Ask the Experts

Nurse Leader Insider, May 4, 2017

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On this week's Q&A, our experts cover disciplinary actions and advanced beginners. Have a question for our HCPro authors? You can send them here.

I am new to the nurse manager’s role and still have trouble distinguishing between the different steps of disciplinary action. Can you identify each step and a necessary instance to use them?

The disciplinary process should be implemented in a progressive, step-by-step approach. As inappropriate behavior increases, your disciplinary actions should intensify, ultimately reaching termination if the employee's behavior does not meet established expectations.
Progressive discipline consists of four steps:

1.    Oral notice: The first step in disciplinary process and it notifies an employee that he or she is not meeting expectations. Such a notice is appropriate when an employee violates a minor policy or procedure that does not jeopardize patient safety. Note that the oral notice is a disciplinary action, and your behavior should reinforce that.

2.    Written reprimand: If, after the oral warning, an employee continues to engage in inappropriate behavior or in practices that endanger patient safety, a written reprimand is necessary. The written reprimand is a serious disciplinary action that lets the nurse know that his or her behavior must improve or job suspension/termination will be imminent.

3.    Suspension: When an employee is suspended, he or she is sent off the job for a specific period of time. Suspending an employee is fraught with legal consequences for the employer, so do not make the decision to suspend an employee on your own. Consult with your supervisor and your facility's human resources department.

4.    Termination: No matter how hard you try, some workers are unable or unwilling to improve their job performance and must be terminated from their position. One instance where termination would be necessary is when you consistently address the employee's behavior, but the employee continues to perform below expectations. Once again, when making the decision to terminate an employee, consult with your supervisor and human resources department.

- Dinah Brothers, RN, JD

Could you please explain the characteristics of an advanced beginner in staff development?

The advanced beginner is not a nursing professional development (NPD) specialist. They have dealt with enough “real life” situations in the form of inservice and just-in-time training that they know that learning activities must incorporate the principles of adult learning, have a purpose that is communicated to the learners, have specific learning objectives, contain appropriate content, and a mechanism for participants to evaluate the learning activity. They follow specific rules and guidelines and are fairly easily “thrown” by the unexpected.

For example, advanced beginners know that resistant learners cannot be allowed to disrupt the education activity. They have been taught specific strategies to deal with resistance and may even have implemented such strategies on occasion. But the first time their repertoire of strategies fails to defuse the resistance they are likely to become flustered. Or they may not be accustomed to receiving a significant number of “negative” comments on evaluations completed by learners. They follow the “rules” for good inservice planning and may be easily offended by negative reactions.

Advanced beginners may be novices who were nurtured and are now ready to assume their initial role in staff development. They may be candidates from another organization or facility who are already well-versed as advanced beginners and are looking for a new employer. Whatever the case, advanced beginners should receive a thoughtful, thorough orientation and become part of an environment that will nurture their professional growth and development.

-Adrianne E. Avillion, DEd, RN


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