Deck 22: Dealing With Disruptive Staff Problems

Question 1

A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which of the following should be the manager's first action?

A) Meet with the coworker in private and discuss the behaviors.
B) Meet with other staff to determine if the coworker has issues at home.
C) Meet with human resources (HR) to determine the best method to terminate the employee's employment.
D) Collect additional information regarding behaviors, absenteeism, or tardiness.

Answer 1

Collect additional information regarding behaviors, absenteeism, or tardiness.

Question 2

A night shift nurse is assuming a day shift nurse's assignment, which includes two clients with pain that is being controlled with oral hydrocodone (Lortab). At shift assessment, both clients complain of pain. During shift report, the day shift nurse reports that both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take?

A) Repeat the medication.
B) Inform the manager of the situation.
C) Call the physician to obtain an order for IV narcotics.
D) Tell the clients that pain medication will be given at the next ordered time.

Answer 2

Inform the manager of the situation.

Question 3

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?

A) "Bullying behaviors make nurses uncomfortable."
B) "Physicians do not want to admit clients to hospitals with an uncivil atmosphere."
C) "Bullying and incivility are just not proper work practices."
D) "Bullying and incivility are dangerous to client care."

Answer 3

"Bullying and incivility are dangerous to client care."

Question 4

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs?

A) Place the nurse on a different unit and allow the administration of all drugs.
B) Reassign the nurse for a period to a unit where no mood-altering drugs are given.
C) Retain the nurse on the original unit and allow the administration of mood-altering drugs.
D) Return the nurse to the original unit at a less stressful time, such as night shift.

Question 5

The manager has determined that a nurse is marginal but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The nurse may harm a client.
B) Other nurses on the unit may become disgruntled by having to cover for this nurse.
C) The nurse may never become a good employee.
D) The manager's employment may be terminated.
E) The morale of the unit may decline.

Question 6

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, "That probably happened when the nurse covering for me at noon or for my breaks was in charge." How should the manager interpret this statement?

A) This is a plausible explanation of who was in charge at the time of the error.
B) The coverage nurse is likely incompetent.
C) This nurse was not in charge when the error was made.
D) This nurse is scapegoating the coverage nurse.

Question 7

Two staff members have a long-standing dislike of one another. Generally, they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?

A) Tell the two staff members to go to the manager's office immediately.
B) Send both of the employees off the unit.
C) Immediately call for security.
D) Stand between the employees and tell them to calm down.

Question 8

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?

A) Call a meeting of all night shift employees.
B) Review the staffing pattern and absentee list for the night shift.
C) Ask employees for their perceptions on missing narcotics.
D) Request that security search employee lockers and personal items.

Question 9

A group of nursing students have just arrived on the unit. Which staff actions would be considered uncivil to these students? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The unit clerk groans when the instructor enters the nursing station with the students.
B) A nurse quietly says, "Please do not assign a student to me today. I have two very sick clients who are going to require my full attention."
C) A nurse whispers, "Not students again today."
D) A nursing assistant asks the students how long they have been in school.
E) A transport worker says, "Just great, more students to get in the way today."

Question 10

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. This problem is likely the result of which of the following situations?

A) The hospital is in a poorer part of town and offers a great deal of charity care.
B) The hospital pays about $0.25 per hour less than other hospitals as a starting wage for nurses.
C) The hospital has a reputation for allowing bullying behavior to occur.
D) The other hospital in town has a more modern building and campus.

Question 11

A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate?

A) "I have no control over what the nurses do on their time away from work."
B) "This does not meet the standards for bullying because it was not a face-to-face encounter."
C) "You two are acting like a couple of high school kids."
D) "I will follow up on this complaint and take action as needed."

Question 12

A night shift charge nurse frequently points out nurses' faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?

A) Lateral violence
B) Unprofessionalism
C) Lack of civility
D) Bullying

Question 13

A nurse manager does not like conflict and would like to allow instances of bullying to "go away on their own." Which rationale by the manager's supervisor is the most important?

A) "The Joint Commission requires that we address instances of bullying."
B) "We don't want to run off good nurses."
C) "If you let bullying go, it just gets worse and more frequent."
D) "A bully makes the work environment unpleasant for everyone."

Question 14

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Nursing assistants
B) Physicians
C) Managers
D) Office personnel
E) Senior nurses

Question 15

What characteristics would cause the manager to classify an employee as marginal? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The employee works only when client census calls for additional staff.
B) The employee's work does not improve with coaching.
C) The employee just made an error for which discipline has already been done twice.
D) The employee has worked at the facility for less than 1 month.
E) The employee does not mix well with the other staff but stays on the margins of the group.

Question 16

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Continue to be persistent in your work with these nurses."
B) "You can fire them at any time."
C) "Be fair and consistent with them."
D) "You must continuously assess the rest of your staff as you work with these two nurses."
E) "You must continue to address the issues with these nurses as they arise."

Question 17

A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "I know. It's a shame that all the old ways are changing."
B) "Why would you want to bully a new nurse? They are all so naïve and cute."
C) "The Joint Commission does not tolerate disruptive or abusive behavior."
D) "The American Nurses Association does not approve of bullying behaviors."
E) "New nurses bring new ideas. Why would you bully them?"

Question 18

A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Tell the nurse to go home for the rest of the day.
B) Have the nurse call the physician back and demand an apology.
C) Document the facts of the encounter.
D) Privately tell the physician that the behavior was bullying.
E) Confront the physician during rounds and demand an explanation.

Question 19

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization's policies. Which statement by the HR director is appropriate?

A) "We should meet with the nurse and offer access to the employee assistance program."
B) "We should confront the employee and discuss involuntary or voluntary termination of employment."
C) "You need to meet with this nurse and confront these behaviors."
D) "We need to set up a counseling session with a psychologist and this nurse."

Question 20

The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility?

A) "Your behavior is rude and disrespectful toward your staff."
B) "This behavior is unprofessional."
C) "This behavior is unacceptable."
D) "This behavior warrants a written warning."

Question 21

________, is the harassment between employees of equal rank.

Question 22

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse?

A) Administration reports the nurse to the state board of nursing.
B) The nurse is counseled and asked to participate in a treatment center plan.
C) The nurse is allowed to continue supervised practice while a treatment plan is being devised.
D) The nurse's employment is terminated with no report made.

Question 23

A nurse manager has been working with a disgruntled employee for several weeks. Today the employee comes to the manager's office with yet another complaint about a new hospital policy. The manager says, "I am sick of your complaining. Leave me alone so I can get some work done." What should the manager do now?

A) Firmly shut the office door.
B) Tell the employee to go to human resources with complaints about the policy change.
C) Apologize to the employee for being unprofessional and ask what the issue with the policy is.
D) Tell the employee to go back to work.

Question 24

Lack of civility includes behaviors that are what?

A) Ill-mannered
B) Rude
C) Violent
D) Impolite
E) Disrespectful

Question 25

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Chart review on effectiveness of pain control.
B) Increase in clients with conditions requiring pain medications.
C) Increase in use of doses of as-needed narcotics that results in wastage.
D) Chart review that reveals that clients require much more narcotic pain medication on one shift than on others.
E) Narcotic containers that look as if they have been altered.

Question 26

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate?

A) Discuss the issues at a staff meeting and elicit methods to improve morale.
B) Use progressive discipline to manage the employee.
C) Monitor the staff's performance to determine the lack of civility.
D) Terminate the employee's employment.

Question 27

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?

A) A certified letter outlining the accusation and investigation should be sent to the nurse's home.
B) A certified letter outlining the accusation and investigation should be sent to the nurse at work.
C) The nurse should be contacted and asked to make an appointment with the nurse executive without giving cause.
D) The nurse should be approached at work with no prior notice and asked to come to the nurse executive's office.

Question 28

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first?

A) Tell the employee to go home and change.
B) Check the human resources policies regarding appropriate dress.
C) Ask the employee why the shirt was worn to this event.
D) Bring the employee a scrub shirt from surgery to change into.

Question 29

A nurse constantly complains about employee policies and procedures and frequently mentions how "they" are "out to get us." The nurse is surprised when referred to by the manager as "disgruntled" during a discussion of this behavior. What information should the manager provide this nurse?

A) "People who are constantly complaining decrease the morale of the rest of the unit."
B) "You have complained so long, it will be impossible to change your behavior."
C) "Being a complainer is a character trait."
D) "Your attitude problem makes everyone else in the unit miserable."

Question 30

A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?

A) "Health insurances generally pay 100% of treatment charges for medical professionals who are seeking help."
B) "If you go to treatment, the state board will never know you were abusing."
C) "Treatment is your best chance at returning to practice."
D) "We will be able to follow your progress through reports from your treatment team."

Question 31

A nurse admits to diverting narcotic drugs while working. The manager says, "All nurses who admit diverting narcotics have to be reported to the state board of nursing." How should the nurse interpret this statement?

A) As true, because any nurse who admits diversion must be reported to the state's board of nursing
B) As false, because in some states reporting depends on other factors
C) As beneficial, because the state board of nursing will help the nurse find a substance abuse program
D) As career ending, because the state board of nursing is required to suspend the license of any nurse who admits to diverting drugs

Question 32

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager, the nurse says, "The nurses who smoke always take longer lunches. No one says anything to them." What is the manager's major consideration before replying to this statement?

A) Policies must be consistently applied to all employees.
B) Because the hospital is smoke free, those nurses who wish to smoke must leave campus for lunch.
C) This nurse complains about everything.
D) The human resources policy is that nurses get 60 minutes for lunch.