We all like to believe that we are good employees in whatever type of nursing job we have. As nurses, we believe that we consistently give the best care possible every time we show up to work.
In my 35 years of nursing leadership experience, I have seen many nurses suffer through the presentation of write ups, indicating to them that they have done something less than acceptable in the workplace. These types of disciplinary encounters hit at the core of our egos. In many situations, the first response is one of denial or defensiveness caused by our inability to take a hit to the ego and the core belief that, “I am a good nurse, how could this be?” The reality is that there are times when we are not at our best, that we make mistakes or have periods in our lives where illness or personal pressures cause stress at work. The key to surviving these hard times and protecting your job in the long run depends in large part on your behaviors and strategies when presented with a disciplinary action.
The first appropriate response to this type of encounter should be one of emotional intelligence rather than defensiveness. Just listen to the scenario and don’t react initially. Take yourself out of the situation and remain objective and analytical. Easier said than done, but in my experience, staff that accepts constructive criticism and has the desire to improve behavior to return to good work practices have a better chance of soliciting support from management and the help to improve.
There seem to be four general categories of write ups that repeat themselves in the workplace. They include attendance and tardiness, inappropriate behavior in the workplace, substance abuse or theft and mistakes made at the point of care. I will discuss all of these separately, as leader responses will vary depending on the type of incidence.
Good attendance is an expectation in all organizations. When you accept a job, by virtue of your contract with the organization, you agree to work when assigned, be ready to work in the appropriate area, at the appropriate time. One of my greatest mentors taught me that “to be on time is to be late.” I live by that rule. This is one of the most objective measures of performance because if you are not there, you are not there. This is poor job performance in nursing regardless of how you feel about yourself in regards to patient care. You have to be present to perform. When confronted with this type of write up, if all the data is true, you need to be accepting of the discipline and work with your manager to focus on strategies for you to improve in this area.
Inappropriate behavior in the workplace
This can be defined as the display of poor attitude, confrontational or intimidating behavior in the workplace or complaints from patients. These offenses are more subjective than attendance and are usually observed by nursing managers, coworkers, patients or visitors. These behaviors are repetitive in nature and usually the staff member does not recognize that their behavior is a problem. These types of behaviors destroy the work environment and can create a dangerous situation for staff and patients.
If you are written up for this type of behavior, your first response should be a reflective look at your behavior and a sincere willingness to change. Most organizations have classes that you can attend and other resources to help you if you ask. With the focus on patient service, this type of behavior is not tolerated, nor should it be. Our work as nurses should be focused on our patients and not our own need for drama.
Theft and substance abuse
If there is documented proof that you have stolen from the organization, you will lose your job. There will be little you can do. It is best for you to admit it and move on. Many organizations will give you the opportunity to resign rather than be terminated. I have actually had staff who were accused of stealing, video images showing proof of the theft, and still they denied it. Do not add a lie to an already bad situation.
Substance abuse in nursing, however, is a delicate subject. The instance of substance abuse continues to rise in hospitals and healthcare organizations. If you are a victim of substance abuse, your best strategy is to approach your manager and ask for help. Most organizations have processes and resources to help staff through these tough times. Your manager will be there for you.
Mistakes at the point of care
Studies in human capability are beginning to suggest that mistakes are not necessarily the fault of the individual but rather a flaw in the process which eventually breaks down and causes injury to the patient. Additional production pressures and under funding of hospitals can also place staff and patients in tentative situations due to reductions in force and other resources.
In response to this knowledge, many hospitals and healthcare organizations are utilizing a non-punitive approach to mistakes and accidents at the point of care. With that said, it is our responsibility as nurses to consistently utilize our inherent assessment skills in the workplace and strive to be the patient advocate at all times, even in situations where we are uncomfortable. It is also important to prevent cutting corners even when busy and to always us the 5-rights of medication administration. Also ask for help when you need it, especially if the workload has increased to the point that you are concerned for the safety of your patients. A proactive approach is always better than a reactive response, secondary to a patient injury.
Appeals processes. If you feel that you have been accused wrongly in a disciplinary scenario, you have the right to appeal the decision. This should be handled in a professional manner, without the emotion and certainly without any drama. This will give you the time to do some follow up work and allow you to present a well crafted, professional defense and to tell your story.
Lastly, life is a journey! We are all human and by the very nature of being human we will make less than good decisions at all times. What is important is what we learn from it, whether it is directly related to your job as a nurse or to your personal life, and how we grow and move forward.
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