Question: Determining an Appropriate Action When Proof Is Unavailable You are the supervisor of a pediatric acute-care unit. One of your patients, Joey, is a 5-year-old boy who sustained 30% third-degree burns, which have been grafted and are now healing. He has been a patient in the unit for approximately 2 months. His mother stays with him nearly all the waking hours and generally is supportive of both him and the staff. In the last few weeks, Joey has begun expressing increasing frustration with basic nursing tasks, has frequently been uncooperative, and in your staff's opinion has become very manipulative. His mother is frustrated with Joey's behavior but believes that it is understandable given the trauma he has experienced. She has begun working with the staff on a mutually acceptable behavior modification program. Although you have attempted to assign the same nurses to care for Joey as often as possible, it is not possible today. This lack of continuity is especially frustrating because the night shift has reported frequent tantrums and uncooperative behavior. The nurse who you have assigned to Joey is Monica.

She is a good nurse but has lacked patience in the past with uncooperative patients. During the morning, you are aware that Joey is continuing to act out. Although Monica begins to look more and more harried, she states that she is handling the situation appropriately. When you return from lunch, Joey's mother is waiting at your office. She furiously reports that Joey told her that Monica hit him and told him he was "a very bad boy" after his mother had gone to lunch. His mother believes that physical punishment was totally inappropriate, and she wants this nurse to be fired. She also states that she has contacted Joey's physician and that he is on his way over. You call Monica to your office where she emphatically denies all the allegations. Monica states that during the lunch hour, Joey refused to allow her to check his dressings and that she followed the behavior modification plan and discontinued his television privileges. She believes that his accusations further reflect his manipulative behavior. You then approach Joey, who tearfully and emphatically repeats the story that he told to his mother. He is consistent about the details and swears to his mother that he is telling the truth. None of your staff was within hearing range of Joey's room at the time of the alleged incident. When Joey's doctor arrives, he demands that Monica be fired.

ASSIGNMENT: Determine your action. You do not have proof to substantiate either Monica or Joey's story. You believe that Monica is capable of the charges but are reluctant to implement any type of discipline without proof. What factors contribute the most to your decision?