Question: Deciding Upon Disciplinary Action You are a supervisor in a neurological care unit. One morning, you receive a report from the nightshift RNs, Nurse Caldwell and Nurse Jones. Neither of the nurses reports anything out of the ordinary, except that a young head-injury patient has been particularly belligerent and offensive in his language. This young man was especially annoying because he appeared rational and then would suddenly become abusive. His language was particularly vulgar. You recognize that this is fairly normal behavior in a patient with a head injury, but yesterday morning, his behavior was so offensive to his neurosurgeons that one of them threatened to wash his mouth out with soap.
After both night nurses leave the unit, you receive a phone call from the house night supervisor who relates the following information: When the supervisor made the usual rounds to the neuro unit, Nurse Caldwell was on a coffee break and Nurse Jones was in the unit with two LVNs/LPNs. Nurse Jones reported that Nurse Caldwell became very upset with the head-injury patient because of his abusive and vulgar language and had taped his mouth shut with a four-inch piece of adhesive tape. Nurse Jones had observed the behavior and had gone to the patient's bedside and removed the piece of tape and suggested that Nurse Caldwell go get a cup of coffee. The supervisor observed the unit several times following this, and nothing else appeared to be remiss. Stating that no harm had come to the patient, Nurse Jones was reluctant to report the incident but believed that perhaps one of the supervisors should counsel Nurse Caldwell. You thank the night supervisor and consider the following facts in this case:
? Nurse Caldwell has been an excellent nurse but is occasionally judgmental.
? Nurse Caldwell is a very religious young woman and has led a rather sheltered life.
? Taping a patient's mouth with a four-inch piece of adhesive tape is very dangerous, especially for someone with questionable chest and abdominal injuries and neurological injuries.
? Nurse Caldwell has never been reprimanded before.
You call the physician and explain what happened. The physician believes that no harm was done and agrees with you that it is up to you whether to discipline the employee and to what degree. However, the physician believes that most of the medical staff would want the nurse fired. You phone the nurse and arrange for a conference with her. She tearfully admits what she did. She states that she lost control. She asks you not to fire her, although she agrees this is a dischargeable offense. You consult with the administration, and everyone agrees that you should be the one to decide the disciplinary action in this case.
ASSIGNMENT: Decide what you would do. You have a duty to your patients, the hospital, and your staff. List at least four possible courses of action. Select from among these choices, and justify your decision.