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I am new to the nurse manager’s role and still have trouble distinguishing between the different steps of disciplinary action. Can you identify each step and a necessary instance to use them?


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The disciplinary process should be implemented in a progressive, step-by-step approach. As inappropriate behavior increases, your disciplinary actions should intensify, ultimately reaching termination if the employee's behavior does not meet established expectations.

Progressive discipline consists of four steps:

  1. Oral notice: The first step in disciplinary process and it notifies an employee that he or she is not meeting expectations. Such a notice is appropriate when an employee violates a minor policy or procedure that does not jeopardize patient safety. Note that the oral notice is a disciplinary action, and your behavior should reinforce that.
  2. Written reprimand: If, after the oral warning, an employee continues to engage in inappropriate behavior or in practices that endanger patient safety, a written reprimand is necessary. The written reprimand is a serious disciplinary action that lets the nurse know that his or her behavior must improve or job suspension/termination will be imminent.
  3. Suspension: When an employee is suspended, he or she is sent off the job for a specific period of time. Suspending an employee is fraught with legal consequences for the employer, so do not make the decision to suspend an employee on your own. Consult with your supervisor and your facility's human resources department.
  4. Termination: No matter how hard you try, some workers are unable or unwilling to improve their job performance and must be terminated from their position. One instance where termination would be necessary is when you consistently address the employee's behavior, but the employee continues to perform below expectations. Once again, when making the decision to terminate an employee, consult with your supervisor and human resources department.

- Dinah Brothers, RN, JD

(December 2009)