Katie Connors is nurse manager of the birthing center in a metropolitan hospital. The hospital has several different nursing programs that utilize various patient care units for clinical instruction. A student nurse, Amber Schroeder, was assigned to work with Natalie Cole, RN, for the day shift. Natalie and Amber’s patient arrives at the birthing center for induction of labor. During the admission process, the patient confides to Natalie and Amber that she is terrified that she might need a caesarean section. Amber tells the patient that a young woman and her baby recently died at the hospital during an emergency C-section. The patient begins to hyperventilate, refuses to let Natalie continue with the admission, and threatens to leave the birthing center. Natalie is so angry at Amber for scaring the patient that she grabs her by the arm and pulls her out of the room. Natalie loudly berates Amber in the hallway to the point that Amber is crying. Katie hears the commotion in the hallway and instructs Amber to sit in the staff lounge until her instructor can return to the unit. Katie and Natalie reassure the patient, who allows Natalie to complete the admission process. Throughout the shift, Natalie tells every staff member and physician about Amber’s “stupid comment.” Katie speaks with the nursing instructor and Amber about the incident. She also checks back with the patient and gently gathers facts about the incident. Katie is concerned about Natalie’s response to the situation. While Natalie has excellent nursing skills, she has often been abrupt or rude to other staff members. Katie has coached Natalie on her communication skills in three other specific incidents and verbally warned Natalie about her lack of professional communication. After discussing the incident with the human resources manager, Katie agrees that a written warning will be placed in Natalie’s personnel file. At the end of the shift, Katie requests that Natalie come to her office to discuss what happened with the student nurse. Katie informs Natalie she is disappointed in how she reacted to the inappropriate comment made by the student nurse. Specifically, physically grabbing the student and verbally attacking her in front of patients and staff was unacceptable and violates hospital policy. Further, Natalie continued to disparage the student to other staff and physicians, which is also unacceptable. Natalie expresses her frustration at the thoughtlessness of Amber’s comment. Katie tells Natalie that while Amber’s comment was inappropriate, Natalie’s response was also inappropriate. Katie reinforces to Natalie the importance of professional communication at all times and reviews the communication points she had provided to Natalie in the past. She also informs Natalie that she will have a written warning placed in her personnel file. Natalie apologizes for her actions and assures Katie she will work on her communication skills. Katie documents the incident and follow-up action in Natalie’s personnel file.

Manager’s Checklist

The nurse manager is responsible for:

● Collecting all necessary facts related to the disciplinary situation

● Communicating with the human resources department and nursing administration about the offense and appropriate penalty

● Disciplining the employee in a timely manner

● Providing strategies to the disciplined employee to improve his or her behavior

 ● Clearly and firmly communicating expectations for appropriate behavior

● Documenting the outcome of the discipline as appropriate

 ● Following up with the human resources department and nursing administration regarding the outcome of the discipline