Disciplinary Question

[cristoloro]

I have a nurse who is generally spoken high of. Patients and families respond well to him. Recently he changed the language on a ventilator as a "joke". He stayed in the room and changed it back once the respiratory therapist entered the room. Nothing happened during the change but the patient's mother complained about the change. I have done service recovery with the mother, but am unsure of disciplinary action. Should he be coached about behavior or should I go forward with formal disciplinary action? As previously stated this is not the normal behavior and he has already taken responsibility for the error and apologized.

Thank you for your input in this matter.

[JustBeachyNurse, LPN]

I'm not a manager but I'd say consult with HR and at minimum a formal verbal reprimand if not written is necessary. You don't joke with patient lives, even if you stay in the room. If that were my child I would be livid could never trust that nurse again. If you could not reassign the nurse then your facility would be paying to transfer my child to a more appropriate unit or facility. The risk was high for a "joke", and it sounds like it was a medically fragile pediatric patient? This time he was caught there were likely other minor incidents that weren't caught. Sometimes saying Im sorry is not enough. The patient/family and nurse professional trust relationship has been damaged.

[BecomingNursey]

I'm not a manager and never have been in nursing. But I was a manager in retail before I went to nursing school. If this is his first infraction and as you say he hasn't had any other disciplinary problems and is well liked by everyone on the unit I would think that verbal coaching would be the way to go on this one.

He didn't cause harm to the patient and stayed with the patient to undo the joke when respiratory came in. The family member has been talked to and has been apologized to and it sounds like you smoothed it over. Just let the nurse know that joking around like that, in front of family members, on the clock, where if something did go wrong it wouldn't be good and could be his fault isn't acceptable and that if anything like this were to happen again it would go into his file. We all make mistakes. Socking it to someone who has never had any problems at work because of one silly joke that he didn't think through is a little harsh.

But that is just my 2 cents. You're the manager and know his work history and know what happened in that room. It's up to you.

[Libby1987]

Re your poll, not sure if answering yes means coaching or discipline.

I've recently re-entered mgmt so will give my opinion..

For someone who doesn't have a pattern with either poor judgement or harassing other staff and seems to have misread/misjudged the effect it would have on family, I would make it a coaching/learning process, unless you think him not capable of learning and growing from it.

[ArmaniX, MSN, APRN]

He simply needs to learn professionalism. Joking is all fun at the nurse station but, sorry, what an idiot to play a joke on respiratory while the child's mother was in the room.

Not that doing it without the mother present is any better.. but if done that way then we wouldn't be having this discussion.

There's such a thing as "being on stage" while in patient care areas.

[caliotter3]

Since he has a good record up until this incident, I would give him a stern talking-to with the emphasis that should there be a second incident of this nature, he will not get off so easily.

As for the little joke of his: I often have walked into a home health case to find the language changed on a feeding pump or vent. I don't understand the reason for doing this and do not appreciate the aggravation. I make the appropriate change and document the situation. I want there to be a written record that the equipment is being messed with and the culprit is not me.

[CrunchRN, ADN, RN]

Tough group. With his good record and having already apologized I would call it case closed. I would give him the benefit of the doubt that there is no need to overreact to one momentary lapse in judgement.

[sharpeimom]

Former manager here. If he has had a satisfactory record up until now, I think I'd give him a very stern talking to. I think, if we're honest, almost all of us have done something we wish we could take back. Not malicious, just unthought out and dumb. Unfortunately, there are no do-overs. All you can do is apologize profusely and move past it.

[HouTx, BSN, MSN, EdD]

Did he violate a policy? If so, this needs to be addressed in the same way that other policy violations are addressed. If you fail to do so, it could be construed as favoritism.

Working from a 'Just Culture' model, this would be considered 'at risk' behavior - because he knowingly did something that could have resulted in a bad outcome for the patient. It's likely that he felt that it was safe to do so because he was confident that he was in control of the situation. But, as managers, our job is to enforce the rules of the organization rather than letting everyone make up their own. The appropriate (Just Culture) response is to: verbally clarify the 'rules' & let him know that any repetition will result in a formal counseling.

This may be an example of 'drift'.... he has become so comfortable with ventilator management that he's not as attentive to the rules - because, hey nothing bad has ever happened so far. If so, he's probably not the only staff member to feel this way so it may be a good time to arrange for a refresher on the rules of ventilator management.

[BuckyBadgerRN, ASN, RN]

Your polling answer options don't make sense, I can't answer on dot alone!

[Orca, ADN, ASN, RN]

In the situation as it was presented, I would go with a verbal counseling. You stated that this is not typical behavior, it seems that the nurse has already realized that what he did was a mistake that could have had serious consequences, and he has owned up to it and he apologized. I see nothing to be gained by more strict disciplinary measures, since it seems apparent that the lesson was learned and (fortunately) no one was harmed. As others have said, however, your facility's policies may or may not give you that latitude.

I believe that some degree of levity in the workplace is essential to maintaining morale, but life sustaining equipment is not an appropriate medium for carrying out practical jokes.

[SummerGarden, BSN, MSN, RN]

This was unprofessional at best and a risk to patient safety at worse (scenario-there is a code somewhere and the nurse has to leave the room without changing the language before respiratory returned or whatever). I agree with the poster that advices you to check with HR. Present the facts and get their guidance as to how to proceed. If you work in a union environment, there are steps you need to take to be fair and just toward the nurse. If you work in a non-just nursing culture, then the law is more lenient on how to proceed. Good luck. :)