Discipline

Trauma Columnist · Nov 17, 2018

Matter of factly.

offlabel · Nov 17, 2018

Yikeeeees...........!!!!!!!How do you face a colleague after you discipline them? When a patient suffers and you need to discipline a colleague........

When a patient suffers you need to discipline a colleague? If it was from negligence, recklessness or incompetence, that isn't a "colleagues" job to address. That is for a superior or governing board to address.

If you are this individuals superior, you face them professionally the same way you did when you "disciplined" them, whatever that means.

If you are a colleague, you apologize.

Oldmahubbard · Nov 18, 2018

Are you serious? In my experience, most "disciplinary action" against a nurse when there has been no harm is entirely political.

Otherwise, it's the BON.

Troll, much?

cayenne06, MSN, CNM · Nov 19, 2018

Discipline a colleague? What?! I am not sure I understand what you mean. Are you in a management role in addition to patient care?

My fellow APRNs and I are a team- we support each other and help each other learn when we make mistakes. I've had some new grad APRNs who have struggled, but I will train and support and educate them alll day long, to help them succeed. Of course, there have been a few new-hires that are seriously just unfit and not able/willing to address their deficits. This goes straight to clinical admin, do not pass go. If they are training with me, I will shadow them constantly, give real time feedback, approve their A&P, essentially treat them like a new student. Essentially, protect my patients until admin figures out what to do with them.

And in terms of my clinical staff- It is my job to ensure my team is providing efficient and excellent care. I provide education and in-the-moment feedback and expect them to work to my standards. I don't "discipline" anyone, because we are all grown adults. If there is an issue I cannot fix or that is a serious patient safety issue, then I bring in my manager for any actual disciplinary measures.

Subby317 · Nov 19, 2018

Thanks so much for your response. A management role... You are absolutely right "we are all adults". Tried in "the moment feed back" to no avail.

Oldmahubbard · Nov 19, 2018

Discipline a colleague? What?! I am not sure I understand what you mean. Are you in a management role in addition to patient care?
My fellow APRNs and I are a team- we support each other and help each other learn when we make mistakes. I've had some new grad APRNs who have struggled, but I will train and support and educate them alll day long, to help them succeed. Of course, there have been a few new-hires that are seriously just unfit and not able/willing to address their deficits. This goes straight to clinical admin, do not pass go. If they are training with me, I will shadow them constantly, give real time feedback, approve their A&P, essentially treat them like a new student. Essentially, protect my patients until admin figures out what to do with them.
And in terms of my clinical staff- It is my job to ensure my team is providing efficient and excellent care. I provide education and in-the-moment feedback and expect them to work to my standards. I don't "discipline" anyone, because we are all grown adults. If there is an issue I cannot fix or that is a serious patient safety issue, then I bring in my manager for any actual disciplinary measures.

I am curious as to how some new APRNs are "unfit"?

Subby317 · Nov 19, 2018

Thanks for your response. "Discipline" is in quotation. On re-reading my posting I can see why it may be misunderstood. The patient did not suffer " physical or emotional harm" ----- voiced " displeasure ".

Subby317 · Nov 19, 2018

I am curious as to how some new APRNs are "unfit"?

New APRNs are not " unfit".. They need a foster environment that provides education and mentor-ship. Totally agree that "discipline" is political....... however for continued failure to adhere to guidelines

A fellow APRN should not " turn a blind eye". " Discipline " here was a pow-pow while throwing in the word " discipline" as gentle reminders failed.

Trauma Columnist · Nov 19, 2018

I am curious as to how some new APRNs are "unfit"?
New APRNs are not " unfit".. They need a foster environment that provides education and mentor-ship. Totally agree that "discipline" is political....... however for continued failure to adhere to guidelines
A fellow APRN should not " turn a blind eye". " Discipline " here was a pow-pow while throwing in the word " discipline" as gentle reminders failed.

Are you in a management position? If no pt harm but there is an issue that needs to be addressed, then you address it and go on with life. What am I not understanding?

Subby317 · Nov 19, 2018

Thanks much!

cayenne06, MSN, CNM · Nov 20, 2018

I am curious as to how some new APRNs are "unfit"?

I thought I was clear with my comment re: unfit providers. I was careful to state that I will happily train and guide any new provider, as long as they are equally invested. Unfit means completely unaware of what they do not know, unsafe practice, and unwillingness to identify and remediate deficits in their practice.

An example would be making a dangerous mistake (esp one you have made before) and then going back and falsifying the chart to try and cover it up. Or forgetting to do part of an exam or POC test, and then pretending you did, even charting fake results. Or gross negligence like sending a patient home on TID iron with a POC HGB of 4 (FOUR), and active menorrhagia. How do you even begin to remediate that, i don't know.

That is compared to someone making (or almost making) a serious mistake, being appropriately freaked out, and using the experience to get better. It is part of my role as a preceptor to help develop the crucial skill of managing mistakes productively, and accepting feedback professionally. When I make a mistake or miss something important, I point it out to whoever i am teaching, and talk it through for both of us to learn.

But if you view mistakes as something to cover up, or a personal affront to your worth as a person, you are digging yourself into a hole that eventually will be too deep to climb back out.