The given case study focuses on the incident that occurred at the emergency department, where a physician and nurse, Cindy, worked in collaboration to examine patients. During the shift, the physician stated that he would go to the cafeteria, yet two hours later, Cindy found that he was not there. Her colleague came back only after four hours, and the nurse feels confused about reporting on his behavior.
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On the one hand, they were friends for several years; on the other hand, she felt that she is not responsible for interacting with patients independently. The principle of nonmaleficence and fidelity applies to this case as it proposes the conduct that does not harm others and remaining committed to patients’ needs (Byrd & Winkelstein, 2014). This paper discusses the possible reason for the conflict, its impacts, potential leadership approach, and the role of an ARNP leader in resolving it.
Possible Ethical Conflict Faced by Cindy
A conflict is inherent to the nursing area as it is characterized by the close communication of care providers with patients, each of which has various attitudes, preferences, and problems. In this case, it seems that Cindy and the physician have a relationship conflict, which is characterized by misunderstanding and a lack of transparency. The nurse feels that the bioethical principles require her to follow beneficence prescriptions to ensure patient safety. She understands that her area of responsibility does not include the work of a doctor and that some mistakes may appear, which violates the nonmaleficence principle (Hartog & Benbenishty, 2015).
At the same time, she knows that the clinic’s hospital may pose strict penalties and even terminate her colleague. Since they are friends and have a long history of working in cooperation without incidents, Cindy doubts reporting to a manager. In other words, misconception in relationships can be regarded as the key reason: the nurse saw that the physician was nervous, yet ignored her questions and continued working as nothing had happened.
Possible Consequences of Reporting the Incident vs. not Reporting
If an employee understands that a colleague is not coping with his or her responsibilities, and the leadership does not know about it, two questions should be asked: how objectively this person can evaluate the effectiveness of the colleague and whether his lack of professionalism affects patients (Byrd & Winkelstein, 2014). Often, the employees do not see the whole picture, and this is the task of a leader.
However, in this case, Cindy encountered a vivid ethical violation, and it is worth discussing it with the physician in order to listen to his point of view on what is happening and explain that his mistakes affect the work of the team. If she would not come to an understanding, she can be recommended to warn him that she will discuss this with the leader. I would suggest that the physician should also be called to this meeting – all the parties will be able to speak out.
If Cindy reports about the incident, a qualified leader will begin the examination by asking proper questions and clarifying the reasons for misunderstanding. Considering that this physician’s behavior was diligent previously, he is likely to avoid termination, while Cindy will be a person who assisted him in resolving the difficult situation. On the contrary, he can blame her for judging him and informing the leadership, which will result in more tense relationships between them. In addition, complaints to managers can lead to deterioration in the atmosphere in the team, stress, and destabilization of the work process.
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At the same time, some colleagues may expect Cindy to report to prevent similar cases in the future, which complicates the dilemma. In other words, by not reporting, she can compromise the professionalism and attitudes of the team members.
Description of a Leadership Approach to Help Cindy Navigate the Situation
The process of decision-making in ethical dilemmas requires a complex approach to be applied by a leader. Taking into account that such factors as experience, care unit, age, and interpersonal relationships, Zydziunaite and Suominen (2014) suggest using a set of leadership styles. Namely, their study found that transformational, affiliative, and authoritative are the nest options, while autocratic and bureaucratic styles are associated with the lowest correlation with resolved issues. In this case, one may assume that the transformational style should be used to make serious changes in the behavior of the physician regarding his work abandonment.
As noted by Chan, Sit, and Lau (2014), these leaders are interested in their own work and deeply immersed in the process, assisting any member of the group in achieving success. Among the strategies that can be considered to resolve the conflict, there is a meeting with both parties, individual conversations, and tools to examine the physician’s work-related stress. The leader can, for example, help Cindy to better understand her responsibilities as a nurse and ethically competent specialist in the context of reporting about the case and its impact on her colleague.
Making the Best out of the Situation
The discussed case can be used by a leader to use it as an example of common workplace conflicts and clearly explaining the ways to navigate them. It is important to change the names of the conflict participants to prevent any judgmental attitudes, yet the details of the ethical dilemma should be identified. First of all, it is critical to emphasize that conflicts are natural consequences of human interactions, and the commitment to ethical principles of fidelity and nonmaleficence are the key directions in resolving them (Zydziunaite, Lepaite, Åstedt-Kurki, & Suominen, 2015).
The educational work should be conducted to explain to the team members that their mutually attentive attitude to each other’s behavior and actions can prevent many errors in patient safety. Second, interprofessional collaboration is determined by Matziou et al. (2014) as the way to increase understanding between different specialists, which may be accomplished via emotional intelligence strategy. Third, self-awareness and productivity of the conflict also need to be assigned a top priority and focus on active listening, being impartial, gathering information, and collective decisions as to the main conflict resolution techniques.
This case study examined the ethical dilemma between nurse Cindy and her colleague and physician, who left his workplace during the shift for four hours. If the nurse reports to the management, she is likely to damage her friendship with the physician, yet contribute to ensuring patient safety. If she does not report, she will violate the principle of nonmaleficence and fidelity. It is proposed to use the transformational style of leadership to impact the employee positively via an open dialogue. It is also beneficial to present this case during team meetings as an example of successful conflict resolution based on such strategies as emotional intelligence as well as interprofessional collaboration. Thus, an ethic of care is considered an important part of the nursing profession, which affects critical decisions and regulates the expected appropriate conduct.
Byrd, G. D., & Winkelstein, P. (2014). A comparative analysis of moral principles and behavioral norms in eight ethical codes relevant to health sciences librarianship, medical informatics, and the health professions. Journal of the Medical Library Association: JMLA, 102(4), 247-256.
Chan, J. C., Sit, E. N., & Lau, W. M. (2014). Conflict management styles, emotional intelligence and implicit theories of personality of nursing students: A cross-sectional study. Nurse Education Today, 34(6), 934-939.
Hartog, C. S., & Benbenishty, J. (2015). Understanding nurse–physician conflicts in the ICU. Intensive Care Medicine, 41(2), 331-333.
Matziou, V., Vlahioti, E., Perdikaris, P., Matziou, T., Megapanou, E., & Petsios, K. (2014). Physician and nursing perceptions concerning interprofessional communication and collaboration. Journal of Interprofessional Care, 28(6), 526-533.
Zydziunaite, V., & Suominen, T. (2014). Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences. Contemporary Nurse, 48(2), 150-167.
Zydziunaite, V., Lepaite, D., Åstedt-Kurki, P., & Suominen, T. (2015). Head nurses’ decision-making when managing ethical dilemmas. Baltic Journal of Management, 10(2), 166-187.