A manager is counseling a nurse who has violated safety protocols several times. The most appropriate action by the manager is to

Question

a. allow the nurse to continue working only under direct supervision.
b. have the nurse prepare an educational in-service on safety protocols.
c. maintain a confidential file on the nurse's actions and outcomes.
d. report the behavior to the state board of nursing for discipline.

Answer 1

D
Protection for nurses who commit errors or are involved in near-miss episodes is an important part of a "just culture." However, according to the Institute of Medicine, protection from disciplinary action from the facility and from regulatory agencies should not be granted in three specific situations: criminal misconduct, active malfeasance, or when reporting an incident has been delayed unnecessarily. This nurse would likely be seen as committing active malfeasance (actively or purposely violates safety protocols) and should be reported to the state board of nursing for discipline.
A nurse who has violated safety protocols on several occasions would most likely be seen as committing active malfeasance by continuing to violate the protocols. The nurse's behavior should be reported to the state board of nursing for discipline.
Having the nurse prepare an educational in-service on safety protocols might have been an option for the first offense, but continuing to violate safety protocols warrants a much more serious response. The nurse's behavior should be reported to the state board of nursing for discipline.
Confidentiality when making mistakes is an important part of a "just culture," in which reporting errors and near misses is institutionalized. However, in the case of repeatedly violating safety protocols, this nurse cannot expect to have the incidents remain confidential. The nurse's behavior should be reported to the state board of nursing for discipline.