Case scenarios
Please read each of these scenarios. While reading think about common strategies and techniques used to resolve conflict. Answer the questions following the scenario's and post in the discussion forum (questions will also be placed in the discussion forum for your convenience).
Scenario 1
"Nurse manager perspective: ED nurse manager Ms. P is walking out the door at 6:50 p.m. when she remembers that she hasn't made the staffing assignments for the next day. She hurries back to her office and realizes that the permanent charge nurse Ms. B had called in sick earlier. Before selecting a replacement, she quickly scans the ED physician schedule to see which physician is on for the early morning shift. It's Dr. N, an excellent practitioner, but very difficult to work with because he doesn't consider the clinical opinion of the ED nurse when selecting a treatment plan. Ms. B is the only charge nurse from whom Dr. N accepts direction. She's able to reach an acceptable solution to any problem that involves Dr. N.
Ms. P looks at the schedule and decides that the direct care nurse Ms. S is the best choice. She's also an excellent practitioner who can quickly find a middle ground to a solution when it involves patient management and patient movement. With a sign of relief, Ms. P thinks to herself, “Thank goodness I remembered to assign charge. What a disaster if I had forgotten.” She pauses as she turns out the light to her office and says to herself, “I need to get back here tomorrow morning to make sure that Ms. S and Dr. N get off to a positive start.”
Direct care nurse perspective: Ms. C, an experienced RN, comes onto her 12-hour shift at 7 a.m. to a typical day in the medical center ED. All of the patient bays are filled, there are stretchers with patients lining the hallways, and triage is backed up with patients waiting to come inside the main ED for evaluation and treatment. When she left the ED at midnight last night, it was jam-packed and there were admitted ED patients still awaiting a bed upstairs because the hospital was at full capacity. When she arrives on the unit this morning, her heart sinks. She learns that the day charge nurse called out sick and Ms. S is covering. Ms. S is an excellent ED nurse, but she's very difficult to work with when she's in charge because she becomes demanding and aggressive. Interacting with her is always a challenge that escalates when she assumes the charge role.
To make matters worse, Dr. N is also on duty. Dr. N doesn't get along with nurses and especially not with Ms. S. They're often in loud debates about patient management and patient movement. Ms. C takes a deep breath, braces herself for the oncoming battles, and is ready to flee the nurse's station when she bumps into Ms. P. She likes Ms. P, who's supportive and always knows how to keep the peace.
Sample conflict management resolution action plan: Ms. C, RN, receives report on her patients from the charge nurse Ms. S and notices that her assignment is disproportionate to her peer Ms. J. Her assignment is heavy, including seven patients, two of whom are unstable. The acuity and number of patients exceed the ED guidelines. She isn't comfortable that it's safe; however, she isn't surprised to learn that Ms. J's assignment is light because Ms. J has the reputation of always getting her way. Her five patients are stable and being readied for discharge. Normally, Ms. C would accept her assignment to accommodate the needs of the unit, but she's tired from working a double shift the day before. When she approaches the charge nurse Ms. S to modify her assignment, she's told that the assignment is what it is and that Ms. S wants to avoid any drama with Ms. J because, “You know how she is.” As Ms. C turns to leave, she sees the nurse manager Ms. P and decides to tell her about her unfair assignment."
1. How does nurse manager Ms. P react to this situation?
2. How does she deal with the charge nurse and Ms. C's perception that her assignment is unreasonable?
3. How does she manage this conflict?
(Johansen, 2012)
"Nurse manager perspective: ED nurse manager Ms. P is walking out the door at 6:50 p.m. when she remembers that she hasn't made the staffing assignments for the next day. She hurries back to her office and realizes that the permanent charge nurse Ms. B had called in sick earlier. Before selecting a replacement, she quickly scans the ED physician schedule to see which physician is on for the early morning shift. It's Dr. N, an excellent practitioner, but very difficult to work with because he doesn't consider the clinical opinion of the ED nurse when selecting a treatment plan. Ms. B is the only charge nurse from whom Dr. N accepts direction. She's able to reach an acceptable solution to any problem that involves Dr. N.
Ms. P looks at the schedule and decides that the direct care nurse Ms. S is the best choice. She's also an excellent practitioner who can quickly find a middle ground to a solution when it involves patient management and patient movement. With a sign of relief, Ms. P thinks to herself, “Thank goodness I remembered to assign charge. What a disaster if I had forgotten.” She pauses as she turns out the light to her office and says to herself, “I need to get back here tomorrow morning to make sure that Ms. S and Dr. N get off to a positive start.”
Direct care nurse perspective: Ms. C, an experienced RN, comes onto her 12-hour shift at 7 a.m. to a typical day in the medical center ED. All of the patient bays are filled, there are stretchers with patients lining the hallways, and triage is backed up with patients waiting to come inside the main ED for evaluation and treatment. When she left the ED at midnight last night, it was jam-packed and there were admitted ED patients still awaiting a bed upstairs because the hospital was at full capacity. When she arrives on the unit this morning, her heart sinks. She learns that the day charge nurse called out sick and Ms. S is covering. Ms. S is an excellent ED nurse, but she's very difficult to work with when she's in charge because she becomes demanding and aggressive. Interacting with her is always a challenge that escalates when she assumes the charge role.
To make matters worse, Dr. N is also on duty. Dr. N doesn't get along with nurses and especially not with Ms. S. They're often in loud debates about patient management and patient movement. Ms. C takes a deep breath, braces herself for the oncoming battles, and is ready to flee the nurse's station when she bumps into Ms. P. She likes Ms. P, who's supportive and always knows how to keep the peace.
Sample conflict management resolution action plan: Ms. C, RN, receives report on her patients from the charge nurse Ms. S and notices that her assignment is disproportionate to her peer Ms. J. Her assignment is heavy, including seven patients, two of whom are unstable. The acuity and number of patients exceed the ED guidelines. She isn't comfortable that it's safe; however, she isn't surprised to learn that Ms. J's assignment is light because Ms. J has the reputation of always getting her way. Her five patients are stable and being readied for discharge. Normally, Ms. C would accept her assignment to accommodate the needs of the unit, but she's tired from working a double shift the day before. When she approaches the charge nurse Ms. S to modify her assignment, she's told that the assignment is what it is and that Ms. S wants to avoid any drama with Ms. J because, “You know how she is.” As Ms. C turns to leave, she sees the nurse manager Ms. P and decides to tell her about her unfair assignment."
1. How does nurse manager Ms. P react to this situation?
2. How does she deal with the charge nurse and Ms. C's perception that her assignment is unreasonable?
3. How does she manage this conflict?
(Johansen, 2012)
Scenario 2
"It is Kate’s third 12 hour shift in as many nights. She arrives at work already tired; she did not
sleep well because her neighbour’s children were playing loudly in the yard next door. Even
though this frequently happens, Kate has never talked to the neighbour next door about her need
for quiet during the day when she is trying to sleep. She figures it would do no good, so why
bother.
She is a few minutes late for her shift since she had to stop for gas on her way to work. The
argument she had with her husband on her cell phone on the way to work is still much on her
mind. Why does he always leave the gas low when she needs to get to work? They have had this
argument many times and yet nothing ever changes. Just once I would like to win that argument
Kate thinks.
Her colleagues look upset and mutter under their breath as she arrives and even worse, Jean the
Nurse Manager is glaring at her as she rushes into the nursing station. Kate has been warned
before about her “time issues” and been threatened with discipline if things don’t get better. Kate
has attempted to talk to Jean but all she gets are threats and ultimatums.
The ED is crowded as usual with the waiting room overflowing. It is going be another busy night
no doubt. As she waits for her colleague to give report on the patients she will be taking over, an
irate man approaches the nursing station and starts yelling. “We have been waiting for 2 hours
and nothing is being done and all of you nurses are just sitting around chatting about your social
lives. This is ridiculous.” Kate starts to try to explain but the man waves her off. As he storms
away he says with a surly voice, “we are out of here and I am going to report all of you.”
A few minutes later as Kate is assessing her patients, Dr. Lane approaches her demanding she
come with him to examine a patient. Even though Kate has not finished what she is doing and has
not assessed all of her patients, she does not want to upset Dr. Lane who has been known to get
very angry when he does not get what he wants. Kate goes along with him, even though she
worries that she has not really got a good handle on what her patients are up to."
1. How does Kate handle the factors that impede her ability to get to work on time?
2. How did Kate manage the situation in the ER with the irate man?
3. What else could Kate have done when Dr. Lane approached her, demanding she go with him?
(Marshall, 2006)
"It is Kate’s third 12 hour shift in as many nights. She arrives at work already tired; she did not
sleep well because her neighbour’s children were playing loudly in the yard next door. Even
though this frequently happens, Kate has never talked to the neighbour next door about her need
for quiet during the day when she is trying to sleep. She figures it would do no good, so why
bother.
She is a few minutes late for her shift since she had to stop for gas on her way to work. The
argument she had with her husband on her cell phone on the way to work is still much on her
mind. Why does he always leave the gas low when she needs to get to work? They have had this
argument many times and yet nothing ever changes. Just once I would like to win that argument
Kate thinks.
Her colleagues look upset and mutter under their breath as she arrives and even worse, Jean the
Nurse Manager is glaring at her as she rushes into the nursing station. Kate has been warned
before about her “time issues” and been threatened with discipline if things don’t get better. Kate
has attempted to talk to Jean but all she gets are threats and ultimatums.
The ED is crowded as usual with the waiting room overflowing. It is going be another busy night
no doubt. As she waits for her colleague to give report on the patients she will be taking over, an
irate man approaches the nursing station and starts yelling. “We have been waiting for 2 hours
and nothing is being done and all of you nurses are just sitting around chatting about your social
lives. This is ridiculous.” Kate starts to try to explain but the man waves her off. As he storms
away he says with a surly voice, “we are out of here and I am going to report all of you.”
A few minutes later as Kate is assessing her patients, Dr. Lane approaches her demanding she
come with him to examine a patient. Even though Kate has not finished what she is doing and has
not assessed all of her patients, she does not want to upset Dr. Lane who has been known to get
very angry when he does not get what he wants. Kate goes along with him, even though she
worries that she has not really got a good handle on what her patients are up to."
1. How does Kate handle the factors that impede her ability to get to work on time?
2. How did Kate manage the situation in the ER with the irate man?
3. What else could Kate have done when Dr. Lane approached her, demanding she go with him?
(Marshall, 2006)
What is it about healthcare that causes conflict?