Nurses are quite vital in health care provision. With instructions from physicians, nurses help in managing, educating and providing care to patients in medical facilities. They also ensure that the patients are in good health by assisting them to lead and maintain healthy lifestyles. Conflict refers to how people may ideologically or physically disagree and get into arguments. Due to daily interactions with physicians and nurses, conflicts may arise while in the line of duty. Conflict with or among nurses may be caused by poor communication, competition, different life values, or difference in personalities. It is within the context of this paper will discuss how, where and when a conflict with or among nurses may arise and how it may be resolved.
On an early morning in New Orleans East Hospital, an emergency ambulance brought in a man who had been shot multiple times. The man was shot three times, in the leg, shoulder and the stomach. Four nurses quickly came and put the patient on a stretcher, and began examining him while pulling the stretcher into the operation room. A physician joined them on the way. The victim was bleeding profusely especially from the stomach wound, and one nurse suggested that they get two sacs of blood from the blood bank. The physician dismissed the suggestion saying the patient would be fine. Another different nurse in the group backed the idea proposed by the other nurse to conduct a blood transfusion on the patient before surgery to ensure he remained stable despite his significant blood loss. The physician, who was a man, quickly and rudely asked the nurses to shut up and follow his instructions, arguing that he was more qualified and experienced to know what to do on such a patient. The nurses appeared disgruntled as they carried on with what the physician had instructed. They worked on the patient for 20 minutes before the situation worsened and more doctors were called in. They all suggested an immediate blood transfusion and this time, it was done. The surgery was complete after 2 hours. The medical report that was given by the physicians who joined later suggested that if the patient had lost any more blood than he already had, he would have died. The nurses reminded the first physician how they had initially suggested a blood transfusion but he still ignored them and walked away. Such acts of dismissing the nurses’ ideas create conflicts between the nurses and the physicians.
In New Orleans East Hospital, nurses and doctors are put into groups of five. Each team consists of four nurses, led by one physician. The type of conflict that might arise in the above scenario is commonly referred to as intragroup conflict. Intragroup conflict is the kind of conflict that occurs among individuals within one team. In this case, nurses of one team are in conflict with their physician. As noted by Almost (2006) such conflicts usually arises due to the disagreement among members of the same group.
Stages of conflicts
According to Finkelman (2016), there are four stages of conflict, which include Collaboration, Coordination and conflict resolution, negotiation and conflict resolution. Collaboration involves making sure that both or all parties involved are satisfied. In this case, the physician must be ready to listen to the suggestions of the nurses while working on a patient and vice-versa. This also ensures that maximum health care is provided to a patient and respect among workmates is maintained.
Coordination and conflict resolution entails having all individuals involved in an activity work together and make effort to put their differences aside. This ensures that the contribution of the parties involved is taken into account and mutual respect is maintained. In the above scenario, coordination is important since it would ensure that the nurses had a say in operations of the patient, and the physician decision is not based on emotions. As such, the group will have to resolve their conflict and work together to provide quality health care.
Another stage of conflict is negotiations. This entails having certain individuals represent an association of workers in a certain field, to negotiate on good working terms and conditions to ensure a conducive working environment. It involves creating a hierarchy and clarifying the tasks to be performed by each department or individuals in the workplace. The last stage of conflict is conflict resolution, and based on the above scenario, the hospital should provide clarification on the specific duties of the nurses and the responsibilities of the physician (Chan, Chin, Lin & Lee, 2009). For example, when the patient was brought in, both the nurses and the physicians should be aware of their specific tasks and responsibility. This ensures no disagreements arise since the boundaries are clear. However, the physician should be open to suggestions.
As noted by Tabak and Orit (2007), there are different approaches and strategies that may be applied to resolve the conflict between the nurses and the physician. First, it is important for the parties to examine the situation before reporting it. For instance, they can solicit advice and opinions from individuals outside their field. However, they should avoid involving third parties from within the hospital for they may have hidden agendas and may worsen the situation.
The group should have a sit down with all its members that is, both the nurses and the physician, and discuss their issues face to face. Such communication is highly preferred in conflict resolution for it allows a smooth exchange of information. Formal communication should be avoided for they are very impersonal and cannot be used to adequately express feelings. Thus, face to face is the best way of communication since it allows the parties involved to expression their emotions.
Another strategy of resolving such conflict is by involving a mediator. The nurses may use outside individual whom they trust to be objective. The work of the mediator is to come up with terms that will help both parties resolve their issues and work together. As explained by Makary, Freischlag, Hollzmueller & Millman (2009), promoting effective communication among the parties can also help resolve such a conflict. Respect must be shown while expressing issues. Delegation essentially involves providing authority and the right to power to a subordinate to act on behalf of the actual person in authority. In this case, there was no delegation since the physician failed to delegate certain duties to the nurses to ensure timely and effective healthcare provision.
As a healthcare administrator in the institution, I would apply collaboration strategy to reach a consensus between the nurses and the physician. Collaboration involves having both parties in a conflict mention their ideal way of performing a particular task and allowing them to examine all the suggestions and agree on what to do. In this case, the nurses and the physician should all provide their views and ideas on how to best operate on the patient and then conclude on the way forward
The experience at New Orleans East Hospital was quite unfortunate. The conflict between the nurses and the physician endangered the life of the patient. The scenario clearly shows how conflict is a can inhibit progress and effective delivery of healthcare. As such, collaboration between the nurses and the physician often translate to excellent health care provision. Maintaining a good working relationship is highly important in the workplaces. Thus, it is important to ensure that respect is maintained among all the employees and that the working environment is conducive and favors all employees regardless of their qualifications and rank.
1. Makary, M. A., Sexton, J. B., Freischlag, J. A., Holzmueller, C. G., Millman, E. A., Rowen, L., & Pronovost, P. J. (2006). Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. Journal of the American College of Surgeons, 202(5), 746-752.
2. Chang, W. Y., Ma, J. C., Chiu, H. T., Lin, K. C., & Lee, P. H. (2009). Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals. Journal of advanced nursing, 65(9), 1946-1955.
3. Almost, J. (2006). Conflict within nursing work environments: concept analysis. Journal of Advanced Nursing, 53(4), 444-453.
4. Finkelman, A. (2016). Leadership and Management for Nurses: Core Competencies for Quality Care, 3rd Edition. Chapter 13: Improving Teamwork: Collaboration, Coordination, and Conflict Resolution, section on Negotiation and Conflict Resolution, pp. 324–333.
5. Tabak, N., & Orit, K. (2007). Relationship between how nurses resolve their conflicts with doctors, their stress and job satisfaction. Journal of Nursing Management, 15(3), 321- 331.