NR 510 Conflict at the Office Discussion

Conflicts arise in the workplace for many reasons. Conflict is the result of variations or disagreements in perceptions and actions when dealing with work goals, personal values, new ideas, attitudes, beliefs, feelings, or actions (Higazee, 2015). Due to the varied and fragile nature of human interactions, conflict is common in healthcare organization. Nurses and other healthcare professionals play different roles, such as care providers, educators, and managers, and these roles are often stressful, which significantly increases the probability for conflict to arise in patient care settings (Higazee, 2015). The most common triggers of conflict in healthcare settings are communication problems, poor organizational structure, role disputes, lack of resources, simple mistakes due to fatigue, indifference and a lack of professionalism (Higazee, 2015). Dealing with conflict can be a negative or positive process, but the goal is to address conflict in a healthy not dysfunctional way (Higazee, 2015). In the scenario, the conflict between the MA and a co-worker caused the MA to neglect her duties. Not informing the NP of the patient’s low blood pressure is problematic because it impacts patient safety. Each member of a healthcare team has the responsibility to act in a professional manner when dealing with colleagues and patients. Healthcare team members also have the duty to make patient safety the top priority in clinical settings before addressing any issues with co-workers. Although conflict cannot be avoided or ignored once it occurs, there is a proper way, time, and place to address conflicts. Being new at the practice and not in a supervisory position, I would not feel comfortable addressing the MA about her conflict with her co-worker. I do feel comfortable reminding the MA of her duty to patient safety and to acting professional at all times. If I could overhear the argument, patients and the other staff could too. I would suggest to her that if a conflict situation arises again to take care of the patients first then go to the offending party once emotions have cooled down to openly discuss the situation. I would even suggest a mediator in light of the history of conflict in the office. Since disagreements among staff happen often at this office, it will be hard for me to avoid getting into a conflict with a co-worker in the future. Even if I am not at fault and am trying to handle the conflict in a positive and constructive manner, the staff is used to addressing each other in a negative way so my positive energy will have little impact. To address and reduce the number of conflicts in the office staff needs to take some time out to conduct a week or two of conflict resolution training (Higazee, 2015). I will suggest this to my immediate supervisor.

Reference

Higazee, M. (2015). Types and levels of conflict experienced by nurses in hospital settings. Health Science Journal, 9(67), 1-6. Retrieved from http://www.hsj.gr/medicine/types-and-levels-of-conflicts-experienced-by-nurses-in-the-hospital-settings.pdf

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The answer to this question has to be addressed based on the type of person with whom I am going to engage. Much of what I say to the MA will be based on my prior knowledge of the person and my perceptions about how they think and act. The problem revolves around losing sigh of why we are here and what our priorities must be. When we allow our own personal feelings of problems interfere with our work it can become a source of concern. in this situation is could have well compromised the well being of a patient. My goal would be to make the MA understand the importance of maintaining focus and how this can be a safety issue as well as affecting the unit as a whole (Yang &Treadway, 2016). Personal interactions can be difficult but maturity dictates that there is an appropriate time and place to resolve personal issues and an acceptable manner in which to conduct yourself. These expectations must be met or there will be consequences. I would remind the MA that they are a professional and that they must maintain that status or risk losing the respect of co workers and patients.

Yang, J., & Treadway, D. C. (2016). A Social Influence Interpretation of Workplace Ostracism and Counterproductive Work Behavior. Journal of Business Ethics, 148(4), 879-891. doi:10.1007/s10551-015-2912-x

The method I would use to approach this subject would be to first point out the simple fact that there is a gap in the relationship between staff and management evidenced by the unwillingness of staff to approach administration regarding personnel issues and conflicts. It takes work to establish and build a relationship and it is all based on trust. Trust is something that must be earned by administration. It has been my general observation that staff tend to think of administration as represent the organization and not the staff. There are exceptions to this rule but they are the minority. It is easy to see this when looking at a strong manager with whom people connect. They have faith and trust and are willing to engage with those types of managers. I have seen other managers that people will not go to and do not trust. The point is that if there is no trust there is no desire to seek help due to lack of confidence in issues being addressed fairly. We have a manager at my place of employment who fits this stereotype. No one seeks her out because they have no faith in her willingness to help. My advice to the administration would be to work on establishing trust by showing the staff you care about their issues in the same way you care about the priorities of the facility.

NR 510 Conflict at the Office Discussion

After reviewing the case study, I do see that the staff has lost sight of what’s important, which is caring for the patients. However, as for me, the tone and attitude of my response would not be based on whom I’m speaking to. I would respond to whomever all the same way with a professional tone and attitude. Our response to unprofessional behavior is just as important as our message and point we are trying to get understood (MacLean, Coombs, and Breda, 2016). I do agree with you that what we say may depends on our prior knowledge and how they think and act. In this case study I do believe that the medical assistants allowed their personal feelings and emotions interfere with their work and how they conduct themselves at work, in a professional environment. I do believe that this kind of behavior will not be resolved overnight or in one intervention due to the fact that the behavior of the MAs have been conducted and accepted for so many years. As professional APN FNP we ought to make it our goal to refocus the MAs on what’s important, caring for the patients in a safe manner.

Reference:

MacLean, L., Coombs, C., & Breda, K. (2016). Unprofessional workplace conduct…defining and defusing it. Nursing Management, 47(9), 30-34. doi:10.1097/01.NUMA.0000491126.68354.be

As future NP’s we will all have different approaches on how to handle office misconduct that may ultimately effect patient care and morale. However, I do feel like these case scenarios will help guide us as to what type of culture we want to create. I do understand your point where maturity and acceptable manners must be conducted into order to function as a whole unit. According to Porter-O’Grady (2015) it is often to not react immediately, ask questions to gain as much information about the error and avoid criticism. Team culture must be developed through positivism and make a slow transition to create purposeful and deliberate work behaviors and actions so that health errors are not educated. Transforming office culture is a collective slow process where we learn by mistakes and work as a team to change them for the better outcome of patients and staff members. I have worked in various facilities where they was collective and collaborative discussions and were the culture was often administrative and had punitive functions. As a staff employee i have always operated best under a culture of caring and collaboration. I have felt protected and valued even if errors had occurred. To err is human. A point we must all come back to. However, strong work ethic, accountability and desire to work must all be attributes staff possess. As as you mentioned, at times some people just don’t have these values and do not work well in a certain environment.

Porter-O’Grady, T. & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4^th ed). Retrieved from https://bookshelft.vitalsource.com (Links to an external site.)Links to an external site.

It has been noted in nursing that work incivility is unfortunately common in the workplace. Incivility can commonly occur because nurses work in fast paced environments that involves human life, numerous workplace hazards and long hours. Because of this high intense situations, this can lead to stress and fatigue that contributes to work incivility. Incivility and bullying are similar but have different definitions as incivility refers to rude and disorderly conduct like gossiping, spreading rumors or refusing to assist the coworker facing the incivility. Bullying takes it one step further because this action is deliberate, occurs with more frequency and intensity. It is not just one occurrence but is carried out in multiple occurrences in an effort to offend, distress and humiliate an intended recipient. Examples of bullying can include hostile remarks, taunting, verbal attacks/intimidation, and withholding support. (Palumbo, 2018)

According to Kisner (2018), there are three different kinds of prevention. Primary prevention aims are designed to prevent incivility, bullying and workplace violence altogether. Secondary prevention aims to reduce the impact of these negative actions on recipients. Tertiary prevention aims to reduce negative consequences through reporting procedures and employer assistance and counseling programs. When experiencing or being in these situations, nurses are advised to address wrongdoers by using skills that combat against it and/or by seeking colleague support. Interventions also include sharing information with employers to set up or refine policies that prevent bullying through follow through interventions to meet the goal of zero tolerance, stopping the person causing the incivility. (Palumbo, 2018)

In the example given above, I would first professional state the importance of patient care and how important vital signs serve as a direct tie to patient care. This situation is complex as one would have to ask the MA what exactly was going on to cause the argument. I would ask her in a more private area like conference room or break room to explain the issue. I would also advice her to talk to management about the issue to see if this can be handled and dealt with. I would also bring this situation up to management to see what can be done about this situation and the rising levels of arguments. I would suggest having a meeting with the whole staff and possible huddles before the beginning of each shift to remind staff the importance of preventing incivility. There should be rules to not have arguments in the hallways, in front of patients or nurses’ station. There should also be zero tolerance in constant arguments. For the first time, a warning, education and a personal meeting with the parties involved should take place. If it keeps happening, a write up and if it keeps going, higher consequences like suspension or termination should occur. Staff should work together to keep a positive flow and energy on the unit as this will help with proper patient care. Combating against workplace violence takes the whole unit to put in positive effort. (McNamara, 2016)

References:

Kisner, T. (2018). Workplace incivility: How do you address it?. Nursing, 48(6), 36. doi:10.1097/01.NURSE.0000532746.88129.e9

McNamara, S. A. (2016). Column: Incivility in Nursing: Unsafe Nurse, Unsafe Patients. AORN Journal, 95535-540. doi:10.1016/j.aorn.2012.01.020

Palumbo, R. (2018). Incivility in nursing education: An intervention. Nurse Education Today, 66143-148. doi:10.1016/j.nedt.2018.03.024

I think because absenteeism will always have a negative stigma placed to it. Usually when people are absent from work, it is usually a negative issue that is making them have repeated call-ins. Burn-out, bullying,home, family, illness, dislike for the job are several reasons why nurses and even from any other job can result in multiple or constant call-ins and tardiness. Most of the time, there is a common negative association with these occurrences. It leads to warnings, write-ups and possible suspension/termination. Positive satisfaction in job leads to a decrease number of call-ins and tardiness. Management would have to investigate what exactly leads to a specific employee that is having this issue. If there is something that can be done, usually good management will try to work with the employee to see what can be done. I believe if constant absenteeism is occurring, this can lead to worsening the conflict. The issue is not resolved in this situation, so this can lead to more work incivility as the employee(s) causing the issue do not work on solving the issue. Plus, this constant call-ins will have the other staff grow increasingly frustrated with being short-staffed. Management should not let it go under the table and should address the situation. (Morin, 2017)

References: Morin, K. (2017). Association of the nurse work environment with nurse incivility in hospitals. Journal Of Nursing Management, 26(2), 219-226

The low blood pressure means the patient was most likely suffering from hypotension, which means there is not enough blood flow and oxygen getting to the brain. I should be thankful there were no reported visible symptoms, such as dizziness, nausea, temporary loss of consciousness. If the patient had become ill due to the MA leaving the patient unattended with such a low blood pressure, the result would have become litigious for the practice and the MA. According to Buppert (2008), the patient has grounds to sue the practice and the MA for malpractice if a medical assistant neglects his or her duties and a patient suffers an injury. This may be deemed as gross incompetence or medical negligence (Buppert, 2008). It is probable that the NP assigned to the patient would be mentioned in the suit because the nurse practitioner had supervisory responsibilities (Buppert, 2008). It is the NPs responsibility to monitor the medical assistant and make sure he or she is acting within the standard of care. Despite this outcome, I must address conflict between co-workers in the same way. There will always be varying levels of conflict among co-workers, and I cannot always assume that all conflict between co-workers will lead to neglect of duties issues. Higazee (2015) state nurses often experience moderate level of conflict, such as intragroup conflict with other nurses and disruptions from physicians. Higazee (2015) recommends that nurse managers should develop effective conflict management strategies to decrease conflict between medical staff. While the result of with the MA’s actions was not as bad as it could have been, we must pay attention to the lack of collaboration between co-workers in that office. The nursing leader and head physician should strive to create a healthier and more productive work environment, which will improve the quality of patient care.

Reference

Buppert, C. (2008). Understanding medical assistant practice liability issues. Dermatology Nursing, 20(4), 327-329. Retrieved from https://www.medscape.com/viewarticle/580647

As nurses, it is so important that we receive the best training possible to provide us with the knowledge to address common and unexpected health related issues. Conflict management is a workplace topic that is often overlooked for various reasons, even though it happens in every industry on a daily basis. Conflict in clinical setting affects the physical, mental, and emotional well-being of patients, nurses, and all staff (Hartman & Crume, 2014). Particularly, unaddressed conflict between nurses compounds more stress on nurses who are already stressed from heavy patient loads and long hours on the job. Teaching conflict management skills should be a priority, especially in clinical settings because conflict is common between medical staff and patients, as well as among medical personnel (Hartman & Crume, 2014). I agree nurses should be required to attend a conflict management session for every new job orientation. This class will review why conflicts arise, who conflicts arise between, work and personal conditions leading to conflict, effects of conflicts, strategies to deal with conflict and stages in each process.

Reference

Hartman, R. L., & Crume, A. L. (2014). Educating nursing students in team conflict communication. Journal of Nursing Education and Practice, 4(11), 107-118. Retrieved from http://dx.doi.org/10.5430/jnep.v4n11p107

No one likes conflict situations at work, but they are bound to happen and must be addressed before they balloon out of control. Unresolved work conflicts can quickly become problematic and result in negative consequences when not addressed by a nursing manager. In this week’s case study, the MA who neglected to notify the NP of the patient’s low blood pressure due the conflict with a co-worker did not act professionally. The patient is the MA’s priority. Her actions negatively impacted the patient’s safety. In practice, nurses should act according to the ethical codes outlined in the code of ethics, to mission statements of the institution, and to general professional standards of care (Walker & Breitsameter, 2013). Conflict among healthcare professionals originates because of competition and variations in professional values (Walker & Breitsameter, 2013). From personal experience, I notice that other reasons for co-worker conflicts are poorly defined roles, unmet expectations, scarce resources, and poor interpersonal skills. I have seen nursing managers handle co-worker conflicts one of three ways—nursing managers ignore the conflicts as long as they do not disrupt daily goals and patient care and hope the conflicts will go away by themselves; nursing managers get into a shouting match with one or both parties involved the original conflict in an effort to exercise control and get to the bottom of the conflict; nursing managers effectively mediate the disagreement. When handled effectively, conflicts become a learning experience and can propel personal growth and productivity (Walker & Breitsameter, 2013). When conflicts are not handled properly, they become toxic to the organization because c-workers become enemies and resentment festers, which negatively interferes with staff motivation. The actions I take to redirect the focus back to patient care must not exacerbate the situation but manage the conflict in an effective manner that improves patient care, patient safety and staff morale. If I am in a supervisory position, I will call a meeting after work to discuss our roles and responsibilities to team members and to patients. I will then set up conflict resolution staff training sessions for each employee; my goal is to remind them of the power of teamwork. If I am not in a supervisory position, I will speak to my supervisor in private and suggest conflict resolution staff training sessions. I think it is very important to find the source of the conflict. Conflicts can be managed and resolved better when the reason for the conflict is identified (Walker & Breitsameter, 2013).

Reference Walker, A., & Breitsameter, C. (2013). Conflicts and conflict regulation in hospices: nurses’ perspectives: Results of a qualitative study in three German hospices. Medicine, Health Care, and Philosophy, 16(4), 709–718. http://doi.org/10.1007/s11019-012-9459-8

When management micromanages and its practices are divisive, inconsistent, and/or abrasive, employees are not going to handle conflicts between co-workers well. Employees are just mimicking the bad behavior of management. Not all qualified managers are good “people” managers (Kumar, Adhish, & Chauhan, 2015). Employees primarily lose respect for managers for multiple reasons: the nursing manager is weak and does not handle or address problems well, inconsistent about addressing inappropriate behavior, shows favoritism toward certain employees (Kumar et al., 2015). All of these poor management practices inflame conflicts between co-workers when they occur. Most nurses would apply for another job if they consistently had to deal with poor management practices. However, the best actions for nurses to take against poor management behavior is to address the manager (Kumar et al, 2015). The nursing manager may be unaware that he or she has poor management skills when it comes to addressing co-worker issues. Conflict on any level is due to the lack of communication. I do not want to be passive-aggressive when I speak to my supervisor, but I do want to be polite and do want to accuse or blame (Kumar et al., 2015). This is counterproductive and puts the manager on the defense. I can tell the nursing supervisor what I need in terms in direction, feedback, and support (Kumar et al., 2015). I can also make positive suggestions on how to handle co-worker conflicts, such as having a conflict management in house training.

Reference:

Kumar, S., Adhish, V. S., & Chauhan, A. (2015). Managing bosses and peers. Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine, 40(1), 14–18. Retrieved from http://doi.org/10.4103/0970-0218.149263

NR 510 Conflict at the Office Discussion