I work at a LTC center. One of the nurses had to sign a discipline form, even though she wasn't guilty and it was to go into her file. She could write that she didn't do it, but she still was counseled to sign, etc. What happens to these papers and future employment or liability? What can you do about the contents of your employment file? We live in MO (the state of Missouri, USA). I haven't done anything yet, but errors happen. It was a medication error that was the issue, not a narcotic.
Gigi
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December 4th, 2007 at 1:52 am
It still needs to be done. The nurse won’t be in trouble. What happens many times is that people don’t report/write up errors and the hospital doesn’t have an accurate record of potential problems that could be worked on to improve.
It also protects the worker who actually made the mistake. If it isn’t written up, and a patient/relative, or even management find out, they will of course ask why.
December 4th, 2007 at 5:26 am
The purpose of ‘writing up’ nurses, as nursingaround suggest, need not be merely a negative one. More recent management practices in many areas (thankfully) use the process to identifies causes and potential remedies other than just ‘disciplining’ people (see the post on “Addicts Need Your Help, Not Your Self-Righteousness” for a good example of this thinking at Nursing Board level). This approach can lead to changes in systems, training or even policy. It may also be used to identify individual staff training & support needs.
Our state health department advocates and demands a ‘no blame’ culture that accepts ‘people make mistakes’. Of course the severity of that mistake has to be accounted for and no one walks away without recognising their part to play in the error if necessary. Staff are still accountable – and can be dismissed for gross misconduct. Rarely is a medication error a ‘discipinary matter’ unless it results in excessive harm to the patient and examples a gross breach of protocols.
When someone is ‘disciplined’ it serves as a record to show that the mistake has been noted so if it happens again, the file shows it was addressed once before. UK rule used to be – 2 written warnings – then dismissal IF the warnings are all in regard the same issue (ie medication error and timekeeping are not the same issue and do not count as 2 written cautions; just two separate and different ones).
However, it should also be an opportunity to identify how it won’t happen again. A simple drug error should need no significant redress, but there was a reason for it and that reason needs to be clarified, documented and management plans to reduced risk of it happening again.
Managers are responsible too for ensuring safety and if she just ‘told her off’ for doing wrong (whether the nurse did or didn’t make a mistake) the manager is also leaving him/herself liable to redress if it does happen again. (The manager is now aware there is a problem – if it happens again, the manager will be required to explain why no action was taken to prevent it – and ‘discipline’ is not a remedial action, it is a sanction.
The purpose of the nurse signing it is to show they are aware of the issue being discussed and have noted the ‘mistake’.
The nurse cannot be forced to sign anything she does not agree with – that is a breach of fundamental human rights. The nurse is entitled to take a copy and consider it, seeking moral/legal support if desired. If she signed merely to say the matter was discussed then that should be ok if that is what the document says. If the document implies or states some form of admission/guilt or states ‘what happened’ then she should not, and cannot be forced to, sign it. Of course, you are then labeled ‘trouble maker’ by the manager and run a different gauntlet.
It sounds like the manager bullied the nurse into signing against her will and coercion is not acceptable practice. I would be interested to know for what alleged action/omission the nurse was disciplined – and also what ‘remedy’ action the manager offered to support it not happening again. If the nurse concerned wants the matter rectified, it may be possible to do so.
I’ve some experience of bully managers – and how to respond to them – both tactfully and tactlessly; but both with good effect 🙂
December 4th, 2007 at 2:56 pm
Mr. Ian I enjoyed reading you response. How do you handle bully managers tactfully and tactlessly? I am more interested in your tactlessly method.
P.S. I agree with your comments. A no blame culture is the way to go because we are all human and we all make mistakes. The important thing is to reduce the opportunities for errors by taking a look at what is happening or what has happened and implement change to improve things.
GiGi make sure you have a copy of what you signed and you keep your own log of events.
January 4th, 2008 at 10:37 am
Disclaimer: These are my personal approaches and may not work for all people in all circumstances… as they sometimes don’t work for me in any circumstance! Enjoy 🙂
Dealing with bullies works easier if the manager above them is approachable. Managers hate problems (which is odd since they are employed to ‘manage’ them).
If both managers are bullies then get another job.
Tactfully:
Direct approach [usually requires some confidence and the ability to act calmly when provoked]: Speak quietly with them about your issue(s) with them. Explain you are not happy about “X” behaviour. Ask them nicely if there is a problem with your performance and can they arrange for supportive measures to address the concerns they might be having with your practice. Then document the discussion and hand them a copy. Once they know you document and record stuff; they usually back down.
Written warning: Issue your bully-boss a letter outlining your concerns and ask them to stop. Invite them to discuss it with you in the presence of your union rep, a colleague or their boss. cc a copy to union/legal rep (discuss with union/legal rep first).
Tactlessly:
Class action: Bullies rarely pick on just one person; once you have 3 or more ‘victims’, go to their manager and complain in person.
Sniper rifle; with dum-dum bullet: Email their boss with concerns, with evidence if available. cc a copy to your union or legal rep and make sure it’s blatantly obvious in the email you’ve done that – external forces scare managers.
Gatling gun random method: Fire off an email or 10 to several managers (DoN, administrator, clinical director,etc) cc to union/legal rep as above – You have to be deadly accurate with any information and opinion and have some evidence to back any claim you make. Rarely will they all come back at you – they usually just prefer to stop the emails coming and will raise it with the bully concerned who then becomes aware that they are on the ‘radar’.
Other tactless methods are available, but creativity is required and possibly a good legal defense. It might be unethical of me to post them all here 🙂
Once again, these are methods I’ve done and haven’t always gone badly. They come with no guarantee 🙂