concern for the person and desire for behavior change
employee and manager should sign forms
try to end on a positive note if possible
130
What does a Performance Appraisal determine
how well an employee carries out duties
determines areas for professional growth, strength, projects, committee involvement
how is employee working toward organizational goals
(should encourage and motivate staff, done in an objective manner not subjective)
131
How to motivate through appraisal
have a positive outcome
have a standardizes appraisal process
shows accountability
appraisal tool must accurately assess the performance
employee input encouraged
known standards among the employees
should be completed with direct supervisor
132
How to be accurate and fair during performance appraisal
be objective
be aware of personal biases
seek other managers input as needed
gather and keep accurate data
obtain positive data about performance, growth, and achievement
note areas of growth needed
self appraisal needed
be fair in equitability and work toward goals
133
Important considerations for Performance Appraisal Day
employee should know reason for the meeting
choose a time not rushed and advanced notice
be ready to give unbiased appraisal
watch body language
begin positive, have employee give self assessment
listen and give full attention, avoid distraction
be specific
set goals
agree (or disagree) on the terms
134
Peer Review
provides feedback and growth opportunities
must orient staff to process
standard tools available
ongoing support, resources
how should the info be used
increases professionalism
135
Component Cycle of Performance Appraisal
Define Expectations --> Measure and Evaluate --> Provide Feedback --> Record Performance --> REPEAT
