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 agency’s 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:

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 The manager’s 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 nurse’s 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.
2. Authorized penalties: The agency’s 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, management’s 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.

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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,
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,

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 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 one’s 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 self-
respecting 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 employee’s 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 employee’s
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

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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

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 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.

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 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 defined 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. Satisfied
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
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.

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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
organisation’s employees at discounted rates.
3. Cost containment to limit each patient’s 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.