Am Boss of Nurse Who Does Not Think For Herself?

Question to Ask the Workplace Doctors about a nurse with poor performance: She is bringing everyone down, and no one wants to work with her!!!! Help Me

I know she has been working here like this for a long time. Yes, she’s a nurse and shows up for work, but she monopolizes the nurses’ aides’ time. She wants them to do all her work–take a patient off the bedpan when she’s in the room and answer a call light when she is standing socializing. She is unorganized, has trouble prioritizing does not follow policy with medications, and is unable to critically think for herself. It really boggles my mind that she is working like this.

I used to work on the floor beside her, and to be honest, I was so wrapped up in taking care of my own patients that I did not see the whole picture. I am now her boss and I see how everyone is working, and she is a weak link. The boss before me knew of her problems but did nothing. The problem is she has been working like this for a long time, so how do you change some one who has been practicing like this for so long? I am scared for her patients. She is bringing everyone down, and no one wants to work with her!!!! Help Me

Signed, Now I’m In Charge

Dear Now I’m In Charge:

So you are in charge. Congratulations. Now, no matter how well or how poorly the former boss carried out her duties, the question is: Will you take charge? That means making sure that high quality care is delivered to ALL patients.

Apparently, a clarification of job description is in order for this individual nurse whose failure to do her job worries you. A private session with her spelling out job duties in writing is called for. Sure, she might have gotten by with what you observe as poor work practices so long that they have been stamped in as habits. To extinguish them probably will require guidance, motivation, cooperation, and persistence.

The guidance and persistence are up to you. Now how do you acquire her cooperation and motivation? In the first session you might open the conversation by inviting her to describe the quality of work that she wants in your department. You might then confirm those dos and don’ts that she has named with which you agree. Next you can present the list of dos and don’ts that you want for your people.

Here is where you frankly and professionally talk with her about the quality of nursing that you expect and you ask for her to do her part to make that happen. And you set weekly “How’s it going sessions?” for one or two months to praise the positives and correct the negatives. Hopefully this will stamp in the good and out the bad. Should she feel like you are singling her out if you do this only with her? Probably. But she will not if also you meet with each of the other nurses and aides under your wing to do the same. The only other way to approach this is to have work group meetings to engage everyone in skull sessions that review what went well and to applaud each action that merit it and you engage all in setting forth the goals for transforming your work group into a team; a team that helps each other deliver quality care and to avoid mistakes.

Both individual and group sessions are what you might consider if you want your crew to be a happy “can do” team. Our Archives have lots of advice about team building.Will you keep us posted on what you do and how it works or falls short? Working together with hands, head, and heart takes and makes big WEGOS.

Second Opinion: Barry Hester, one our guest respondents, has sent his advice. It comes a bit late because your question that I shared with him was misplaced. It provides a bit different perspective, one from that of an administrator and who has members of his family in the medical profession–his wife is a nurse and son a doctor:

Dear Nurse, You cite several problems related to the worker on your floor. If you “are scared for her patients,” a legal and ethical issue is at hand. If you “are now her boss” the responsibility and authority to correct the problem is yours. You have the power; use it and don’t look back. A conference with this worker and a firm directive is in order. Get your ducks in a row and do it. Your first step would seem to be documentation. You need to concretely present the issues to her and demand improvement. Keep note cards on your person.

Maintain notations relative to her inefficiency and policy violations. Include dates, times, incidents in detail, and any witnesses who might be present. Do so for several days and summarize your observations in document form. You then need to schedule a conference. Start this conference by presenting to her, and reviewing with her, the published job description. Emphatically emphasize that she is not meeting its expectations. She will most probably be resistant.

At this point present your documentation and review it. Give her a copy for her records and maintain one in her personnel file. The next step is an improvement plan. You can do it, but it will be more effective if she does so. By all means give her a concrete deadline for its submission. You then review it and add to it those expectations she does not address. Schedule a second conference, review this plan, and set up time lines for evidence of improvement.

After each conference summarize it in memo form and provide the employee a copy. Use such terms as, “I directed you to- – -; It is imperative that you – – – ;I shall expect you to- – – .” Also include in this summary a statement that disciplinary action is pending unless terms of the plan are met. Have the employee sign the document and place it in her personnel file. If your operation has an educational director, you might want to involve this person who can offer classes and/or materials to supplement the improvement plan. Do not let this problem linger. You as well as your employer are liable for damages if negligent patient care exists. If requirements of the plan are not met within a reasonable timeline, the employee should be dismissed. Good luck. I hope the employee gets the message and preserves her job.

Barry Hester & William Gorden