Lesson 12: Performance Appraisals and Dealing with Problem Employees

-Imagine you are a nurse manager and record ways of terminating an employee-

First of all, let me just put out there in the universe that I do not ever want to be in a situation where I have to terminate an employee. 

I feel the text hat some good idea of how things should go when an employee must be terminated. The four steps it outlines are:

1.  Calmly state the reasons for dismissal.

2.  Explain the employment termination process.

3.  Ask for employee input.

4.  End the meeting on a positive note, if possible.

I feel that this would be an ideal way to terminate an employee. The reality of this actually happening are dependent on the relationship that already exists between the employer and the employee. If the relationship is cordial, than I think the above steps could actually happen. I also believe that if an employee has reached the point of termination, it's most likely not going to come out of the blue. In most corporations or businesses, there are a series of steps that must be completed before termination and sot he employee would have been given time to modify their actions before being terminated. 

In a situation where the above steps were not possible, I believe it would be because the employee did not know the termination was coming. But, in reality i don't know how this is ever really plausible. If an employee has been dishonest in some way, and thereby circumventing the steps that usually occur before termination, they have got to have some idea that they are going to be caught sooner or later. The above steps most likely would not happen because the employee would start to rant and rave and blah, blah, blah....you know, the wicked take the truth to be hard.

Lesson 11: The Nurse Manager’s Role in Quality Control

What do you consider elements of quality care when receiving healthcare services?

 The biggest element of quality care when I am the patient is how the nurse makes me feel. Being the patient puts you in a very vulnerable position. I've had surgeries, emergency room visits, lots of tests,  and hospital stays and the thing I always remember is how the nurse treated me. A long wait in pre-op is made bearable by an attentive and caring nurse. The fear of tests that can be painful is lessened when the nurse really cares. The entire situation is affected by the nurse.

What do you consider elements of quality care as a professional nurse?

I think the biggest element of quality care on the nursing end also has to do with the attitud e of the nurse. Ensuring the patient receives the best care possible is my number one goal as a nurse, and I believe the core of the care is the atmosphere that is set by my attitude as I provide that care. I understand, more than I would like to, that medical care is a business and as such there are certain responsibilities. However, my patient does not care about that. All they care about is that they are being taken care of at a vulnerable time in their lives.

Are the two similar or different?

Obviously, I feel that the two are pretty much the same. I think what I consider as the keystone of quality of care as a patient greatly influences the care I give as a nurse and what I see as key to delivering quality care. I think had I not needed to be cared for nurses throughout my life, I would probably see things differently, and perhaps on a more clinical side of things. But the care I received greatly influenced the care that I give. 

Lesson 10: Conflict Resolution Collective Bargaining, Unionization and Employment Law

While  I was working at an upscale assisted living center as a nurse, a new nurse was hired to be our Enhanced Care Coordinator. The woman, who I will call Laurie, was a very passive aggressive person which was the cause of a large amount of conflict.

One time in particular, I had been charting in the new "nurses" office in our enhanced care unit. Lisa came in and said, "I want you to know that I'm fine with you using the office to chart, but Mary (the facility administrator) has asked that it be used only by administration. I'm fine with it, but if she sees you in here charting, she may say something." I said "Okay" and in my mind thought, "I'll just walk down and talk with Mary and get permission to chart in the new office." An hour or so later, after Laurie had gone home, another member of the staff said, "So I hear you were kicked out of the office." I stared blankly, not knowing what she was talking about. Turns out after her conversation with me, Laurie had gone to other staff and said, "I have told Somer in very clear terms that she is not to be in this office and she keeps pushing the boundaries and charting in here." Since I am not one to sit by when my reputation is being impacted negatively, I asked her about it the next day...

"Why did you say you were okay with me charting in the office and that Mary objected to it when you are the one who had a problem?"

She game me some run around about how I'm "scary" to talk to so she thought I'd take her more seriously if she used Mary's name. I asked her the next time she had a concern to please speak with me herself instead of talking about me behind my back. However, it didn't stop. Laurie continued to talk to other staff negatively about me behind my back, telling them things that were not true. Since I had already spoken with her directly to try and resolve the issue I took it to our director of nursing, the next step in the process. I explained the situation and asked that he please talk to Laurie.

More than two months passed and nothing happened. I went back in to the DON to explain that the back biting was still a regular occurrence and to follow up on why he had not taken any action. He explained that he liked to take an approach to "sit and watch" and that things would eventually work themselves out. Work our they did as I got tired of hearing daily reports from other employees on what had been said about me and found another job. Thankfully, my fellow coworkers knew me and did not put any stock in the negative things Laurie was saying about me on a daily basis.

Had I been a nurse manager, or the director of nursing in this case, I would have handled the situation completely different. If my employee had come to me with the same concern I brought to my DON, I would have first pulled Laurie into my office and explained that staff had a concern with her and there were reports of this specific behavior, and that the employee had reported that she had already approached Laurie with the concern and they felt like the issue had not been resolved. After listening to Laurie's side of the story I would encourage her to approach the concerned staff member to work things out. Then, if the situation still persisted, I would call both parties into my office and facilitate some open communication between them to see if the issue could then be resolved.

Lesson 9: Creating a Motivating Climate Organizational, Interpersonal and Group Communication

--Motivation: The force within an individual that influences or directs behavior--

So what motivates me to act? It depends on what the situation is. For some things it's obvious. If it's something I want the motivation is intrinsic. When the goal is to achieve something others expect of me, it's extrinsic. For the achieving of other goals, however, the motivation is not so clear. Take, for example, the completing of this reflective journal/blog. I feel it is mostly busy work. I don't feel that I benefit from it or that it contributes to my nursing abilities in anyway. So, there is definitely not any intrinsic motivation there. However, I want to graduate with my Bachelors degree, and to do so I need to pass this class, so there in lies some intrinsic motivation. Passing this class requires that I read the text and write these blogs, and that brings in the extrinsic motivation. 

With the majority of things in my life, however, the majority of the motivation comes from inside me. I have set goals for myself and I want to achieve them, so the motivation is intrinsic. Even with my career. I have always wanted to be a nurse and help people. The decision was never because of money, or scheduling, but because I have an inherent desire to take care of people. I think my classmates have heard me say at least 100 times over the last three semesters that if I could have provided for myself and family by remaining a CNA and providing the hands on bed side care that I love, I would have stayed a CNA forever. But, I do need to provide for myself and my family and so I require higher pay, which is definitely an external motivation. 

The way with which I perform my duties in my job are motivated intrinsically as well. Before starting my job at the boys ranch, I worked in geriatrics for almost 14 years. I worked hard and did my job to the best of my ability because I loved my residents and wanted them to have the best care possible. I did it regardless of pay or staffing. At the last facility I worked, the memory support unit had an RN that was the coordinator of care for that section of the facility. From the moment she started the moral of the staff, the residents, and the resident's families changed. This nurse did not know how to motivate effectively. She often cut employees down to others in the same position to try and motivate them to do better. Instead she only succeeded to violate the trust of the staff. When I approached her and directly brought this to her attention she became defensive and placed blame on the fact that she was new to the facility and trying to fit in. Things never changed and staff continued to distrust any praise she gave them directly as it was nullified by the things that were said behind their back. 

I feel that managers can have such a positive impact on motivating their staff. Simple words of praise and recognition can make a large impact on increasing the spirit of morale and a desire to do their best work. Also, when I work with other staff and team members who are appropriately motivated, it motivates me to work at a level that exhibits my best self and best abilities.