Making Decisions About Second Chances

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I met with a nursing director the other day who told me that she “was beating herself up” because she gave a nurse a second chance and the nurse made a serious mistake that seriously injured a patient. The first situation was one in which an unclear system contributed to the error. She confessed she gave the nurse the benefit of the doubt. In the second situation, the nurse had clearly not followed policies and procedures. She told me that she was a strong believer in a just culture and always worked to help staff learn from their mistakes. When it happened a second time, she could not believe the level of sloppiness in the nurse’s practice and her unwillingness to accept professional accountability.

Her story raised an important question about second chances. What should leaders think about when they are about to give the staff member a second chance. Making these decisions is never easy. Our current healthcare environment is very demanding and the stakes are often very high when mistakes are made. Leaders worry about the ramifications if there is no improvement and it happens again. Yet all of us know of situations where a nurse has made a serious mistake in his/her career and later was able to turn things around. Each situation is different but here are some questions to consider as you individually evaluate each situation:

1. How serious were the problems that led to failure?

There are some problems that led to failure that may be too serious to consider giving the individual a second chance. Most nurse leaders are reluctant to give a second chance to a nurse who has diverted drugs, even when the individual goes through rehabilitation. A time and attendance issue might be a very different situation if trust was not fractured, and there were extenuating circumstances. Organizational human resource policies often play a big role in whether a leader can even consider a second chance in certain situations.

2. Where are they in their professional development?

Although we all make mistakes, younger staff often lack the judgement that evolves with more life experience and career development. Traumatic life experiences can also drive behavioral changes that lead to failure, and these also need to be considered.

3. Have they learned from the failure?

This is an important question to consider. When the staff member does not take full accountability for what happened, it is unlikely that they have learned what they need to know to be successful.

4. What we will they do differently if given a second chance?

When I give staff a second chance, I expect to hear what behaviors will change to create success a second time around.

5. Is the environment conducive to helping them succeed?

The culture of a unit or organization needs to be considered when giving staff a second chance. Will they be supported by those they work with, or is the trust irrevocably fractured. As well intentioned as you might be, you could be setting the individual up for a second failure if the culture is not supportive.

6. Are you prepared to extend the same opportunity to others if the situation presents itself?

Fairness is important in leadership. I remember as a young leader often being told by my director that decisions I made about staff requests would be closely monitored by other staff members. I needed to be certain that whatever special considerations I gave staff, I was prepared to extend to every other staff member. This was good advice that I used throughout my career.

As nurse leaders, second chances are among the valuable gifts that we can extend to others. It is a decision that requires thoughtful consideration. Sometimes, you give a second chance, and find that your confidence has been misplaced as was the case with my colleague. But sometimes, you can be very surprised at what happens when you do. There is nothing that is more gratifying in leadership than watching a staff member make an incredible comeback from a failure.