As nurse manager of a behavioral health unit in an acute care hospital, you are responsible for the overall management and quality of care provided on a 30-bed inpatient unit with an average length of stay of four days. Staffing is short, and you have four new nurses with limited or no mental health experience. Last night a patient was injured during a restraint procedure. You are reviewing the incident report in your office and decide to review restraint data for the past three months. You are shocked when you see that restraints have increased by 15% and that one nurse, who has been there only four months, has been involved in 75% of these restraints regardless of the shift she worked. You then review the medical records for these patients and find that documentation of the incidents is not complete, there is little reevaluation of the patient as required, and basic patient needs were not met effectively. You then talk to several staff members who have worked with the nurse during the shifts when the restraints occurred. They describe the nurse as “difficult” and “demanding” with “limited tolerance for negative patient behavior.” She does not include staff in decision making such as whether to restrain a patient. This all concerns you, so next you look at her personnel file. The nurse had six months of previous mental health experience and two years of acute care medical nursing experience. You notice that she should have had two to three completed reference checks, but only one is in the file and that one is vague. You are overwhelmed with what you have uncovered.
1.What do you think about this nurse manager and how she has handled quality improvement issues, personnel issues, and overall decision making in her unit?
2.What are the legal and ethical issues related to the care this staff nurse has provided?
3.How should the nurse manager respond to this nurse and to her multiple problems?
4.Following this experience, what does the nurse manager need to do long term to improve her own management competencies?
