A Nurse Manager’s Role in Resolving Conflict

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Situation

As the nurse manager of a 30-bed surgical unit, AM facilitates the unit’s daily interdisciplinary rounds (IDR) during which multiple disciplines convene to collaborate and discuss effective treatment interventions and discharge plans for each patient. The IDR participants include the unit nurses, physicians, physical therapists, dieticians, and care coordinators. During the discussion of a specific patient who for the last couple of days has been having breakthrough postoperative pain, the primary nurse suggests increasing the dose of the patient’s pain medication or treating the patient with additional pain medication because the patient’s current pain medication, Percocet, has not been controlling the patient’s pain throughout the day. This is the second shift the primary nurse has cared for the patient; thus, the nurse has witnessed the patient’s breakthrough pain on more than one occasion. The physician disagrees with the primary nurse’s suggestion and indicates the current pain management regimen should be more than enough to control the patient’s pain. The physician refuses to add another pain medication to the patient’s treatment plan and requests to move on to discuss the next patient. What should AM do as the facilitator of the IDR meeting?

Approach

Having been a nurse manager for over 10 years, AM has facilitated many IDR meetings and experienced all types of conflict situations in the work environment. Fortunately, AM is well-versed in various styles of conflict management and has implemented different styles to resolve conflict, depending on the situation. In this particular example, the unit IDR meeting is running over on time, with more than half of the patients still requiring discussion. As such, AM has decided to utilize the compromising style of conflict management that seeks to find a middle ground between involved parties.

Outcome

To resolve most conflicts, AM typically prefers utilizing the collaborating style of conflict management that focuses on having all participants provide their perspectives on the situation to come up with a mutual resolution. Nonetheless, as time is not permitting, AM decides to employ the compromising style to facilitate IDR flow. AM interjects the conversation, reiterates the patient’s more than one instance of breakthrough pain and suggests the physician reassess the patient’s pain status after IDR. The decision to either increase the patient’s pain medication dosage or add another pain reliever to treat the patient’s breakthrough pain can be determined after patient reassessment.

Discussion Questions (the first question is about the above Case scenario; the other two are not)

1. What type of conflict best describes the listed situation? Name another conflict management style AM could have utilized to manage the situation. List two healthcare-related consequences that could occur from poorly managed conflicts

2 Discuss the application of complexity leadership and the contributing influence on quality and safety. Describe 2 factors that most influence spread, sustain, and scale and how you might modify those factors as they relate to quality and safety.

Sample Solution

Conflict Analysis and Leadership Strategies

1. Type of Conflict and Alternative Management Style

The conflict in the given scenario can be categorized as a task conflict, which arises from disagreements over tasks, goals, or procedures. In this case, the primary nurse and the physician have differing views on the appropriate pain management strategy for the patient.

While compromising was an effective approach in this situation, AM could have also used the collaborating style. This style involves working together to find a solution that satisfies everyone involved. AM could have facilitated a discussion to explore the underlying reasons for the disagreement and seek a mutually agreeable solution, such as consulting with a pain management specialist or trying a different pain medication.

Healthcare-related consequences of poorly managed conflicts:

  • Patient safety: Poorly managed conflicts can lead to errors in patient care, delays in treatment, and decreased patient satisfaction.
  • Staff morale and burnout: Conflicts can create a toxic work environment, leading to decreased morale, job dissatisfaction, and increased turnover among healthcare professionals.

2. Complexity Leadership and Quality and Safety

Complexity leadership is a leadership approach that recognizes the complex and dynamic nature of healthcare systems. It emphasizes adaptability, collaboration, and a focus on systems rather than individuals. Complexity leadership can significantly influence quality and safety by:

  • Promoting a culture of learning and innovation: Complexity leaders encourage experimentation, continuous improvement, and a willingness to adapt to changing circumstances. This can lead to the development of new and innovative approaches to improving quality and safety.
  • Fostering collaboration and teamwork: Complexity leaders emphasize the importance of collaboration and teamwork among healthcare professionals. This can help to break down silos and improve communication, leading to better patient outcomes.

Factors influencing spread, sustain, and scale of quality and safety initiatives:

  1. Leadership support: Strong leadership support is essential for the successful implementation and sustainability of quality and safety initiatives. Leaders must be committed to these initiatives and provide the necessary resources and support.
  2. Organizational culture: A positive and supportive organizational culture can facilitate the adoption and implementation of quality and safety initiatives. A culture that values teamwork, innovation, and continuous improvement can create a favorable environment for change.

Modifying these factors:

  • Leadership support: To enhance leadership support, AM can engage in leadership development activities, such as mentoring and coaching, to equip leaders with the necessary skills to champion quality and safety initiatives.
  • Organizational culture: AM can foster a positive and supportive organizational culture by promoting open communication, recognizing and rewarding achievements, and creating opportunities for employee involvement in decision-making. Additionally, AM can implement initiatives to address issues such as burnout and job satisfaction, which can significantly impact the organizational culture.

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