Coping with eight types of problem personnel
Although the vast majority of ED personnel are genuinely interested in hearing about their workplace and sharing ideas, occasionally individual staff members will create obstacles to good communication. Here are some expert tips for dealing with these problematic staff members:
• Constant complainers. If a particular staff member tends to blow off steam by complaining about a problem to other staff members, turn the tables and ask that person to submit suggestions as to how the problem might be solved. "Once they realize the solution isn’t that easy, they’ll appreciate why the problem has existed for so long," says Katherine Heilpern, MD, assistant professor in the division of emergency medicine and director of medical student education at Emory University School of Medicine in Atlanta. "It’s one thing for people to get frustrated and complain, but they also need to participate in the solution."
• Problem partners. When two staff members don’t get along, the entire department can be adversely affected. "If Mary and Joan are having a problem, and one of them comes to me to complain, I’ll say to one of them, It seems to me that there is more to this situation, it doesn’t seem like you two are clicking,’" says Liz Jazwiec, a Chicago consultant who works with EDs on communication issues. Supply guidance and advice, but ultimately allow feuding staff members to resolve the matter on their own.
If the complaints don’t stop, and the situation is obviously personal, be firm. "At some point in time, I say, We’ve talked about this a million times and I’ve given you my best advice,’" says Jazwiec. "Now it’s time for you to come up with five ways you’re going to communicate better with her."
• Abusive consultants. Although specialists from other departments aren’t part of the ED team, consultants do interact regularly with staff members. If a consultant is abusive to a nurse or physician, it’s time for managers to step in. "No one needs to take abuse," says Jazwiec. "Clear documentation is always helpful, with witnesses. As leaders, we need to be the ones to tell them, Even if you feel we screwed up in some way, we can’t tolerate this in front of our patients.’ If there is a public confrontation, it needs to be taken to a private area."
In high-stress situations, tempers are bound to flare occasionally. "When you get a group of professionals working together, you’re going to have some friction from time to time," says Jazwiec. "ED directors should look at the medical staff as customers. We don’t always have rational customers, and we know that."
Staff should be careful not to take out their frustrations on the chart. "If cardiology was not immediately available, we do need to document it, but also make sure you’ve done everything right, have the right pager number, and so forth," says Jazwiec. "In some organizations it has to be documented each time a person is called, but realize there are huge legal implications to this. It’s never smart to take issues out on a chart."
• Substance abusers. If drug or alcohol abuse is suspected, the human resources department will need to be involved. In these situations, there is typically a lot of gossip in the department, but a high degree of confidentiality must be maintained. "I explain to the staff that the matter will definitely be addressed, but I won’t be able to discuss the results," says Jazwiec.
After action has been taken, it’s best to be as upfront as possible about the situation. "Tell the staff member who complained, I know you came to me about Joan, and I’m sure you’ve noticed she’s been taken off schedule for three weeks,’" says Jazwiec. "But as a leader, I can’t discuss any of it because I need to protect Joan’s confidentiality, and, if you were in a similar situation, I know you’d want the same."
Staff members often resent having to cover shifts for a nurse or physician who is on leave of absence to cope with a substance abuse problem. "If everyone is saying she gets to go weave baskets for three weeks at drug rehab while we’re here working her nights, you might even call a special staff meeting. Tell everybody you appreciate them covering for Joan, who had to take unexpected time off, but it’s not anything she planned or is pleasant for her, and I can’t share all the details with you because it’s a highly confidential matter.’"
While some ED staff members will feel the substance abuser should be fired, some pointed comments can go a long way toward giving them a fairer outlook. "I tell them, When these things happen it’s devastating, and I can assure you it’s much worse for her right now than it is for you rearranging your schedules, and I hope none of you would ever be in that situation,’" says Jazwiec.
• Incompetent staff. When staff members complain about caregivers who aren’t meeting standards, stress that action will be taken but that it will remain confidential. "You can say, I know you’ve complained about Tyrone a dozen times, and I can’t tell you what I do with that information because it’s confidential, but thank God no one can get fired here on the first round,’" says Jazwiec. "We’ve got a process that takes four steps for a reason. If you’re wondering about things, have faith that things are going in the right direction.’"
Following up on staff complaints is essential. "You have to act on their complaints," says Jazwiec. "If you never write him up people won’t feel there is any point to coming to you."
Staff should be encouraged to discuss their suspicions with managers. "Even on a relatively minor scale, such as with people taking home gauze or other supplies, I tell them, If you’re not part of solution, then you’re part of the problem,’" she says. "If someone is not consistently meeting patient-care standards, don’t cover up for them. It’s as much your responsibility as mine to identify those issues."
On one occasion, Jazwiec terminated an employee for sleeping on the job. "After the termination, people came to me and said It didn’t surprise me; that was going on all the time.’ I said to them, If you knew about this, why didn’t you come to me? I am really disappointed in you, because the time to be talking about this is not after the fact.’"
• Attitude "poisoners." Unfortunately, negative attitudes can be contagious. Employees who thrive on putting a negative spin on every new development can infect the entire staff. "Usually, their negativity isn’t the only aspect of their attitude or behavior that’s problematic, so you have to aggressively deal with them," says Jazwiec.
Avoid giving these employees extra attention. "Ignore them as much as possible. If you spend all your time trying to get these poisoners to buy in, it will be wasted because you’re never going to convert one," says Jazwiec. "You’re better off putting that effort toward those who do want accurate information."
If negative staff members aren’t able to get the attention they crave, they often leave for a new work environment. "It doesn’t happen overnight, but after several months or a year, negative people end up leaving because they don’t have an audience," says Jazwiec.
The best weapon against negative thinkers is good communication. "If you’re communicating well with your staff, it’s hard for someone to keep saying, This is stupid,’" says Jazwiec. "When I introduce new things, I tell people we’ll try it for three months, and if it’s not working out, you have my absolute assurance that we’ll take another look at this."
Address the negative comments immediately and always out in the open, she says. "If you overhear an employee saying, Can you believe they’re planting trees out there? Why don’t they just hire another nurse with the money they’re spending?’Be open about the issue," says Jazwiec. "Tell everyone, You’ll notice that one issue we’re concerned with these days is our image. We’re giving our front door a more user-friendly look, so you’ll notice some landscaping out front."
• Gossipers. There is a tendency to share information with staff members who are constantly spreading the latest rumors, but that can intensify the problem. It’s important to share information consistently and not selectively. "We usually tell too much to problem employees and gossipers," says Jazwiec. "We’ll call them into the office and say, Patty, I understand you were telling people we were spending half a million dollars on a new skywalk, and I wanted to let you know where the money is coming from and why we’re doing this.’"
The problem with that scenario is that the problem employee is then given more power. "Because you’re always calling her in and setting her straight, Patty now gets more credibility as an informal leader," says Jazwiec. "If you tell her it’s true that people’s schedules might be changing soon, and she goes out and tells everyone, then when it actually happens she is more credible, and that’s a danger."
The best way to handle gossipers is out in the open. "Handle them at a staff meeting or in the middle of the nurses’ station," says Jazwiec. "Say, Have any of you heard there will be a layoff in housekeeping? I can assure you there isn’t going to be one, although every department is being looked at to find where we can cut expenses.’ Then look around the room and say, Does anyone have any questions? Patty, I know you’ve been concerned about this.’ Let her say No, I don’t," or That makes sense to me,’ in front of other people."
• Always absent at meetings. Employees who frequently miss meetings should not be let off the hook. It’s impossible to get everyone to attend a given meeting, but regular attendance should be required. "Instead of trying to do 50 meetings to try to get to everyone, plan out your meetings a year in advance and let people know the expectation for attendance," says Jazwiec. "If it’s six out of 12, hold them to that at evaluation time and let them know it’s noted if they haven’t done it."
It’s important to hold staff accountable for the information, regardless of whether they attend or not. "If they don’t go to a meeting, they should get their own personal copy of the minutes," says Jazwiec. "Let them know they’re responsible to know anything that’s in there."
First-time offenders shouldn’t necessarily be disciplined, but they should be aware of their responsibility. "If someone says, Nobody told me we had to do this differently in triage,’ pull out a copy of the minutes and explain, You weren’t there, but you did receive these minutes. If it happens again we’ll have to move into disciplinary action,’" says Jazwiec. The extra time it takes to give staff members copies of the minutes is well worth it, she says.
The responsibility of the leaders to transmit information only goes so far, she says. "A lot of leaders try to jump through hoops to make information available to their staff. Instead of going on a guilt trip thinking you didn’t communicate clearly enough, turn the tables and explain it’s their responsibility to find out what’s going on in the workplace. "
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