You believe that a traveler on assignment at your facility did not use good judgment in a clinical situation. Perhaps, while
supervising an LPN or nurses' aide, the mobile RN didn't follow institutional protocol. Or maybe there is a completely different
circumstance at hand, pertaining to attendance or tardiness.
While any of the above examples would likely be deemed a rare occurrence, conflicts with temporary, as well as permanent,
employees do occur and must be addressed. Just as acute care managers have established policies regarding disciplinary actions
for regular staff, comparable strategies should be in force with respect to the mobile providers who practice within their
settings. Yet, procedures for dealing with these matters might not be clearly defined in the contracts between institutions
and travel companies. In what could be perceived as a gray area by many, how do decision-makers address traveler-related
disciplinary issues?
Contractually speaking Various travel companies have added clauses to their agreements with hospitals, declaring a clinician's contract may be terminated-with
or without notice -if he or she has not practiced safely and competently while on assignment. However, several contracts may
not outline the manner in which other, less consequential events should be handled. "While our contracts do not specify the
way every incident should be treated-due to the uniqueness of each occurrence-we request that all episodes be reported to
our department as part of quality and risk management policies and procedures," says Susan Collier, MHA, vice president of
risk management for CompHealth. "These terms are the same in our client and traveler documents."
Whether or not guidelines on dealing with disciplinary issues are in writing, administrators are encouraged to contact the
appropriate representative of the traveler's staffing agency about any adverse event. Although a manager is certainly free
to discuss such topics directly with the mobile professional, following up with his or her firm ensures that a record is established
and enables the staffing company to take immediate action to amend the situation. "Being proactive is essential," states Patricia
Carter, RN, CLNC, corporate nurse liaison for Richards Healthcare. "After obtaining very detailed accounts from the unit director,
as well as the traveler, I am able to piece the occurrence together and respond to our client's concerns accordingly and efficiently."
Minor versus major issues The approach used to correct a minor problem would almost certainly vary from that pursued to address a chief concern. Although
the type-and severity level-of incidents reportable for disciplinary action may differ, the means by which they are documented
are fairly similar.
Placement firms go to great lengths to ensure their employees are of the highest quality, and facility executives should expect
nothing less. If a traveler behaves in an unacceptable fashion, managers can share details of the incident with his or her
agency recruiter who would assess the situation and respond accordingly. Depending on the findings of the investigation, a
healthcare professional may be suspended, terminated, instructed to take a medication review course, go before peer review,
receive a written warning-or be completely exonerated. Through teamwork, acute care administrators and travel company representatives
can ensure a thorough evaluation and swift resolution of any matter.
Though minor transgressions-such as repeated tardiness or taking an excessive amount of time to give report-can be rectified
when a nurse manager speaks candidly with the clinician involved, most travel companies still wish to be made aware of these
improprieties. "If a disciplinary situation arises, my team and I prefer to work jointly with a client," says Ms. Carter,
"determining not only the validity of the allegation, but also the appropriate action that should be taken if it is found
to be legitimate."
Echoing her sentiments, other industry experts note that secondary indiscretions are easily correctable and "coachable," especially
when institutions and agencies partner for resolution. If there has never been an issue with a given professional in the past,
investigators should consider any possible extenuating circumstances. It's quite likely that an isolated incident could be
remedied with some additional training or support.
With situations of significant magnitude, other factors come into play. Consider events that could jeopardize patient safety
and a practitioner's license-like a claim that a nurse, therapist, or technologist began his or her shift under the influence
of alcohol or narcotics. "Should a provider test positive for drug use, we would perform a thorough investigation," says Ms.
Collier. "For instance, if the individual in question had been taking a certain type of prescribed medication and was able
to offer proof through a physician's statement, that would be deemed a reasonable explanation and not a matter for disciplinary
action. We have a 'no tolerance' drug policy, and if we determined a traveler had been under the influence of a substance
illegally, he or she would be terminated immediately and we would file a report with the appropriate licensure board."
