PERFORMANCE CORRECTION NOTICE

DISCIPLINARY LEVEL

Verbal Correction—(To memorialize the conversation.)

Written Warning—(State nature of offense, method of correction, and action to be taken if offense is repeated.)

Investigatory Leave—(Include length of time and nature of review.)

Final Written Warning

Without decision-making leave

With decision-making leave (Attach memo of instructions.)

With unpaid suspension

SUBJECT:Falling asleep at the ICU panel

Policy/Procedure Violation

Performance Transgression

Behavior/Conduct Infraction

Absenteeism/Tardiness

PRIOR NOTIFICATIONS

Incident Description and Supporting Details: Include the following information: Time, Place, Date of Occurrence, and Persons Present as well as Organizational Impact.

Rolf,

On June 28 at approximately 2:30 in the morning, patient #11236 pressed on their help button but did not receive a reply. Likewise, the patient light outside their room was activated but had gone unnoticed for almost forty minutes. The patient’s family member made a complaint the following morning after your shift had concluded, and it was discovered via video that you were asleep at the ICU desk. Your head was resting on your arms on the desk, and there was little body movement until approximately 3:10 A.M., when you woke up and responded to the patient’s request.

When we asked you about this at the beginning of your next shift tonight, you stated that you might have fallen asleep. You stated that you recalled seeing the patient’s light and responding to it, but you don’t remember seeing it go on. You confirmed that it very likely was the case that you had fallen asleep at your workstation.

Further, you acknowledged the critical nature of remaining vigilant at the ICU desk—especially during the midnight shift—because patients’ lives could be in jeopardy. As a result of this transgression, which could have potentially compromised patient care, you are receiving this final written warning, confirming that any similar transgressions in the future could result in termination of employment.

PERFORMANCE IMPROVEMENT PLAN

1. Measurable/Tangible Improvement Goals: I realize that you recognize the critical nature of patient care at all times, especially during the midnight shift. Likewise, I appreciate your willingness to accept responsibility for this particular occurrence. However, I expect that you will never again compromise patient safety by putting yourself in a situation where you could potentially fall asleep during your shift and especially while monitoring the ICU desk in the late-night hours.

2. Training or Special Direction Provided: None

3. Interim Performance Evaluation Necessary? No

4. Our Employee Assistance Program (EAP) provider, Prime Behavioral Health Group, can be confidentially reached to assist you at (800) 555-5555. This is strictly voluntary. A booklet regarding the EAP’s services is available from Human Resources.

5. In addition, I recognize that you may have certain ideas to improve your performance. Therefore, I encourage you to provide your own Personal Improvement Plan Input and Suggestions:

(Attach additional sheets if needed.)

OUTCOMES AND CONSEQUENCES

Positive: I will remain available to help you and discuss areas where you require additional support. If you meet your performance goals, no further disciplinary action will be taken regarding this issue.

Negative: If you ever again fall asleep on company time and on company premises, further disciplinary action up to and including dismissal will result. In addition, if you ever again fall asleep at the ICU desk while monitoring critical patients, your employment will be terminated.

Scheduled Review Date: None

EMPLOYEE COMMENTS AND/OR REBUTTAL

EMPLOYEE ACKNOWLEDGMENT GOES HERE