Managing In-appropriate Staff Behavior
In the case study, there are some problems and issues that are evident which are affecting the integrity of the nursing profession. Among these problems is the in-appropriate behavior of the senior registered nurse (RN) who was obviously upset for losing the appointment for the position of Assistant Director of Nursing (ADON). Her attitudes was affecting the patient care as she tends to be abusive with some patients particularly with the 94 year old frail lady, as well as with her relations with other staff and the newly appointed ADON for issuing derogatory remarks. Another problem is that the behavior of the senior RN is creating trouble not only with her co-employees but among patients as well, as she exhibits destructive attitudes by making in-appropriate negative statements and ill treatment of older patients. A further issue is that, it was quite evident that the problem has been going on for a period of time. The reactions of the older patients interviewed reflects that are used to the attitude and behavior of the senior RN, and they simply avoid getting under her care. If this is the case, the issue is grave abused of the ethics of the profession and unfit conduct of a health care professional.
In order to appropriately define the problem, it is important to identify the proper behavior of a health care professional. Charles R. McConnell stated that professional behavior
“does not seek status as one’s primary goal, does not attempt to acquire the advantages of both the exempt and none exempt employee while avoiding the disadvantages of both, is accepting of the responsibility of the profession, is supportive of both the ethics of the profession and the policies of the organization, and is result oriented as opposed to task oriented” (p. 66).
Based on the reactions of the older patients on the query regarding the behavior of the senior RN in her treatment of them, it appears that the complaints of the two qualified registered nurses about the behavior of the senior RN are true. The senior RN is supposed to exhibit flexibility and ethical behavior while performing her duty. The fact that they ignore her and just prefer not to respond although they are “very offended and upset by her actions” to avoid being implicated in any unconstructive care consequences that may result, defines her actions to be unethical and unfit conduct of a health care professional.
The Gaps in the Information Provided
However, despite of the confirmation regarding the complaints, there are gaps on the information given. First, it was not clear whether she was by passed in the nomination process for the appointment, the reason why she was so upset, second, the information failed to clarify whether her actions occurred only after she failed to be appointed as ADON, or it was her consistent character, as she may have just been misinterpreted in her actions. To some extent, it looks like the older patients have been used to her actuations but merely afraid to speak out. If this is the case, her in-appropriate behavior has nothing to do with my appointment as ADON but it has something to do with her demand for fast accomplishment of the task.
The Problems and Issues organized into Heading
The in-appropriate behavior of the senior RN is a grave abuse of the ethics of the health care profession, an unfit conduct of a health care professional.
The attitude of the senior RN is affecting her relationship with her colleagues and the patient care.
It was her habit to display such in-appropriate behavior when she wants things done.
The Leadership Model
One of the leadership models that can help in analyzing the situation in the given case study is the Servant Leadership Model. Larry C. Spears and Michele Lawrence stated that servant leadership is not about a personal quest for power, prestige, or material rewards but a “true motivation to serve others” (Spears & Lawrence p. 144). Spears and Lawrence pointed out that servant leadership is not about controlling or wielding power but “works to build a solid foundation of shared goals by listing deeply to understand the needs and concerns of others, and working thoughtfully to help build a creative consensus…” (p. 144).
This type of leadership model provides many areas wherein the problem and issues can be analyzed. The problems and issues above seemed to anchor on personal interest and motivation that when it is not satisfied, it leads to an upset feelings resulting to in-appropriate behavior. Since this leadership model is based on ‘solid foundation of shared goals’ it is concern on the problems and is willing to listen and to settle the problem.
Another leadership model that could be of help in analyzing the case study is the Spiritual Leadership which emphasizes ethical behavior, values, relationship, skills, and a healthy balance between work and self. Linda E. Swayne and W. Jack Duncan cited that spiritual leadership “emphasizes a high interest in ethics, relationship skills, and a balance between work and self” (p. 381). They explain that spiritual leadership occurs when behaviors as follows are practiced,
a.) Focus on Values – Swayne and Duncan stressed those values such as ethics, quality, diversity, and spirituality influences the way executives’ leads…and the standard they set for the organization (p. 381).
b.) Provide employees with an opportunity to explore and express their spirituality Swayne and Duncan noted that people “enter health care because they consider it a calling and want help people” (p. 381).
c.) Plan for and encourage community involvement –Swayne and Duncan emphasized that an organization that values caring for others “will reach beyond its walls and care for the need” (p. 381).
Based on the above leadership models, the problems and issues identified in the case study are undeniably ethical and obviously, there are undesirable motives hidden in the actions of the senior RN which made her abusive in her treatment with patients and colleagues. It is clear that her actions did not match to her supposed duty as a health care professional and she is liable for those actions.
Models of Leadership that could help Progress resolution of the Situation
One of the concept of leadership that may help progress resolution is the Cognitive Skills of Leadership which is commonly called ‘helicopter view’ or as Roger Gill explained, “the ability to see a problem or issue in context and to focus on the detail and to move easily between each activity” (p. 66) However, Roger emphasized that leadership concept is not sufficient with out wisdom. Citing Sternberg’s correspondence, Gill puts it “the extent to which a leader uses successful intelligence as moderated by values to seek to reach a common good by balancing intrapersonal, interpersonal, and extra personal interests…” (p. 66).
In addressing the problems and issues in the case study, it is important to see the problem and the issue in its context. That means there is a need to consider the reasons behind the in-appropriate action of the senior RN and resolve the issue with balanced and intelligent judgment including her unethical behavior. Donna Hardina et al cited that “once staff members are hired, it is imperative that social service organization holds staff accountable for their actions” (p. 208). Based on the Hardina’s argument, the senior RN is accountable for her action before the social service organization she is working with. The senior RN should be subjected to performance evaluation which includes an objective investigation of her alleged inappropriate behavior, and if she is proven guilty of the complaints she should be meted with disciplinary actions to which the weight is based on the degree of her wrong doings (Hardina p. 210).
Health care organization cannot afford to tolerate wrong doings of any employee even if the wrong actions were committed by some body in position. The senior in-appropriate behavior of the senior RN can be harmful not only to the patient but to the organization too. Ed Lamb noted that code of conduct is very important in the organization, because frightening and upsetting actions can trigger medical errors and add to poor patients’ approval and to avoidable unpleasant results (Lamb). According to Lamb, the primary reason of the dissatisfaction and discouragement in the work place is the disruptive behavior. Lamb Cited that health care organizations should develop and implement a code of professional conduct written with input from various groups that are covered by it and enforce disciplinary actions against erring members.
Thus, it is very clear that the senior RN’s behavior is in-appropriate and is subject to disciplinary actions what ever reason behind it. As a health care professional she has a duty to exemplify professionalism particularly in her dealing with patients. Therefore, the first resolution that has to be made is to propose for investigations of the allegations of the two qualified registered nurse about the abusive treatment of the senior RN of the elderly patients and her derogatory remarks against the newly appointed ADON.
Based on the different leadership models and concepts, the senior RN’s action has no place in the health care service and should not be tolerated by any health care organization, even if it was triggered by an upset feelings because she was by passed in the appointment process for the position of ADON. The investigation will be conducted to find out the gravity of the offence and what kind of disciplinary actions will be meted against her. Norman Brand, Patricia Thomas Bittel, and Henry G. Stewart cited that suspension or discharge is upheld “where there has been a prior disciplinary action, or if the conduct has been repeated or was particularly egregious, even when the harassment takes place away from the employer’s work site” (p. 299).
In the case of the senior RN if her actions were caused by upset feelings because she was by-passed in the appointment process, she will be reprimanded of such inappropriate behavior but will be given only light disciplinary actions in order not to aggravate her feelings, however, if the same offense happened she will have no excuse for a full disciplinary actions.
Brand, Norman et al. Discipline and Discharge in Arbitration USA: BNA Books 1998.
Gill, Roger Theory and Practice of Leadership Great Britain: Sage Publication, 2006.
Hardina, Donna et al. An Empowering Approach to Managing Social Service Organizations USA: Springer Publishing Company, 2007.
Lamb, Ed “Tolerating Bad Behavior May Impact Health Facilities Accreditation”
Connell, Charles managing the Health Care Professional UK: Jones and Barlett Publishers, Inc., 2004.
Spears, Larry C. & Lawrence, Michele Focus on Leadership New York: John Wiley & Sons, Inc. 2002
Swayne, Linda E. & Duncan, Jack Strategic Management of Health Care Organizations UK: Blackwell Publishing, 2006.