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ALLEN COLLEGE
NU: 460 Nursing Leadership and Management

Managing Personal/Personnel Problems

Chapter 24

Objectives:
1. Differentiate common personal/personnel problems.
2. Examine strategies useful for approaching specific personnel problems.
3. Review the roles and responsibilities of the Human Resources department.
4. Identify the crucial aspects of the nurse managers role in documentation and
implementation of personnel problems.

Personnel Problems

I. Personnel Problems
A. Absenteeism
Really a side effect of personnel problems
Contributing factors may include:
- Poor employee health
- Poor family health
- Job stress
- Poor support
- Nurse fatigue
- Poor work satisfaction

May be linked to role stress and role strain (based on framework of role
theory)
- Employees withdraw from their situation
- Many times you see increased absenteeism before employees leave
their positions

Attendance policies must be in place and enforced consistently

Employee motivation is affected by four factors:
1. Job itself
2. Organizational practices
3. Absence culture
4. Employee attitudes

Nonpunitive discipline:
step 1: oral reminder of standards
step 2: written reminder
step 3: decision point
step 4: termination if employee decides not to adhere to standards or if
he/she says they will adhere and then does not.
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B. Uncooperative or unproductive employees

1. Two related dimensions: motivation and ability

a. Lack of ability: lack of competence. They dont know how to do it.

Educate them.

b. Lack of motivation: dont want to it, but they know how to.

C. Immature Employees
1. Emotional intelligence underdevelopment
- Socially inept
- Cannot control impulse
- Emotional and defensive
- Do not recognize their own behavior
- Hostile
- Challenge authority

2. Nurse manager response: relate to employee in positive and mature

manner. Try to use humor to reengage the employee.

D. Clinical incompetence (Can be at any level)

1. Concept of collegial accountability: coworkers cover for incompetent
employees

2. Skills checklist:

- Used to evaluate competency levels

- Ensures ongoing competencies are maintained
- Demonstrate ability to perform specific functions on the unit

E. Emotional problems
1. Manifestations:
- Decrease productivity
- Increased errors
- Poor judgement
- Negative attitude
- Sick calls

2. Managers responsibility: identify the issue, provide support, assist to

professional help if needed
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F. Chemical dependency

Impacts the unit, patients, and coworkers

Coworkers must report ASAP
Managers must intervene
Keep the relationship professional
Refer for help/EAP/rehab
Offer support

G. Incivility
Lateral or horizontal violence
Bullying
Interpersonal conflict
May include the following behaviors: criticizing, backstabbing,
refusing to help, sabotage, etc.

Managers responsibility: intervene immediately, zero tolerance

attitude, start with talking to the nurse, then move to written
discipline and follow discipline policies and procedures

H. Documentation
** Most important aspect of nurse managers job
- Document at time of incident
- Include: date, time, incident, actions taken, and follow up

I. Progressive discipline
- Counsel
- Reprimand-verbal then written
- Suspend without pay
- Return to work with plan to change
- Terminate

J. Termination
Must follow established guidelines
Results from failure on the part of the employee to change a problem
behavior
Third party present to serve as witness
Guidelines:
- Manager must have done everything possible to help the employee
- Manager must recognize their continued employment will have a
negative effect on patients
- Employee has to be fully aware of problems
- Consult human resources
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ALLEN COLLEGE
NU: 460 Nursing Leadership

Case Study Ethical Decision Making Personnel Problems

Mary Kay OConnor has been working in the intensive care unit (ICU) for over six
months. Mary Kay came to the unit after several years of experience on a medical-
surgical unit in another institution. Mary Kay loves her work and finds the staff
approachable and competent.

One evening, Mary Kay noted that the narcotic count was off. Mary Kay tried to find out
what had happened to the missing narcotic. She reviewed the charts and patient
requirements and could not locate the missing morphine. She reviewed the hospital
policy for such a problem, called the evening supervisor, and filled out the appropriate
forms.

Mary Kay did not give the matter another thought. She assumed it was an oversight, and
she was happy to learn how to handle such a situation for the future.

A month later, the same thing happened, and Mary Kay was working with the same staff
personnel. Mary Kay observed the staff and suspected that one of the new registered
nurses might have a drug problem.

Questions:

1. What should Mary Kay do?

2. What are the pros and cons for any action she may take?
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Personal/Personnel Problems

Learning Exercises:

1. Review a healthcare organizations policies regarding termination. What are the

conditions, such as stealing or violence, that are described as cause for immediate
dismissal? Is abusing substances at work one of those conditions?

2. Review the policy manual at a local healthcare organization. Determine what

constitutes excessive absenteeism. What are the identified consequences?

3. As a nurse manager in a community health agency, you have just had a meeting
that was called by several of your staff nurses. They expressed concern regarding
another nurse colleague who has come to work tearful several times during the
past week. They state she often goes into the break room when she is in the
agency and appears as if she had been crying when she comes out. She has
refused to discuss her distress with her colleagues. These nurses express concern
and want you to help her. What is your response? What would you do?

4. Review your states nurse practice act and rules and regulations. What are your
required to do if you believe a nurse has a problem with chemical dependency?

5. Review the steps of appropriate documentation of personnel problems. Create a

scenario for an incident involving a staff nurse and prepare appropriate
documentation for your identified case.