Chapter 25

1. Chapter 25 Problem Employees: Rule Breakers, Marginal Employees, and the Chemically or Psychologically Impaired

2. 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 • Not disciplining an employee who should be disciplined jeopardizes an organization’s morale

3. Discipline versus Punishment • Discipline • Involves training or molding the mind or character to bring about desired behaviors • Is often considered a form of punishment but is not quite the same thing as punishment • Punishment • An undesirable event that follows unacceptable behavior, which may have negative consequences but can be a powerful motivator for change

4. 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

5. 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

6. 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 is possible only if subordinates know the rules and accept them as valid

7. 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

8. Strategies to Create an Environment of Self-Discipline • Clearly written and communicated rules and regulations • Atmosphere of mutual trust • Judicious use of formal authority • Employee identification with organizational goals

9. Rules • If a rule or regulation is worth having, it should be enforced. When rule breaking is allowed to go unpunished, groups generally adjust to and replicate the low-level performance of the rule breaker • As few rules and regulations as possible should exist in the organization • All rules, regulations, and policies should be regularly reviewed to see if they should be deleted or modified in some way

10. Rule Breaking • Most common reason for discipline • If rule is consistently broken, need to ask the following: • Whose rule is it? • Do we still need the rule?

11. Four Common Steps in Progressive Discipline • Verbal admonishment • Written admonishment • Suspension from work without pay • Dismissal

12. Question A formal reprimand is which step in a system of progressive discipline? • First step • Second step • Third step • Fourth step

13. Answer Answer: Rationale:

14. When using progressive discipline, for all but the most serious infractions, the slate should be wiped clean at the conclusion of a predesignated period Using Progressive Discipline

15. Performance Deficiency Coaching • Manager actively brings areas of unacceptable behavior or performance to the attention of the employee and works with him or her to establish a short-term plan to correct deficiencies

16. The Disciplinary Conference • 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

17. The Termination Conference • State the facts of the case and the reason for termination • Explain the termination process • Ask for the employee’s input and respond calmly and openly • End the meeting on a positive note, if possible

18. Termination • It should always be the last resort when dealing with poor performance, but is necessary for employees who continue to break rules despite repeated warnings • It 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

19. The Formal Grievance Process • A grievance is essentially a statement of wrongdoing • The steps are generally outlined in union contracts or administrative policies • It typically entails progressive lodging of complaints up the chain of command • If differences are not settled in formal grievance process, the dispute generally proceeds to arbitration

20. Rights and Responsibilities in Grievance Resolution • Both parties have rights and responsibilities to be heard and to listen • Employee has not only the right to a positive work environment but also a responsibility to express discontent responsibly • Manager has a right to expect employees to follow the rules but must make sure employees know and understand the rules

21. Question The grievance process: (Select all that apply) • Generally follows lodging complaints according to a chain of command • Is often outlined in union contracts • Usually proceeds to arbitration • All of the above

22. Answer Answer: Rationale:

23. Marginal Employees • These employees disrupt unit functioning because the quantity or quality of their work consistently meets only minimal standards • These employees often make tremendous efforts to meet competencies yet usually manage to meet only minimal standards at best • Traditional discipline is generally not constructive in modifying their behavior

24. Union Presence • 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

25. 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

26. Impairment resulting from drug or alcohol addiction Chemical Impairment

27. Incidence of Chemical Impairment in Nursing • The chemical impairment rate of health professionalsis generally acknowledged as being greater than that of the general public • 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

28. Profile of Impaired Nurse • May vary greatly • Typically, behavior changes are seen in the following three areas: • Personality/behavior changes • Job performance changes • Time and attendance changes

29. Chemicals Most Commonly Abused by Nurses • Alcohol (most frequently used) • Demerol • Oxycontin • Klonopin • Valium • Morphine

30. Question Which are changes that can be indicative of substance abuse? • Irritability • Forgetfulness • Social isolation • Change in physical appearance • All of the above

31. Answer Answer: Rationale:

32. Late-Stage Chemical Dependency • 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 • The individual characteristically exhibits high defensiveness • Employee must continually use the substance even though he/she generally no longer gains pleasure from it

33. Confronting 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 • Denial of the impairment or use of defense mechanisms should be expected; manager should not nurture or counsel the employee • The manager should outline the plan for the employee to overcome chemical impairment

34. Question When a substance-abuse problem is suspected, what is the cause for immediate confrontation? • If the employee is defensive • If the employee may pose a risk to clients • If it is not possible to gather sufficient evidence

35. Answer Answer: Rationale:

36. Reentry Guidelines for the Recovering Nurse • No psychoactive drug use is 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

37. Reentry Guidelines for the Recovering Nurse—(cont.) • 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 • 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

38. THE END