WHO, ME? Some nightmare nurses might not think they're doing anything wrong.

You know who the bad apples are. They're the last to arrive almost every day. They talk during staff meetings. They direct staff to do what they think is best instead of what you want. They buddy up to physicians. They constantly call in sick. So how do you handle the troublesome few who push every one of your buttons and test every ounce of your patience?

Intervene immediately
Let's say one of your nurses is supposed to arrive at 6:45 a.m. to set up an OR. Instead, she arrives 30 minutes late and doesn't say anything to anyone. The OR team had to scramble to open her room while opening theirs, and they aren't happy about it. You might not know what happened until later in the day, when the team is sniping at each other. Once you're made aware of the situation, act at once.

If you didn't directly witness what occurred, bring the nurse into your office and ask her to explain why she was late. The excuse may be valid, but she was late nevertheless. Explain why this was a problem for her co-workers. Write up the incident, and explain that it is unacceptable and can't happen again. Ask the nurse to verbalize her understanding of the discussion.

Remember that all reprimands are confidential. You don't owe other employees any explanations about what you have done or said. If they ask about interventions, tell them that you would keep any discussions with them private and confidential, as you're sure they would want.

What if you don't intervene immediately? Other staff members see the problem employee as getting away with the behavior and begin to wonder why they should be on time when you don't care enough to enforce your policies.

The problem behavior may have a ripple effect as other employees begin to test your limits. Staff members who do play by the rules watch peers get away with misbehaving over and over again. That negatively impacts the morale of your entire staff and causes rifts in the ranks. Worse, problem behavior soon becomes the norm, and unless you intervene, you're indirectly telling the rest of the staff that you condone the behavior, which makes it much harder to put your foot down and reinforce the discipline you should have established long before things spiraled out of control.

Fire when ready
The nurse is late again, with no excuse. Call her into your office right away and have the same discussion. This time, explain that the situation is more serious. Write up a formal counseling and explain that if it happens again within a certain time period, she could be terminated. Again, ask for a verbalization of her understanding.

What if the nurse is late a third time, after you gave her the serious warning? It's time to terminate her employment. Make sure your documentation of past offenses is thorough and detailed, including mention of the counseling sessions. Explain that firing her isn't personal, but that the current situation isn't working for either of you, and that today will be her last day. Keep the discussion short and to the point, and don't get emotional. The best time to do this is at the end of the day on a Friday, so the employee isn't embarrassed in front of peers.

There are always many legal issues to consider before terminating an employee, and it's well worth the time and money to consult with an HR firm. Always consider the race, age, gender and sexual orientation of the person you're firing. If your documentation is poor, she can sue for wrongful termination based on one of these factors. If the firing is justified and your paperwork is clean, you should be fine from a legal standpoint.

Establish expectations
Some employees might not realize they've become problems. Perhaps you didn't set clear expectations and the problem behaviors began gradually. Perhaps their home lives have changed through no fault of their own in ways that impact their behaviors at work: a child is habitually sick, a spouse loses a job or a family member is battling a grave illness. On the other hand, maybe a problem employee has become disgruntled and is acting out to test your authority.

To avoid trouble in either case, set expectations before you make a job offer. Ensure that the potential employee understands the job description and your expectations regarding attendance, hours, behavior and attitude. Ask candidates if there are any circumstances that would make it difficult or impossible to comply with those expectations. Remember, however, that you can't directly ask if they have children, if they're pregnant or if they have any illness that would prevent them from meeting the demands of the job. These are interviewing no-no's that can get you into a lot of legal trouble.