Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ required on change of shift.

      Before acting, investigate! Speak to observers and targets of Ron’s behavior. Begin a private discussion with Ron from his perspective and to coach him on his behavior. A first-time complaint or observation may not require disciplinary action. A private conversation and coaching may uncover the basis of Ron’s behavior and a gap on a professional communication standard between shift changes. Document your coaching interventions with Ron.

      As a nurse manager, you should meet with each shift. Coaching and disciplinary action require your active involvement to change behavior. As a nurse manager, speak to all staff on your expectations at shift change. Create a policy and procedure with a checklist for shift change to ensure a consistent approach. And, as their manager, model the professional behavior you want to see in your staff. Unprofessional behavior disappears in the manager’s presence, so be prepared to continue surveillance and keep communication open.

      Formal disciplinary action is required if Ron’s behavior continues. To continue coaching or disciplinary action, consult with human resources and employee health services. Human resources will counsel and strengthen your approach on coaching or progressive disciplinary action according to policy. Employee health services can schedule psychological counseling for the employee or unit, if needed.

      –Peggy Ann Berry

      reflections

      Do you think Ron’s behavior counts as bullying? If not, why not? Identifying bullying can sometimes be difficult—and can feel like drawing an arbitrary line in the sand. Where do you draw that line in your unit? What do you do when a behavior might be right on the line, but not clearly over it?

      As a nurse manager, what strategies can you use to work with Ron?

3.2 Passing Judgment

      scenario

      The nurses on the Labor and Delivery floor know that Tessa is openly critical of the ER and calls the nurses who work there “lazy and sloppy.” One day, an emergency admission arrives on L&D just as Tessa is returning from lunch. As everyone hustles around the patient, Tessa grabs the chart and begins flipping through it.

      “Just what I expected,” she says to the patient’s husband, who is standing near the room where his wife is being treated. “The ER nurses didn’t get most of the information we need. Now I’ll have to go through it all over again with you.”

      Tessa makes sure to tell the nurse manager what happened, along with complaining to the other L&D nurses about the ER’s “crappy” patient care. The next time there is a transfer, the ER nurse makes sure to be as rude as possible to Tessa, and a unit-to-unit “feud” develops between the ER and L&D.

      nurse leader insight

      Acting out feelings, even by one individual, rather than discussing problems openly is an indication of a team that is not functioning as a team—either on their own unit or between units. There are tension points in all jobs. Everyone has a responsibility to deal with conflicts in an adult manner, not display emotion as a child who throws a tantrum when she does not get her way.

      In a family-centered care environment, the patient comes first, not a staff member’s tension points. Judgmental behavior such as that displayed by Tessa communicates an “I don’t want to work here with these incompetent people” attitude. This in turn communicates to the patient and her husband that they are being cared for by an organization that does not value excellence. Otherwise, why would the hospital employ staff who do not know what they are doing? Tessa’s behavior puts everyone on the team and the organization as a whole at risk as the patient and her husband potentially lose confidence at a time when they need their confidence to be reinforced. Respect for patients and a willingness to make them the center of all services must be an organizational value that is reinforced in all interactions. To deliver anything less is a violation of the trust that an employer places with the employee and the consumer expects from those in which care is entrusted.

      What are the options?

      Tessa is clearly angry and out of control. She is displaying unprofessional behavior to her coworkers and to the patient and the patient’s husband. A staff member, manager, or supervisor needs to be brought into the discussion before the shift ends to review the outburst.

      With the support of the unit manager, the L&D staff must confront Tessa about the issue with the ER staff. This can be done in a small group discussion and then followed up in a larger staff meeting. In conjunction with the managers of each of the units, “lazy and sloppy” work must be identified and remedied in a businesslike manner. A review of patient-centered care must be reinforced with all staff understanding how this is translated in practice. Language such as “crappy” patient care is not to be tolerated, and Tessa must receive an unequivocal warning that such behavior has to stop.

      The unit, service, and organization as a whole must reinforce the values that are held. Policies, procedures, brochures, posters, and the strategic plan must reflect that patient-/family-centered care is the focus. This will serve to support staff in their work. In addition, such value statements can be used in disciplining Tessa for her behavior, thus keeping her personally accountable and the team accountable to each other to uphold these values every day as they partner with each other and with those who are served.

      –Nancy M. Valentine

      Tessa has been openly critical at transfers (or handoffs) from ER to the L&D unit. These complaints are well known to her peers, and she has come to the nurse manager with the latest incident. Her continual complaints may or may not be justified. However, Tessa was unprofessional verbalizing her complaint in front of a laboring patient’s husband.

      First, it doesn’t take much imagination to see a red-faced expectant father screaming at the ER staff after Tessa’s statement. After a full investigation confirms a public complaint to the patient and husband, a written reprimand should be privately issued to Tessa. This written reprimand should also include instructions on immediate cessation of public criticism of the ER to her peers or anyone other than the manager. ER communication at transfer after the incident is obviously strained. As the nurse manager, you will be the one to bring the ER and the L&D staff together by apologizing for Tessa’s behavior to the ER manager. This will begin to repair the breach to ensure professional communication is reinstated at transfer.

      Second, does Tessa know how to constructively present complaints up the chain of command? Have her previous complaints been met with resistance to address issues? Do her complaints have merit on transfers from the ER to L&D? Handling Tessa’s ongoing complaints constructively may reveal gaps in transfer. Ask her to bring solutions with her complaints. Determine if a transfer policy, procedure, or education is needed to meet the transfer needs of L&D and the ER. A new checklist that fairly addresses responsibilities between the ER and L&D on documentation and transfer to L&D may increase patient safety and decrease tension during handoff.

      Successful channeling of staff complaints may create quality improvement with other processes. In my research, I have found that nurses who file complaints and see no change become increasingly disempowered or disgruntled by lack of action on management’s part. Lack of trust in management related to poor follow-through on legitimate issues leads to silent resignation and disempowerment.

      As a nurse manager, are you listening? When a problem or complaint comes up, how do you inform your staff of your actions to correct the problem? Do you consider the psychosocial and physical safety of your nurses a priority, given that nurse job satisfaction is correlated to patient СКАЧАТЬ