Q&A With Nurse B: Co-worker Keeps Calling In Sick!
Beth Boynton, RN, MS Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She offers advice on how to navigate common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions.
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I’m the practice manager (also a nurse) for a busy primary care physician’s office in an urban area. We have five physicians and three advanced practice registered nurses (APRNs); there are also four registered nurses, each assigned to work with two providers.
One of the nurses – I’ll call her Nurse Jones – has a chronic health issue and calls in sick considerably more often than the others. At first, the staff was willing to help out in covering for her, but over the last few months I’m noticing signs of resentment; exasperated sighs and eye-rolling occur when I share the news of the latest call out. There is also a sense of growing tension among the staff whether she’s working or not. I’m worried that patient care and staff morale may become compromised.
We tried hiring a per diem nurse to cover, but he left after a few months because we weren’t using him enough. Upper management does not want to train anyone new based on the current frequency of sick calls. I’m in charge of staffing, but I’m not sure what to do about this situation. I don’t question the legitimacy of the nurse’s condition and also understand the staff’s frustrations, not to mention management’s budgetary concerns; overall, I’m concerned about the toll this is taking while worrying about the next call!
Thanks for sharing this challenging situation with us. When such situations go unchecked, resentments often arise that lead to staff turnover, poor patient experiences, and legal battles. Your willingness to address it early on and to consider things from all perspectives is a hopeful platform for collaborative problem-solving.
It sounds like you have the complicated challenge of balancing this employee’s limitations and availability with the needs of your organization and staff. Finding the “Third Door” will require insight into the needs, wants, and limitations of every stakeholder, as well as a belief that everyone can be part of a healthy balance. Let’s be curious and assume a good faith effort on everyone’s part as we explore the perspectives of Nurse Jones, the organization, and the staff.
The Other Perspective
Is there any predictability in terms of Nurse Jones’ sick calls? When she calls in sick, is she totally disabled for the day, or is there room for her to provide some support to the team in some as yet unknown capacity?
Is it possible to look for opportunities outside of the box, such as partial days; scheduled phone calls for questions/support/triage; or off-site work which can be completed on her own time when she feels well? It may be surprisingly beneficial to ask Nurse Jones if she has any ideas related to meeting the goals associated with her job description despite frequent sick calls; this can help shift the focus from what she can’t do at any given moment to the value she brings to the organization…
Also, how clear are her work restrictions? Some physicians are more detailed than others, and if the employee is willing to seek support, she may be in the best position to communicate this to her medical provider and develop a new work-related release. For example, a work release stating, “Nurse Jones may work a reduced number of hours/day at a sedentary capacity as tolerated” is one that empowers the nurse and you to work together. This kind of release is only likely if there is a collaborative spirit among all parties.
The Organization’s Needs
How clear is Nurse Jones’ job description, and are there areas where creative flexibility in response to physical limitations could result in increased opportunities for the employee to meet important goals? Is there a way to redistribute any aspects of the job which would create a better balance for the team? This will be tough if the employee is a direct care provider, but it may be worth looking at the issue through this lens. Documentation support, phone calls, and the development of teaching materials may be potential tasks to consider.
Is there a Human Resources representative to help you determine what would constitute reasonable accommodations(s)? You need to establish a bottom line that helps you define this and whether or not the employee’s limitations create an undue burden on the organization. The Occupation and Industry Series: Accommodating Nurses with disabilities is a great resource for more information from the Job Accommodation Network (JAN). It may also be worth checking with your insurance company to take advantage of any short term disability support available for this nurse. Again, if the relationship between employee and employer is collaborative, this will be much easier.
Staff and Collaborative Solutions
While respecting privacy issues, you might hold a brainstorming session with key staff in order to elicit their ideas about managing sick calls, and optimizing the use of Nurse Jones’ skills while honoring her restrictions. What suggestions do the staff have for making sure the team gets the job done? What do they need for support? How can you help? This type of intervention will be more effective if there is team support; it’s so very important that you use your judgment and frame the situation appropriately.
Checking in with Nurse Jones about this would be the most collaborative process to follow. This may be intimidating or embarrassing for her, and if she has concerns in this regard, I would suggest that you do your best to honor them. In an ideal situation, she would feel welcome and safe to participate in such a meeting.
There’s a great opportunity for you to see where building a sense of collaboration can lead to creative and effective problem-solving while preventing adversarial relationships and outcomes. I hope these ideas are helpful, and I wish you the best as you and your staff move forward.
What ideas do you have to help this practice manager with this situation?
Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015). Her third book, Medical Improv: A New Way to Improve Communication is scheduled for release in 2017.
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