DISCIPLINE

INTRODUCTION One method by which a nurse manger can control subordinates behaviour is to invoke official disciplinary procedure. Discipline can be self-control by which an employee brings his or her behaviour into agreement with the agencys official behaviour code, or it can be a managerial action to enforce employee compliance with agency rules and regulations. TERMINOLOGIES 1. Appeal: Making an earnest or formal request 2. Arbitration: An impartial judgment given to settle a dispute 3. Code of conduct: A code of conduct is a set of rules outlining the responsibilities of or proper practices for an individual or organization. 4. Collegiality: Relationship between colleagues 5. Demotion: Reduce to a lower rank or category 6. Dismissal: Send away or reject from a position or employment 7. Emolument: A fee or salary 8. Misdemeanor: A misdeed or a wrong doing 9. Penalty: Punishment for breaking a law, rule or contract 10. Reprimand: Rebuke 11. Restitution: The restoring of a thing to its proper owner or original state; compensation. 12. Suspension: Deprive temporarily of a position or right DEFINITION Discipline is defined as a training or moulding of the mind and character to bring about desired behaviours. Discipline refers to working in accordance with certain recognized rules, regulations and customs, whether they are written or implicit in character.

AIMS AND OBJECTIVES OF DISCIPLINE The aims and objectives of discipline are: 1. To obtain a willing acceptance of the rules, regulations and procedures of an organization so that organizational goals can be achieved. 2. To impart an element of certainty despite several differences in informal behavior patterns and other related changes in an organization 3. To develop among the employees a spirit of tolerance and a desire to make adjustments 4. To give and seek direction and responsibility 5. To create an atmosphere of respect for the human personality and human relations

6. To increase the working efficiency and morale of the employees so that their productivity is stepped up, the cost of production brought down and the quality of production improved. PRINCIPLES OF DISCIPLINARY ACTION 1. Have a positive attitude: The managers attitude is very important in preventing or correcting undesirable behavior. People tend to do what is expected of them. Therefore the manager must maintain a positive attitude by expecting the best from the staff. 2. Investigate carefully: The ramifications of a disciplinary action are serious. If a staff nurse is disciplined unfairly or unnecessarily, the effects on the entire staff nurse may be severe. Therefore managers must proceed with caution. They should collect facts, check allegations, and even ask the accused employees for their side of the story. 3. Be prompt: If the disciplinary action is delayed, the relationship between the punishment and the offense becomes less clear. 4. Protect privacy: Disciplinary actions affect the ego of the staff nurse. Discussing the situation in private, causes less resentment and greater chance for future co-operation. However, a public reprimand may be necessary for the nurse who does not take private criticism seriously. 5. Focus on the act: When disciplining a staff nurse, the manager should emphasize that it was the act that was unacceptable, not the employee. 6. Enforce rules consistently: Consistency reduces the possibility of favoritism, promotes predictability, and fosters acceptance of penalties. 7. Be flexible: Individuals and circumstances are never the same. A penalty should be determined only after the entire record is reviewed. 8. Advise the employee: The employees must be informed that their conduct is not acceptable. Anecdoctal notes can be of little value if the staff nurse is not informed of the contents promptly. 9. Take corrective, consistent action: The manager should be sure that the staff nurse understands that the behavior was contrary to the organizations requirements. 10. Follow up: The manager should quietly investigate to determine whether the staff nurse behavior has changed. If not, the manager should determine the reason for the nurses attitude. COmponents of a disciplinary action program 1. Codes of conduct: The employees must be informed of codes of conduct. Agency handbooks, policy manuals, and orientation programs may be used. Eg. Employee code of conduct.
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2. Authorized penalties: The agencys disciplinary action program should indicate that the current action is being administered without bias and is directly related to the offense. 3. Records of offences and corrective measures: The personnel record should clearly indicate the offense, managements efforts to correct the problem and the resulting penalties. 4. Right of appeal: Formal provision for right of employee appeal is a part of each disciplinary action program. EMPLOYEE CODE OF CONDUCT The basic pre-requisite for effective discipline is employee awareness of agency rules and regulations governing employee behaviour. Behaviour rules should be written in clear and concise language, incorporated in a hand-book and given to new employees during induction, posted in each work unit and discussed with employees by manager of each unit. The significance of code of conduct is that each employee should behave and perform in a way that preserves the company values and commitments. PENALTIES Oral reprimands: For minor violations that may have occurred for the first time, managers may opt give an oral warning in private. When oral warning is given, the nurse manager is advised to make an anecdoctal record of time, place, occasion and gist of the reprimand. Written reprimand: If the offense is more severe or repeated, the reprimand may be written. The written notice should include the name of the employee, name of manager, nature of the problem, the plan for correction, and consequences of future repetition. The employee has to sign it, to indicate that the employee has read it. A copy should be given to the employee and one retained for the personnel file. If again the terms are not met, other penalties will probably be necessary. Other penalties: Fines may be charged for offences such as tardiness. Loss of privileges might include transfer to a less desirable shift and loss of preference for assignments. Demotion is a questionable solution. It creates hard feelings which may be contagious and more likely places offenders in a position for which they are overqualified. Suspension: for a period of time Withholding increment Termination(dismissal): permanent termination of services. APPROACHES OF DISCIPLINE 1. Traditional approach It emphasizes punishment for undesirable behaviour. The purposes of traditional discipline are punishment for sin, enforce conformity to custom, and strengthen authority of the old over the young. Here discipline is always applied by superiors to subordinates,
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the severity of punishments is designed to be proportional to the severity of the offense, and when no single individual admits to the violation, the whole group is punished to motivate group members to identify the violator or punish him or her themselves 2. Developmental approach It emphasizes discipline as a shaper of desirable behavior. The purpose of developmental discipline is to shape behaviour by providing favourable consequences for the right behaviour and unfavourable consequences for the wrong behavior; and avoidance of physical punishment, protection of the rights of the accused and replacement of arbitrary individual judgements of guilt. 3. Positive discipline approach It is based on the assumption that an employee with self-respect, respect for authority, and interest in the job will adhere to high quality work standards; and when an interested, respectful and self-respecting worker temporarily strays from his/ her usually highs standards, a friendly reminder is enough to redirect their efforts in the desired direction Organisations that have employed a positive discipline have noted a subsequent decrease in absences, dissmisals, disciplinary actions, grievances and arbitration, along with improvement of employee morale. 4. Self controlled discipline approach The employees bring his or her behaviour into agreement with the organisations behavioural official code i.e. the employees regulate their own activities for the common good of the organisation. As a result human beings are reduced to work for a peak performance under self controlled discipline. 5. Enforced discipline approach A managerial action enforces compliance with organisations rules and regulations ie. It is a common discipline imposed from the top. Here the manager exercises his authority to compel the employees to behave in a particular way.

SELF DISCIPLINE It refers to ones effort at self-control for the purpose of adjusting oneself to certain needs and demands. This form of discipline is based on two psychological principles. First, punishment seldom produces the desired results. Often, it produces undesirable results. Second, a selfrespecting person tends to be a better worker than one who is not. CONSTRUCTIVE VS DESTRUCTIVE DISCIPLINE Constructive discipline (positive discipline) uses discipline as a means of helping the employees grow, not as a punitive measure. The primary emphasis here is assisting employees to behave in a manner that allows them to be self-directive in meeting organizational goals.

Destructive discipline (also called enforced or negative discipline): If employees are forced to follow the rules and regulations of the organization by inducing fear in them, then it is termed as negative discipline DEALING WITH DISCIPLINARY PROBLEMS Disciplinary action may be ineffective because of methodological weakness or of procedural omissions by the manager. Methodological problems result from improper documentation of disciplinary interview and procedural problems from failure to apply discipline in a timely fashion and to follow due process. 1. Disciplinary conference It is a group discussion using both directive and non-directive interview techniques. It is damaging to employees self-esteem to receive criticism from an authoritative figure. Thus a disciplinary conference is anxiety provoking situation for both employee and the manager. 2. Disciplinary letter It is a letter send to the nurse/employee immediately after the conference, documenting the interview content from the managers viewpoint. It is needed as sometimes employees anxiety may block perception of the painful feedback offered by the manager. 3. Model standing orders It specifies the terms and conditions which govern day to day employer-employee relationship, infringement of which could result in a charge of misconduct 4. Errors in disciplinig employees The frequent errors encountered while disciplining the employees are: Delay in administering discipline Ignoring rule violation in hope that it is an isolated event Accumulations of rule violations, causing irritated manager to blow up Administering sweetened discipline Failure to administer progressively severe sanctions Failure to document disciplinary actions accurately Imposing discipline disproportionate to the seriousness of the offense Disciplining inconsistently

DISCIPLINARY PROCEEDINGS ENQUIRY IN MANAGEMENT CCSR (CENTRAL CIVIL SERVICES RULES) AND KCSR (KARNATAKA CIVIL SERVICES RULES) General Civil Services Rules The essence of Government service is the sense of discipline to which all Government employees are subject and it is related to the employees code of conduct and discipline.

Article 311 of the constitution enumerates two fundamental principles upon which the whole procedural law concerning departmental punishments on civil servants rests. The first clause of the article contains the guarantee that no civil servant shall be dismissed or removed by an authority surbordinate to that by which he was appointed. The second clause guarantees to him a reasonable opportunity of defence on the charges against him, supplemented by a second opportunity of showing cause why such a punishment should not be imposed on him, if after enquiry it is proposed to dismiss or to remove or to reduce him in rank. Only the appointing authority can impose major punishment (dismissal, removal or reduction in rank). The power of punishment can never be delegated. Enquiry officer is a officer subordinate to the appointing authority; who conducts formal enquiry about the charges on the charged official. The enquiry report contains findings of the charges, but there should be no recommendations about the punishment. CAUSES OF DISCIPLINARY PROCEEDINGS A. Acts 1. Acts amounting to crimes Eg. Bribery, corruption 2. Acts amounting to misdemeanor Eg. Misbehavior, insurbordination, disobedience 3. Acts amounting to misconduct Eg. Violation of conduct rules or standing orders B. Omissions Eg. Habitual late attendance, irresponsibility, negligence.

STAGES OF DISCIPLINARY PROCEEDING ENQUIRY 1. Preliminary enquiry 2. Decision to start formal departmental enquiry 3. Suspension 4. Charge sheet and its service 5. Appointment of enquiry officer 6. Written statement of defence 7. Recording of evidence by the enquiry officer 8. Personal hearing of charged official 9. Report of enquiry officer 10. Show cause notice by the disciplinary authority 11. Reply to show-cause notice and decision thereon 12. Review of punishment order 13. Appeal or revision 14. Reinstatement and restitution 15. Show-cause notice against withholding of emoluments for suspension period in the case of a reinstated.

CONCLUSION

Discipline is the most intimate term needed by all organisations. Management should also know the issues and challenges commonly occurring and the ways to resolve and bring discipline and harmony in the organisation.

EVALUATION
INTRODUCTION The realisation of goals and objectives is based on the accuracy of the judgements and inferences made by decision-makers at every stage. To arrive at a good decision the test, measurements and evaluation are being used in all situations. Thus evaluation has become a part and parcel of every system to determine the achievement of goals in a given period. MEANING AND DEFINITION The term evaluation is derived from the word valoir which means to be worth. Thus evaluation is the process of judging the value or worth of an individuals achievements or characteristics. It is an act or process that involves the assignment of a numerical index to whatever is being assessed Evaluation is an act or process that allows one to make a judgement about the desirability or value of a measure SELF EVALUATION DEFINITION Self evaluation is defined as judging the quality of ones work, based on evidence and explicit criteria, for the purpose of doing better work in the future. PURPOSES OF SELF EVALUATION 1. To encourage continuing self-evaluation and reflection and to promote an ongoing, innovative approach. 2. To encourage individual professional growth in areas of interest to the employee 3. To improve morale and motivation by treating the employee as a professional in charge of his or her own professional growth. 4. To encourage collegiality and discussion about practices among peers in an organisation 5. To support employees as they experiment with approaches that will move them to higher levels of performance BENEFITS OF SELF EVALUATION 1. Increased confidence in their own learning, in trying out new ideas, in changing their practice and in their power to make a difference. 2. Enthusiasm for collaborative working, despite initial anxieties about being observed and receiving feedback 3. Improved team-work and greater flexibility in their use of their skills
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4. Increased awareness of new techniques and greater insight into thinking 5. Enhanced planning skills to ensure more effective task management. TOOLS FOR SELF EVALUATION Staff annual professional review procedures Peer support o Coaching o Joint preparation of materials o Planning o Team building Observation can involve experts, can be informal or formal procedures. Feedback from such observation is very valuable, but must be handled sensitively Audit checklist

PEER EVALUATION
INTRODUCTION In response to the publics clamor for improved care quality, some nursing organizations instituted peer review as one method for increasing nurses accountability for effective decision-making and interventions. It is a mechanism for developing faculty leaders who can meet the challenges posed by public demands for accountability in healthcare management. DEFINITION Peer review is a process by which employees of the same rank, profession, and setting evaluate one anothers job performance against accepted standards. O Loughlin and Kaulbach

THE SUCCESS OF PEER EVALUATION DEPENDS ON Short but objective method Trained observers Constructive feedback for faulty development Open communication and trust

METHODS OF PEER EVALUATION Direct observation Videotaping Evaluation of course materials Analysis of portfolios PROCESS OF PEER REVIEW I. Establish a policy requiring peer reviews II. Establish criteria for peer evaluations III. Procedure for conducting peer evaluations a. Faculty chosen to conduct peer evaluations shall be tenured and hold on academic rank higher than that of the faculty member being evaluated

b. A written report, addressing the criteria, shall be prepared and signed by the evaluator c. The department shall archive the written evaluations for use in future evaluations d. One copy of the peer evaluation shall be placed in the permanent personnel file of the person being evaluated e. All reports of peer evaluations shall be included in the tenure file, and are to be carefully reviewed at the department.

PATIENT SATISFACTION
INTRODUCTION Consumers of health care services demand quality care. Patient satisfaction has been used as an indicator of quality services provided by health care personnel. The most important predictor of patients overall satisfaction with hospital care is particularly related to their satisfaction with nursing care. In recent years, the focus on consumerism in a highly competitive environment has led to increased interest in measuring patient satisfaction with health care. DEFINITION Patient satisfaction is defined as a health care recipients reaction to salient aspects of the context, process, and result of their service experience. Pascoe (1983)

Patient satisfaction is dened as the extent of the resemblance between the expected quality of care and the actual received care. - Scarding (1994) NEED FOR EVALUATING PATIENT SATISFACTION Data about patient satisfaction equips nurses with useful information about the structure, process and outcome of nursing care It is a requirement for therapeutic treatment and is equivalent to self therapy. Satised patients help themselves get healed faster because they are more willing to comply with treatment and adhere to instructions of health care providers, and thus have a shorter recovery time. METHODS OF MONITORING PATIENT SATISFACTION Medical audit Quality assurance committee reviews Indices of nursing performances Judgemental method COMPONENTS OF EVALUATION OF PATIENT SATISFACTION 1. Evaluation of the programs and activities of various departments including outpatient care, inpatient care, overall health education activities of the hospital 2. Evaluation of the various resources available in the hospital for effective health care
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3. Evaluation of effectiveness of hospital personnel including medical, paramedical, nursing as well as non-medical employees of the hospital. 4. Services are relevant to the needs of the population it serves. Patient satisfaction with nursing care is important for any health care agency because nurses comprise the majority of health care providers and they provide care for patients 24 hours a day. ULITILISATION REVIEW The utilisation review program includes determining appropriate hospital length of stay and necessary treatments for various illnesses and conditions and reviewing patient medical records on admission and at intervals during hospitalisation to ensure that the patient receives appropriate care. AIMS AND OBJECTIVES 1. The main aim is to curb the exploding health care costs with conservative use of hospitalisation and expensive diagnostic and treatment procedures. 2. They work in liason with a business organisation to provide healthcare services to the organisations employees at discounted rates. 3. Cost containment to limit each patients diagnostic and treatment measures to the fewest, least expensive procedures that will relieve patient symptoms, avert costly complications, and return the patient to fullest possible function in the shortest time possible. UTILISATION REVIEW NURSE A utilization review nurse is a registered nurse who reviews individual medical cases to confirm that they are getting the most appropriate care. They can work for insurance companies, determining whether or not care should be approved in specific situations, and they can also work in hospitals. Members of this profession do need to possess compassion, but they also need to be able to review situations dispassionately to make decisions which are fair, even if they may be uncomfortable. At a hospital, a utilization review nurse examines patient cases if the hospital feels that a patient may not be receiving the appropriate treatment. In an insurance company, the utilization review nurse inspects claims to determine whether or not they should be paid. The nurse weighs the patient's situation against the policy held by the patient, the standards of the insurance company, and the costs which may be involved in treatment. To work in this field, it is usually necessary to hold a current nursing license, and to have experience in the field.

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JOURNAL ABSTRACT The peer review process is referred to frequently in Magnet Nursing Standards as a key element in professional nursing. The peer review process allows professionals from common practice areas to systematically assess, monitor, make judgments, and provide feedback to peers by comparing actual practice to established standards. Peer review can engage a multigenerational workforce and lead to more satisfied, engaged employees. As a component of the annual performance appraisal, peer review can create positive relationships, foster a better work environment, and allow peers to increase individual and group accountability. Peer review has many common elements that can be individualized to fit any type of unit or work culture. It is very necessary to know how to design, implement, and evaluate a unit-based peer review program. The content and steps are intended to support nurse managers in implementing unit-specific peer review programs by focusing on existing expertise and best practices. The implementation steps are divided into 5 phases describing the introduction of concepts and getting nurses engaged, implementation guidelines, piloting the process, staff education, and ongoing evaluation. Staff involvement is the key to a successful unit-based peer review process. BIBLIOGRAPHY
1. BT Basavanthappa, Nursing dministration, Jaypee Publication, Delhi, 2nd edition, 2008, pg no. 590-610. 2. Dee Ann Gillies, Nursing management-A Systems Approach, 3rd edition, W.B. Saunders Company, pg. 550-558, 528, 84.

3. B. Sankaranarayan, B. Sindhu, Learning and Teaching Nursing, 1st edition, Brainfill publications, pg no. 203 4. Lynne E Young, Teaching Nursing, 1st edition, Lippincott Publications, pg no. 183, 586 5. K.P. Neeraja, Textbook of Nursing Education, 1st edition, Jaypee Publications, pg no.404. 6. http://journals.lww.com/naqjournal/Abstract/2009/07000/Implementing_Peer_Review_ _Guidelines_for_Managers.11.aspx (Nursing Administration Quarterly: July/September 2009 - Volume 33 - Issue 3 - p 251-257)

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