Question 1

An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first?

Accepted Answer

1. Planning a private meeting is not the first step in the process.
2. The manager has decided discipline is required. There is no need to wait for another infraction to occur.
3. The manager must first be certain that the facts about infraction are complete and correct.
4. The human resources department should be informed, but this is not the first step.

Question 2

A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. The manager should take a few moments to prepare before this meeting occurs.
2. The manager should not include other staff in this issue.
3. The manager should not get cafeteria workers involved in this confrontation.
4. It is important to stay calm and to relate the facts. This assistant has been late twice already this week and is late again today.
5. The manager should anticipate that the assistant will offer a reason for the lateness. It will be up to the manager to decide if the explanation is reasonable.

Question 3

The nurse manager identifies a minor problem with the way a staff nurse documents client care. The manager meets with the nurse and discusses the issue, but does not issue a warning. What is the manager's next action?

Accepted Answer

1. There is no need to report the meeting to the human resources department.
2. Involving another nurse is not professional.
3. Even when the discussion does not lead to a formal warning, the manager should record the specific behavioral steps discussed with the nurse for future reference. If there is absolutely no record of what was said, the manager may forget and be unable to evaluate the nurse's progress.
4. Telling the nurse that a warning may occur is a threat and could negate the atmosphere of trust established by the meeting.

Question 4

A certified nurse's aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective?

Accepted Answer

1. Asking if the CNA needs a class on hand hygiene is demeaning.
2. The employee needs to realize the unwanted behavior has consequences for the client. A better understanding may prevent the behavior in the future.
3. There is no choice except for the CNA to perform hand hygiene. Why it is not being performed is not as important as reinforcing the need.
4. The employee must understand the consequences if the behavior does not change but this should not be communicated in a threatening manner.

Question 5

An OB nurse has violated a unit policy. The OB manager is discussing the incident with the nurse. During the discussion, the nurse informs the OB manager of the actions of other staff and the physician's attitude leading up to the event. How should the manager address these issues?

Accepted Answer

1. The physician's attitude is not the issue the manager is addressing at this moment.
2. The nurse is already aware of the policy violation because it has been discussed.
3. The physician's attitude and the staff's actions are not the issue the manager is addressing at this moment.
4. The nurse may be attempting to divert the manager's focus from the nurse to others. The focus of this discussion is the nurse's violation of policy.

Question 6

A nurse has frequent visitors while working. The manager has discussed with the nurse the negative effect of these visits on client care. What should the manager do next?

Accepted Answer

1. Having staff monitor the actions of a nurse is not appropriate.
2. Arranging for a follow-up meeting allows for evaluation and communication regarding the issue.
3. There is no reason to talk to all staff concerning personal visitors.
4. Being visible on the unit when this nurse is working may adversely impact the manager's productivity. It is also a transparent method of "watching" the nurse.

Question 7

The staff has complained that a nurse receives frequent personal phone calls, which is a violation of policy. In what manner should the manager address this nurse?

Accepted Answer

1. The manager should address the behavior in private and investigate the situation.
2. It may or may not be appropriate to give a warning.
3. It is not necessary to tell the nurse that peers are complaining about the phone calls if it is a violation of policy.
4. It is inappropriate to have nursing staff address the issue.

Question 8

A charge nurse on the night shift did not notify the anesthesiologist regarding an emergency case. The manager investigated the matter and learned the charge nurse thought the primary care nurse would call the anesthesiologist. Which response by the manager would be most appropriate?

Accepted Answer

1. While this is probably a true statement, it is not the best response to the situation.
2. The manager should obtain information; ask questions in a calm manner and offer instruction or solutions so the supervisor learns from the experience.
3. The manager should remain calm while coaching.
4. The question regarding the urgency of the case is not applicable to the situation.

Question 9

A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. The manager should keep notes on everything discussed regarding discipline. This would benefit the institution.
2. Even though coaching is done in short sessions, it should be documented.
3. Intervention in less than 1 day shows that the manager was aware of and quickly handled problems.
4. The HR director would be party to problems with employees. This does not violate confidentiality.
5. This note could be a problem for the institution as it is the manager's opinion, not a defensible fact.

Question 10

Which statement by the nurse manager is the best example of day-to-day coaching?

Accepted Answer

1. This is not a good example of coaching because 30 minutes is too long for a coaching session.
2. Giving advice about child care assumes the manager knows the employee's problem.
3. This statement is accusatory and would not set up a good coaching opportunity.
4. Coaching is a mentoring relationship. It is a brief interaction.

Question 11

The nurse was reported for not following unit policy in relaying a client's complaint regarding another staff member. During a meeting, the nurse insists he managed the situation appropriately. How should the manager respond?

Accepted Answer

1. There is no reason to let the nurse reflect further on the situation.
2. Exploring alternatives allows the nurse to develop problem-solving skills and assist in the prevention of future problems related to the situation.
3. There is no evidence to suggest that a meeting with HR is indicated.
4. This statement is inflammatory and will likely make it more difficult for the manager to improve the nurse's practice.

Question 12

An ICU nurse does not follow policy when administering a medication intravenously. Which would be the most appropriate action by the manager to assist the employee?

Accepted Answer

1. Providing written instructions for the medication is not as constructive as providing and discussing the policy.
2. The ICU staff does not need remediation or reprimand.
3. This strategy helps to educate the nurse and improve practice. Documenting this action also sets the scene for further action if the policy is not followed in the future.
4. Reprimanding is not the first step in this process.

Question 13

A nurse who receives frequent phone calls informs the manager the phone calls are related to a health crisis concerning a family member. Other nurses also receive personal calls, but not as many as the first nurse. Which action by the manager is appropriate?

Accepted Answer

1. The manager should not get involved in the personal family issues of this nurse.
2. The manager should discuss how personal phone calls are affecting client care, perhaps by taking this nurse away from duties. The fact that calls should be limited should be stressed.
3. The manager should not bring the morale of other staff into this conversation.
4. If the manager allows one nurse to carry a personal cell phone, the rest of the nurses must be afforded the same right.

Question 14

The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. The manager should investigate why the nurse is being tardy.
2. The impact on client care is always the most important aspect of meeting job expectations.
3. Accusing the nurse of not caring about others in the workplace is not appropriate at this point.
4. The employee must first know that the tardy behavior is unacceptable.
5. The manager should develop a plan for behavior change that the nurse can agree to.

Question 15

A newly hired certified nurse's aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager?

Accepted Answer

1. Since the CNA was misinformed regarding the length of meals, the coaching should be documented, but not as tardiness in the real sense of the word.
2. The first step is to determine whether the employee is aware of the policy. It seems this employee was not. It would be most appropriate to show the employee where the policy is written.
3. Warning the employee is not justified at this time.
4. Threatening the employee is not justified.

Question 16

A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client's cardiac rhythm after the medication was administered, the surgical nurse states, "I don't know." What actions should be taken by the unit's nurse manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. The manager should meet with the ICU nurse to determine if policy was followed in delegating medication administration.
2. The manager should meet with the surgical nurse to determine if the nurse was aware of the policy requiring monitoring the cardiac rhythm.
3. Until the manager meets with this nurse, it is unclear if a warning is indicated.
4. Until the manager meets with this nurse, it is unclear if a warning is indicated.
5. Until the manager has more facts, it is unclear whether a warning is necessary and, if so, what kind of warning is required.

Question 17

It has been reported to the nurse manager that an employee is repeatedly parking in the client/visitor parking area. What action should the manager take?

Accepted Answer

1. When there is a policy violation, it is necessary to confront the employee. The steps of confrontation are similar to those of coaching.
2. It is not necessary for the manager to use valuable time checking the parking lot.
3. The problem cannot wait until the next employee appraisal.
4. It is not necessary to involve the entire staff in an education session.

Question 18

A manager has been informed by a reliable RN that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate?

Accepted Answer

1. It is inappropriate for the RN to issue a warning.
2. While many hospitals have a policy of verbal warning or coaching as a first step, the real issue is that the assistant's due process was not followed.
3. The manager should investigate the matter and listen to the assistant's reasons for the RN's complaint. If a written warning is appropriate, it should not be written until after the complaint has been investigated and the assistant has had an opportunity to discuss the issue.
4. It is inappropriate for the human resources department to issue a warning.

Question 19

Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning?

Accepted Answer

1. When the termination will occur is important but is not the most important aspect.
2. Notifying the human resources department and keeping them up to date is very important but is not the most important aspect.
3. Before termination there must be sufficient and accurate documentation to support the termination. This not only protects the employee from wrongful termination, but also protects the manager and the institution.
4. Hopefully, terminating a poor employee will not adversely affect unit staffing, but this is not the most important consideration.

Question 20

What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy?

Accepted Answer

1. The manager does not confront policy violations as a means of punishment.
2. The primary reason for confrontation is not as a protection from liability.
3. The manager does not confront policy violators to set an example for others.
4. The primary reason a manager confronts policy violation or inappropriate behavior is to encourage correct behavior.

Quiz 20: Feedback and Coaching, Disciplining, and Terminating Staff