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.

[IdahoNurse]

I would give him a coaching session. Related to the fact that it WAS not professional, and the family didn't take it as a joke... I love being a joker myself, and I can see this easily happening to a jokester.

[jrt4]

As a manager who operates in a "just culture" facility, he needs more than just a verbal counseling. Generally I would agree that people are human and make mistakes...however...

Just culture means that you do not punish people for speaking up when a mistake is made. Just culture does not mean you do not write someone up when they are reckless and put the patient at risk. This is a serious offense and needs to be taken seriously regardless of his record. You don't pull over a drunk driver and say well...this is your first time and you made it all the way to your street so I am going to let this one slide.

We really need to educate ourselves on what it means to operate in a just culture. Many times mistakes are made because of a poor process or an enculturated poor practice. For example: dual signing blood at the nurses station instead of the patients bedside...if this is something that happens routinely and someone speaks up you would not punish them but take the opportunity to learn from that mistake and develop a process that works or re-educate on the safety. On the opposite end of the spectrum, the nurse does not ask for dual sign off until the blood is already hanging...someone speaks up...that would be a time for a write up because the nurse was reckless and willingly violated a known standard that it requires a 2 person sign off. It truly does not matter if the patient is harmed or not (in terms of a write up)...its about risk.

Thats my soap box.

[Tisme]

The nurses are unionized where I work. We have to be careful in ensuring that all are treated the same for the same infractions, scheduled time off, overtime, canceling of shifts, policy issues, etc.... Treat one, treat all.

In this case, if it was me, and I did not write up the offender for breaking policy, I would have a hard time writing up the next person who did the same thing because the Union member could say, you didn't write up Mr. Well Liked in August 2015, why are you writing me up now for the exact same thing? In effect, I would be endorsing this behavior if not addressed.

I know it seems harsh but the policy was written for patient safety AND a family member saw it and complained. If this is his first offense, you could give a verbal warning and put this in his file and there is proof that you addressed the issue. He has apologized so there is proof that he knows his actions were wrong.

My hands would be tied and I would be compelled to take action. Besides, 'treat one, treat all' saves a manager from being jammed up in the future.

Tis Me