As nurses, it is paramount that we learn how to deal with conflicts on a daily basis. These conflicts can range from patient care, to being a strong patient advocate. Some conflicts are easily corrected and others take more time and energy away from what should be focused on the patient. Many times these conflicts can take away from patient care, and can ultimately cause harm or some type of neglect to the patient. When a conflict arises we as nurses need to stay on top of the situation so that it does not get out of control. The more we allow conflict to linger, the more danger it can cause. According to Khalid and Fatima, “health care professionals are also vulnerable to conflict as they are faced with pressures while they strive to provide quality care to patients,” (Khalid & Fatima, 2016, p. 122). Many times, conflicts arise from changes that take place in the departments.
The most recent conflict we have experienced on our med-surge floor is that the chlorhexidine baths are not being given nightly to patients. On a nightly basis all patients that are going to have a procedure are to receive chlorhexidine baths to prevent infections. This job is a job that has been delegated to the CNA’s (certified nursing assistants). We have been battling this issue for months now. Many conversations have been had in regards to performance issues, as well as the importance of these baths. At the beginning of my shifts I approach the CAN’s and let them know which patients need to have these baths done, and every shift it seems I have to constantly stay on the CAN’s to complete the tasks. There have been times where certain CNA’s has told me that the bath was done, and it had not been or even that the patient refused. Being that this is a delegated job it is my responsibility to follow up to make sure that the tasks are completed. Many times, when I have spoken to the patients the patients informed me that they were never approached about having a bath. Finkelman wrote, “effective resolution of conflict requires an understanding of the cause of the conflict; however, some conflicts may have more than one cause,” (Finkelman, 2016, p. 325). When we consistently have to deal with this not being taken care of on a daily basis then it is obvious that this conflict is far from being resolved.
This conflict is considered a manifest conflict. Staff knowingly realizes that there is an issue, but policy is consistently being ignored. There are four stages of a conflict as described in Leadership and Management for Nurses; latent, perceived, felt, and manifest. Conflicts begin in the latent stage. The latent stage is where we anticipate the beginning of a conflict. It would be great if all conflicts never went past the latent stage. In this stage we can hopefully address the conflict head on and prevent it from further escalating. The next stage of conflict is called the perceived conflict. In this stage we are aware there is an issue and we can start working towards how this conflict can be resolved. Next is the felt conflict. In the felt conflict we start to have emotional connections towards the conflict. These can be in the form of anger and or anxiety. At this stage our emotional connection can hinder the process of resolving the conflict. The final stage is the manifest conflict. This is the stage that can cause destruction or even harm. Unfortunately this is the stage that our current conflict of the chlorhexidine baths are located.
Since the conflict on our floor has escalated to this point, we are now approaching the baths in a different way. Instead of just telling the CNA’s which patients needs these baths we now make rounds with our CNA’s at the beginning of the shift to discuss the plan of care together with the patients. This not only lets patients know about the nightly baths, but this also allows the nurses to educate the patients about the importance of the chlorhexidine baths. Management has felt that this can solve the problems that we have been facing. This also makes the CNA’s fully aware of their responsibilities for that shift. While we have been practicing these rounds for a few weeks now, we are still experiencing issues with certain staff.
Jernigan, Beggs, and Kohut wrote, “nurses are on the front line in health care and are viewed as the linking pin between the health care establishment and individual patients,” (Jernigan, Beggs, & Kohut, 2016, p. 113). Being that nurses are with the patients 24 hours a day it is important that the nurses are involved in the daily practices and have input on decision making that affects the care of our patients. Delegation will always be a part of our jobs as nurses we face many conflicts and we must use our skills to approach these issues correctly for the safety of our patients. Management of conflict can also be defined as team building. We may not always agree on how things should be done, but we need to learn to listen to one another and work together to come up with the best solution for our patients and their safety.
Gardner writes, “the focus on benefits of collaboration could lead one to think that collaboration is a favorite approach to providing patient care, leading organizations, educating future health professionals, and conducting health care research,” (Gardner, 2005, para. 2). Collaboration may not be a favorite approach to all, but it can provide good communication with the team to help provide the best possible care to our patients. As nurses, we are all working towards the same goal; providing the best possible care to our patients.
Collaboration does not always come easy it takes practice. It is like the old saying, “practice makes perfect.” Being in the healthcare industry we are always collaborating in one way or another. Our biggest collaboration comes with our patients. We need to collaborate with the healthcare team to come up with a multidisciplinary plan of care for our patients to provide the best possible outcomes available. Working together as a team for our patients utilizes the individual skills and knowledge of each person. As nurses we are with the patients 24 hours a day, so the physicians rely on us to inform them of the patients’ status. If a patient develops an infection due to the chlorhexidine baths not being given, or a patient that cannot turn on their own not being turned every two hours; then those healthcare associated infections are a result of our neglect. Not only will we now have to treat those healthcare associated infections, but we are treating them without getting paid by the insurance company. That unnecessary money we spend out of pocket could have been used elsewhere to add more equipment or even more staff to lower patient to nurse ratios.
I am a firm believer in the need to collaborate with the nurse leaders and managers in the hopes to have a floor that runs smoothly as well as to make all the difference in the patients’ outcome while on our floor. Being on a med-surge floor we get all kind of illnesses the last thing we want to do is to make matters worse for our patients and maybe extend their stay. Many times we are confronted with ethical dilemmas that we know we need to handle because it could eventually cause major problems for our patients. This is where it is imperative that we collaborate with our nurse leaders or managers.
Being that I work night shift, there are many times that I do not have face to face contact with my nurse manager. Since there are issues we are facing with certain staff I find it important to keep in contact with my nurse leader and manager through email the majority of the time. If I feel the issue needs immediate attention I do know that I can contact my nurse manager at any time day or night. She is always open for communication.
With the current issue we have been facing I have had to have more contact with my nurse manager more than normal. We have mostly been communicating through text messages and phone calls when I am on my drive home in the mornings and she is on her drive into work. Communicating on our drives have worked great for us because it has allowed us to talk things through without any distractions. This is actually how we came to utilizing a bedside shift report with the CNA’s. While speaking with her one morning we were discussing how she thought I felt that bedside shift report was going with the prior shift since this was something new, we had recently started. After we finished discussing that we started discussing the issues that we were facing on a nightly basis. Being that we have tried multiple things to fix the problem as in checklists, timed assignments, and etc., I just happened to mention trying something like the bedside shift report with the CNA’s. She thought it was a good idea and decided to discuss it with the other staff to get their input, and after about a week we started utilizing this every shift. So far the issues have decreased.
No matter what position we hold we will always have to deal with conflict in one way or another. As a nurse we need to have the confidence that we can handle the situation or at least know what avenues are available to help resolve the conflict. The end goal should always be the same, and that is to provide the best possible care available to our patients while keeping them safe for unnecessary harms. As mentioned in the beginning, the more we allow conflict to linger the more danger it can cause.
- Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3 ed.).
- Gardner, D. (January 31, 2005). “Ten Lessons in Collaboration”. OJIN: The Online Journal of Issues in Nursing. Vol. 10 No1, Manuscript 1. http://ojin.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/volume102005/no1jan05/tpc26_116008.html
- Jernigan, E., Beggs, J., & Kohut, G. (2016). An Examination of Nurses’ Work Environment and Organizational Commitment. Journal of Organizational Culture, Communications and Conflict, 20:1, 112-131.
- Khalid, S., & Fatima, I. (2016). Conflict Types and Conflict Management Styles in Public and Private Hospitals. Pakistan Armed Forces Medical Journal. , 66, 122-126.