1. Hader, Richard RN, CNA, CHE, CPHQ, PhD, FAAN, Editor-in-Chief

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Criminal activity, insubordination, unsafe practice, discrimination, and threatening or intimidating others are often punishable by termination. As a leader, dealing with these issues can be difficult because you're often called on to serve as investigator, interrogator, prosecutor, judge, and jury. If you don't fully understand the consequences of each of these roles, you may find yourself in an uncomfortable position: The ramification of your decision may lead to a staff member's job loss and, subsequently, that staff member may experience economic insecurity and difficulty attaining new employment.

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Most frequently, a patient, family member, or peer tells you of a staff member's inappropriate behavior that you didn't witness firsthand, requiring you to facilitate an intensive investigation to determine the facts of the situation. This may seem like a simple task, but all too soon you're likely to find that conflicting views and interpretations of the event exist. As you gain more information, it's vital to remain objective with a calm demeanor because the seriousness of the event often sparks strong and turbulent emotions.


Be systematic, not sympathetic-remember, your role is to enforce policies and ensure that patients receive quality care in a safe environment. Allow all involved parties the opportunity to share their perspective on the events. After you've heard from everyone, begin your inquiry by asking open-ended questions, then transition to more specific inquiries. Because these situations often require referral to chronologic and verbatim details, you should take specific notes during your investigation.


You must also have a thorough knowledge of your organization's disciplinary procedure. Failure to follow human resource procedures may result in legal retaliation against yourself or your institution. Involve your human resource professional early in the process. If the staff member is represented by a bargaining unit or another peer assistance program, notify his or her delegate as soon as possible of an impending discipline.


If a reprimand is warranted, it must be carried out. Be prepared to present your case for disciplinary action clearly, concisely, and without bias by articulating the facts you've gathered. Don't be swayed by extenuating circumstances or parallel or intersecting issues surrounding the incident at hand. Your role isn't to justify or rationalize inappropriate behavior; report and take action on the facts as you know them.


If discipline is a result of criminal behavior, you must remember to involve the local authorities. Many state nurse practice acts require an organization to report disciplinary actions against a licensed practitioner. Ignoring your responsibility to do so may result in action taken against your own license.


Discontinuing the employment of a nurse is one of the most stressful leadership challenges. You must maintain composure, act as an agent of your organization, and refrain from personalizing the situation. Don't hesitate to offer assistance to the terminated employee consistent with your organization's grievance or arbitration procedures and assistance programs.


Richard Hader


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