Mistakes in Care

It happens that employees make mistakes. The background to why mistakes are made varies. Someone may have concerns at home and have difficulty concentrating. Another may have misunderstood an instruction or lacks information. In other cases, it may be a matter of negligence or carelessness.

Healthcare organizations are often cautious about using employment law measures. There are a number of ways to handle or support those who make mistakes or errors in the operation. It is always the employer who leads and allocates the work. There are cultural problems at some workplaces that cannot be blamed on the individual employee. The manager is always obliged to point out phenomena that are not acceptable in the workplace. There are a number of laws regulating the field of employment law. Examples are the MBL (Co-Determination Act) and the Employment Protection Act. Often there are also rules in the collective agreements to take into account. However, the ultimate consequence of misconduct is always dismissal or termination. There are a number of milder measures.

Handling of Personnel Matters

In all handling of personnel matters, it is important for the manager to act promptly to clarify the circumstances, have a conversation to gain clarity, speak plainly - be clear, document everything and give a reprimand or warning if needed.

The first step is to have a conversation about what happened. The conversation is documented and the manager requests a written statement. It may be a misunderstanding and not misconduct. If it is a serious event, it can be supplemented with a verbal or written reprimand.

Revocation of Delegation

In the event of errors in medication management, the nurse can immediately revoke the delegation for the employee. This means that the person is not allowed to distribute medication.

Competence Development

In case of lack of knowledge, the employer may need to offer competence development. This could be due to language difficulties or a lack of knowledge in areas such as hygiene or the importance of following other routines.

Suspension

In cases of serious deficiencies, the employer may decide to temporarily take the employee out of service. Suspension is a temporary measure while an investigation is ongoing. The employee is in principle always allowed to keep the salary during the investigation period while waiting for more long-term measures. The reason for suspension could, for example, be suspicion of drug abuse or committed crimes.

Occupational Health

If it emerges that the mistake was made as a result of ill health, it may be appropriate to offer the employee contact with occupational health. If an event is repeated, the employer may call for a corrective conversation. More people from the employer often participate in this and the employee can have support from, for example, a union representative. All conversations are documented and stored in the personnel file.

Relocation, Admonition, Warning or Written Warning

Relocation can be a measure. It must not be used as punishment or with the intention of getting an employee to quit. In a care unit, it may be necessary if there is a resident who harbors special animosity towards the employee or if the work group is not functioning.

A warning or written warning is a way of indicating that the employer takes the incidents seriously. Repeated warnings may be grounds for dismissal. Salary deductions may be an option in some cases.

Crimes should always be reported to the police but should also at least lead to a warning. The same applies to unauthorized absence, poor treatment of residents or failure to perform certain tasks.

Termination

A valid reason for termination may be personal circumstances such as unauthorized absence, refusal to obey orders, misconduct or similar. This also applies to misconduct due to drug abuse, such as coming to work under the influence of drugs or not fully recovered. However, illness is usually not a valid reason. Doctors determine whether drug abuse is to be considered as a disease. If the disease results in the employee neglecting their work to the extent that they no longer perform work of any significance, there may still be a valid reason.

Misconduct can be about refusing to work, repeatedly arriving late, unauthorized absence, drunkenness on duty, difficulties in cooperation, poor work performance, criminal actions, disloyal actions such as supporting competing activities, consequences resulting from illness or abuse.

When it comes to illness, it is normally not a reason for dismissal. The employer has a far-reaching responsibility to adapt the work, provide opportunities for rehabilitation and to also try the possibility of relocation.

Probationary Employment

For employees on probationary employment, employment can be terminated at short notice.

Responsibility of Licensed Personnel

The Patient Safety Act stipulates that if a healthcare provider believes there is reasonable cause to fear that a person, who is licensed for a profession in healthcare and who is active or has been active with the healthcare provider, may pose a danger to patient safety, this should be reported as soon as possible to the IVO.

The IVO investigates licensed health and medical care personnel whose professional practice may be questioned from a patient safety perspective or from a confidence perspective. The reasons for the review may be incompetence, inappropriateness, criminality, illness or misuse of alcohol, drugs or other drugs.

Reflection Questions - Employment Law Measures
Care staff:
- Does the operation have a good way of working to remedy deficiencies?
- Is there clear leadership that corrects deficiencies in work methods?
- Do you have good routines that make it "easy to do right"?

Manager, nurse, occupational therapist and physiotherapist:
- Do you have a consensus on how different deviations should be handled?
- Do you have support outside the unit if more powerful measures need to be taken?
- Do you always document corrective conversations in the personnel file?

Residents and relatives:
- Have you seen phenomena that you perceive as misconduct from any employee?
- Have you brought it up with the manager of the operation?

Erland Olsson
Specialist nurse
Sofrosyne - Better Care Every Day