When I was elevated to the position of department head for the first time, my boss gave me sound advice: don’t do anything for six months. I thought, “what did you hire me for?”
Coming from a military background, I was a mission-first manager, and I was used to breaking eggs to make the omelet. The worst decisions I made were in that first three-month period, where I refused to listen to good advice, and instead, followed my experience.
The number one mistake new managers make is not in acting too quickly, which sometimes can’t be helped. A situation presents itself and action must be taken.
No, the number one mistake is in acting without full information. This can and does lead to litigation, and sometimes has collateral consequences for others.
Take the case of Nurse D.
A solid worker in the cardiothoracic unit of a large hospital, the nurse was well respected by peers and supervisors. The supervisor wrote a glowing letter of recommendation for the nurse’s application to CRNA school. Then that supervisor came in one morning to find complaints that the nurse had “slept” patients with unordered and unauthorized administration of Propofol. Two empty bottles of the drug were found in one of the patients’ rooms. Other nurses swore they hadn’t given the drug to any of their patients. The patients were obtunded at 8:30 in the morning, and the conclusion was that Nurse D had done it. The nurse came in for a regular shift three days later and was summarily terminated. The nurse was reported to the Board of Nursing for discipline. There was only one problem: no one had done a careful investigation.
Propofol has a relatively short half-life. The nurse left at 0645 and at 0700, when new nurses took over, both nurses found both patients were alert and oriented with Glasgow Coma Scores of 15. They did not become obtunded until later. And while the change was reported to the supervisor, the nurses curiously never mentioned it to the attending physicians. When walked through the medical record step-by-step at the Board of Nursing hearing, the supervisor had to agree that nothing the nurse did could have caused the change in patient orientation. He also attested he would write the same glowing letter of recommendation again, if offered the opportunity.
Jumping to conclusions without data nearly cost a nurse their professional license.
I have cautioned before that anyone who starts a conversation with a manager with words like “you didn’t hear this from me, but…” should be immediately suspect.
If a co-worker makes an error, or worse, enters fraudulent data, it is an ethical duty to tell the truth about it in order to protect the patient from harm. Similarly, while it may be tempting to rush to judgment and fire someone on mere accusations, the better course is to suspend the individual with pay and do a thorough investigation first. Where employers get sued is where their own standards are not met in termination proceedings.
History is full of disastrous outcomes where people acted on too little information, or which turns out to be bad information.
During World War II, the United States sought to invade the island of Leyte in the Philippines. A massive flotilla steamed toward Leyte Gulf. Owing to insufficient intelligence data, American battleship forces were out of position several hundred miles away from that flotilla when the Japanese Navy under Admiral Kunita came racing through the San Bernadino Straight to attack the more than 100,000 soldiers on the support ships. Japan had the clear advantage, but two exceptional naval captains Ernest E. Evans and Robert W. Copeland, charged into the much larger Japanese force with guns blazing, sacrificing both ships, but turning the fight for the U.S. Assuming, incorrectly, that they were outgunned by the U.S. forces, Admiral Kunita withdrew.2 The invading flotilla was saved.
To avoid the trap of acting without sufficient information in employee discipline cases, here is a checklist to follow in handling situations that may involve employee discipline or termination:
- Ensure that the decision-maker (the person determining whether to suspend or fire the employee) is not the person conducting the investigation. This prevents creating the illusion that the manager decided on the discipline then found the facts in accordance with that decision.
- Have the person who does an investigation come from a different department or different shift if at all possible (they are less subject to pressure, and more likely to render a fair and honest finding).
- Insist that statements be taken and reduced to writing and signed. If someone says “I don’t want to get involved,” that is not ethically appropriate and should be grounds for discipline in and of itself.
- Insist that a report by the investigating manager be written and provided.
- Question everything. Look at the medical record. It will be exhibit one if there is a lawsuit later, and you want to ensure you have properly interpreted the facts.
- Before making your decision, get a second opinion from a peer you trust. No one of us is as smart as all of us, and sometimes a different view can prevent making big mistakes.
- Finally, if the investigation and report leave room for mercy, remember that taking less drastic action than firing can sometimes create a better worker in the future.
The checklist looks like a lot of work, and it is. Trust me on this: no one ever got into a courtroom and said “gosh, I wish I had not been so thorough with my documentation.”
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