The Challenging Workplace

Chapter 12

Challenging Interactions • Personal embarrassment – Put things into perspective – Use some humor • Personal attacks and disruptive behavior – Verbal attacks – Inappropriate in the work setting – Considered abusive behavior

Challenging Interactions (cont’d) • Complaints – Legitimate complaints need to be addressed and dealt with promptly – Use good interpersonal skills • Anger – Frequently encountered in the health care environment – Goal should be to diffuse the anger

Anger • Normal emotion, occurs when: – Unjust or unfair situation – Individuals rights aren’t respected – Individuals expectations aren’t met – Someone is hurt, frustrated, or afraid • Stimulates “fight or flight” response • Expression can differ depending on culture and background

Anger • How to cope: – Remain objective, depersonalize the anger – Use active listening – Be empathetic – Speak in a calm, clear tone; do not provide additional threat or cause for frustration

Challenging Interactions (cont’d) • Coercion –Places us in intrapersonal conflict –Inherent dangers –Ethically wrong!! • Divided loyalties –Middle management role –Honesty –Confidentiality

Divided Loyalties • Divided Loyalties – If you are in the middle of 2 groups, and must meet the needs/expectations of one, while advocating for another – Example: manager with administration and staff – Example: RN with physician and patient • Must maintain confidentially standards at all times – Managers may hear policy changes weeks before employees do – May hear patient diagnosis from physician before it’s disclosed to patient

Question • Which of the following places us in the position of having intrapersonal conflict?

A. Anger B. Coercion C. Complaints D. Divided loyalties

Answer B. Coercion Rationale: coercive situations are stressful because they place us in intrapersonal conflict. We are eager to please those who supervise us but we are unwilling to compromise our own ethical standards to do so. To remain true to one’s own convictions and values, it may be necessary to directly oppose one in a superior position.

The Chemically Impaired Employee • The ANA Code for Nurses states that a nurse “must be vigilant to protect the patient, the public, and the profession from potential harm when a colleague’s practice, in any setting, appears to be impaired.” It also states, “If the impaired nurse poses a threat or danger to self or others regardless of whether the individual has sought help, the nurse must take action to report the individual to persons authorized to address the problem.” (ANA, 2001)

The Chemically Impaired Employee • The BNE and Nursing Practice Act detail how this situation is to be dealt with • http://www.bon.state.tx.us/nparr.htm

• http://www.texasnurses.org/tpapn/

The Chemically Impaired Employee • Organization Effects: – Sickness – Absenteeism – Tardiness – Accidents – Errors – Decreased productivity – Staff turnover

The Chemically Impaired Employee • Employee Effects: – Physical deterioration – Undetected/untreated illness – May put patients at risk through impaired judgment, decreased psychomotor skills

The Chemically Impaired Employee (cont’d) • Understanding the problems – In 2001, substance abuse was listed as the number one reason by state boards of nursing for disciplinary action – Diversion programs – Be aware of the policies of the licensing authority in your jurisdiction – Early recognition and treatment are critical

The Chemically Impaired Employee- Manger Role • Identifying the problem – Denial is a key aspect – The employee’s personal and professional life becomes focused on his or her need for drugs • Gathering and analyzing the data – Gather as much data to support your suspicions as possible * Note dates/times of incidents in writing – Check narcotic records for inconsistencies

The Chemically Impaired Employee (cont’d) • Anticipating the next step – Review policies and procedures – The Americans With Disabilities Act (ADA) • Meeting with the employee – Arrange a meeting to discuss the problem – Do not preach, moralize, rebuke, or blame – Observations should be supported by documentation

The Chemically Impaired Employee (cont’d) •Documenting – Should include facts as to who, what, when, and where – Should be objective- only facts – Documentation should include: o Date o Time o General content and decisions reached at any meetings that take place

The Chemically Impaired Employee (cont’d) • Referral and follow-up – Employee assistance programs – Implement policies developed by the institution – Intervention – State programs – The goal is to rehabilitate the impaired nurse – Guidelines for reentry into the workplace

Question • Jocelyn has a long history of tardiness and absenteeism. The nurse manager begins to note other evidence of erratic behavior and has received several patient complaints. The nurse manager suspects that Jocelyn has an alcohol abuse problem and contacts the hospital’s employee assistance program. What might be planned to help Jocelyn with her problem?

A. A conference B. A seminar C. An intervention D. An indictment

Answer C. An intervention Rationale: in some instances, there may be clear evidence of chemical impairment or substance abuse. In these situations, the employee assistance program may arrange for an intervention.

Boundary Violations • Boundary violation refers to a situation in which nurses move beyond a professional relationship and become personally involved with their patients and the patients’ lives

Boundary Violations (cont’d) • Professional boundary – An abuse of the power of the position – Affects individuals physically, emotionally, mentally, and/or spiritually • Professional sexual misconduct – Extreme form of boundary violation – Importance of the perception of the patient

Boundary Violations (cont’d) •Overinvolvement – Overidentifying with a particular family member – Pseudofamily relationship – Serious implications o Nurse’s work and personal life may suffer o Possibility of legal action by family

Boundary Violations (cont’d) • Early indications – Spending extended time with a client beyond assigned duties – Visiting the client when not on duty – Showing favoritism or possessiveness of a client – Trading assignments to be with the client – Meeting clients in isolated areas not required in direct patient care – Excessive personal disclosure by the nurse

Boundary Violations (cont’d) • What to do – Carefully document – Share information with immediate supervisor – Follow policies and procedures • If minor or elderly adult – You must take immediate action – Notify supervisor or administrator on call – Do not try to investigate without law enforcement

The Incompetent Employee •Health care facilities – Checklists – Skills tests – Required by the Joint Commission

The Incompetent Employee (cont’d) • Incompetence must be addressed – Problem identification – Data gathering – Meeting with employee – Documentation – Follow-up – Remediation plans

The Employee Exhibiting High Absenteeism •Effects – Financial – Unit morale – Role stress – Frustration

The Employee Exhibiting High Absenteeism (cont'd) • Organizational approaches to absenteeism – Report to manager – Combine all types of leave • Managerial approaches to absenteeism – Difference in value systems – Appropriate record keeping – Damage control

Nonproductive Employee for money Behaviors • The employee motivated by self-interest- in it • The employee who is a doomsayer – Negative without suggestions for improvement – Involve in team activities • The employee who is insubordinate – Help change behavior • The employee who is an accommodator • The employee who is a superachiever – -point out unacceptable behavior • The marginal employee – Help develop goals for improvement

The Employee Experiencing Emotional or Personal Problems • Important to recognize • Assist the employee to get professional help • Manager needs to be supportive, understanding, and helpful, but do not become their counselor

The Employee Experiencing Emotional or Personal Problems (cont’d) • Mental health problems –Appropriate referral –Human resources –ADA

Question • Is the following statement true or false?

There is an employee on your unit that you believe has a mental illness. When documenting what you have seen, you should include your diagnosis of the problem.

False.

Answer Rationale: although a manager may suspect that an employee has a mental health problem, the manager’s role is not to diagnose.

The Importance of the Coaching Role • Be seen as “trying to be helpful” • Be certain that the employee understands what you expect • Select the right time and place to discuss your concerns • Give specific suggestions for change • Recognize the change and commend the employee

General Guidelines for Working with Problem Employees • Treat all employees with dignity and respect • Set an example for others • Give credit for good ideas, good work, responsible behavior, and actions that go the extra mile • Address problems as soon as possible

General Guidelines for Working with Problem Employees (cont’d) • Develop active listening skills • Be honest and forthright in your dealings with others • Be slow to judge others • Know your own limitations • Place a high value on good interpersonal skills and excellent communication