leadership

Chapter25.pptx

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

Learning Objectives

1. Describe the steps typically followed in progressive discipline (ATI p 15—Steps in Progressive Discipline) (Text p 688-91)

2. Compare how the disciplinary process may vary between unionized and nonunionized organizations; understand components of the grievance process (ATI p 17—Grievances) (Text 694-96; 699-700)

3. Determine appropriate levels of discipline for rule breaking in specific situations (Text p 691)

Learning Objectives

4. Describe the risk factors that result in an increased risk of chemical addiction in the nursing profession (ATI p 45—Impaired Coworkers) (Text 702-705)

5. Identify behaviors and actions that may signify chemical or psychological impairment in an employee or colleague (ATI p 45—Behaviors Consistent with a Substance Abuse Disorder) (Text 205-07)

6. Analyze how personal feelings, values, and biases regarding psychological and/or chemical impairment may alter one’s ability to confront and/or help the psychologically or chemically impaired employee (Text p 707-08)

Learning Objectives

7. Identify steps in the Recovery Process of a Nurse who has experienced Substance Abuse Disorder (SUD) (ATI p 45—Impaired Coworkers

Problem Employees: Rule Breakers, Marginal Employees, and the Chemically or Psychologically Impaired

Managers 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.

Rules #1

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.

Rules #2

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.

Rules #3

If a rule is consistently broken, one needs to ask the following:

Whose rule is it?

Do we still need the rule?

Rules #4

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

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

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.

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

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.

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

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

Four Common Steps in Progressive Discipline #1

Verbal admonishment

Written admonishment

Suspension from work without pay

Dismissal

Four Common Steps in Progressive Discipline #2

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

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.

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.

Termination

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 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 #1

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.

The Termination Conference #2

The grievance procedure is essentially a statement of wrongdoing or a procedure to follow when one believes that a wrong has been committed. All employees should have the right to file grievances about disciplinary action that they believe has been arbitrary or unfair in some way.

The Formal Grievance Process

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.

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.

The manager has a right to expect employees to follow the rules but must make sure employees know and understand the rules.

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.

The Disciplinary Process for Unionized Employees

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

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.

Chemical Impairment

Impairment resulting from drug or alcohol addiction

Incidence of Chemical Impairment in Nursing

The chemical impairment rate of health professionals is 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.

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

Late-Stage Chemical Dependency #1

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 or she generally no longer gains pleasure from it.

Late-Stage Chemical Dependency #2

The manager should not assume the role of counselor or treatment provider or feel the need to diagnose the cause of the chemical addiction. 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 Chemically Impaired Employee #1

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.

Confronting the Chemically Impaired Employee #2

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.

Reentry Guidelines for the Recovering Nurse #1

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.

Reentry Guidelines for the Recovering Nurse #2

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.