1. Hader, Richard RN, CNA, CHE, CPHQ, PhD, FAAN

Article Content

Why have you placed me in the position to decide whether or not to terminate you? This is my first thought when I'm confronted with the difficult prospect of involuntarily separating someone's employment. Making the decision to let an employee go is one of the most difficult challenges for nurse managers. Because of the ramifications of the decision, we must be confident in our ability to thoroughly investigate the circumstances surrounding the incident, and objectively formulate a judgment based on fact, adherence to standards, and behaviors of professional performance.


Far too often during my career, I've sat in suspension hearings and heard recanted situations of professionals who have made the choice to steal, portray behavior of physical or verbal abuse in the work setting, significantly jeopardize patient safety, or use extremely poor judgment in a variety of clinical or interpersonal relationships. How do you begin to sort through the facts and dismiss emotion to effectively make an informed and appropriate decision?

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

A manager must undertake a thorough investigation of the incident. Discuss the situation with others who witnessed the event. It's imperative to obtain the particulars in sequential order and document the findings as you've obtained them. Take notes so that you're sure you don't neglect important information that may be necessary to defend your position if later challenged.


Conscientiously listening to the employee tell her side of the story is essential. Oftentimes when a manager listens to the employee's perspective of an event, it may yield evidence that suggests system problems, stress in the workplace, or poor implementation or understanding of policies, procedures, or practice. These situations require immediate management intervention to prevent a recurrence of a similar event.


If the employee made an error in judgment or action, does he understand that he made a mistake? Does she illustrate remorse or demonstrate an insight into her actions? How will he best handle this type of situation in the future? The manager must receive the answers to these questions prior to a final determination of their employment.


When a co-worker is terminated for performance, it affects the entire department. Typically, sides will be taken, and potentially the nurse manager is in conflict with some of the members of her staff. At times, sharing the facts of the case may be beneficial to improve the quality of care or safety of patients, or to highlight the need to ensure that the staff continues to perform at acceptable behavioral standards. It's imperative for the manager to remain objective and share only that information which is relevant to the entire team. Through a consistent approach, the staff who objected to your decision will eventually come to understand the rationale for your approach. Managers are more likely to lose credibility and the respect of their staff if they fail to take the necessary action that's required to maintain a positive work environment for both employees and patients.


Due to the case of Charles Cullen, the nurse who claims to have killed 40 patients with lethal doses of medication, many states now require employers to notify the Board of Nursing if they terminate a nurse or if the nurse resigns while under investigation for performance-related issues. Nurse managers should share all the facts with the Board and allow its members the opportunity to conduct their own investigation into the matter to determine if any action is necessary against the practitioner's license.


Whatever the situation, it's always difficult to terminate the employment of a colleague. Nonetheless, it's incumbent upon the nurse manager to act in a responsible manner and make a decision after carefully deliberating on all aspects of the event.


Richard Hader