Area of Conflict
Collaborative interactions with co-workers and patients are a hallmark of nursing practice. Due to a diversity of perspectives, these relationships are bound to be strained. One potential area of conflict relates to the ambiguity surrounding advanced practice registered nurse (APRN) roles. Completion of graduate-level education prepares APRNs to practice as certified RN anesthetists, nurse-midwife, nurse specialists, or practitioners (American Nurses Association, 2020). However, patient care needs, not the healthcare environment, often dictate the APRN’s scope of services. An APRN is expected to work to meet the varied needs of the population within inter-professional teams. In this context, the APRN role is deemed autonomous, multidimensional, and adaptable to changing demands of clinical practice. Thus, in most healthcare settings, the APRN role is unclear – a workplace factor that could lead to tensions with other members of inter-professional teams.
Inconsistent scopes of practice across healthcare contexts and states have the potential of placing APRNs in roles that do not match their expertise. Differences in scope-of-practice restrictions between state and national laws add to this ambiguity. While an APRN’s credentials may allow him or her to conduct specific diagnostic tests or offer treatment, in some states, approval from to healthcare center is required. Additionally, local hospital privileges may limit APRN clinical freedom to practice, leading to an interdisciplinary conflict. Further, Medicare laws restrict APRNs from patient history taking or physical examination, only physicians can do so (Fealy et al., 2018). Thus, role conflict may arise between nurses and doctors, affecting effective collaboration.
Potential or Real Barriers Creating the Conflict
Hospital regulations are the main obstacles to APRN performing to the full extent of their expertise and a potential source of workplace conflict. Each facility stipulates when and how APRNs can use certain clinical privileges. In some states, hospitals are granted the leeway to decide not to credential non-physician practitioners or require that APRNs perform specific roles under physician supervision (Fealy et al., 2018). Increased reliance on doctors has the potential of increasing workload and compromising the quality of care. Another barrier that creates role conflict is the lack of hospital strategies on how to incorporate APRNs into primary care teams. Models or committees required to foster credentialing and integration of APRNs into inter-professional work processes are lacking in most facilities (Dubree, Jones, Kapu, & Parmley, 2015). Additionally, the unique contribution of APRNs to health outcomes is not clear to hospital staff. Thus, effective collaborative interactions are impeded by the limited role of APRNs in healthcare teams.
The APRN role conflict impacts negatively the quality outcomes and care. The scope-of-practice restrictions limit APRNs capacity to apply their full expertise in primary care. Improvement in patient outcomes, including reduced preventable hospitalizations, readmissions, and ER visits, has been reported after adding APRNs into the inter-professional teams (Dubree et al., 2015). Significant cost savings in delivering care and higher patient satisfaction constitute other impacts of APRNs. Therefore, the state or hospital-level role restrictions affect care quality and are a barrier to conflict resolution.
Identified Reaction Mode
Effective handling of a dispute can yield positive outcomes and prevent it from escalating. My dominant Thomas-Kilmann Instrument (TKI) reaction mode to a conflict is the collaborating category. The collaborator attends to not only his/her needs, but also to those of others without compromise to achieve a win-win situation (Wolfe, Hoang, & Denniston, 2018). This conflict-handling approach reflects a high dedication to team goals and is appropriate when the matter is so crucial to compromise. For example, I used the collaborating approach when deliberating vacation cover off with colleagues last year. A team meeting was held to discuss a rotating shift schedule that was beneficial for all of us. The diverse issues and interests were shared and creative solutions were proposed that allowed each team member adequate vacation time without compromising care delivery.
Based on the TKI assessment, my reaction mode is both assertive and cooperative. Collaborators score highly on the assertiveness and cooperativeness scales (Wolfe et al., 2018). The level to which I strive to address my concerns or meet personal goals is matched with the value I place on relationships. Thus, the collaborative approach has been applied to deal with conflicts related to day-to-day values, incompatible goals, misperceptions, or poor communication.
Most Appropriate Reaction Mode to the Conflict Topic
Based on the TKI model, collaboration is the ideal approach to resolving the APRN role conflict described in this paper. Achieving optimal patient outcomes is the goal of any provider or practitioner within inter-professional teams. Therefore, the collaborative approach is the most appropriate reaction mode to promote the resolution of interdisciplinary role conflicts, as it can support free and effective communication between APRNs and physicians to arrive at a solution that is in the best interests of the patient. Both parties can recognize specific values, expertise, and skills that may be used to realize specific health outcomes. Subsequently, they can arrive at a consensus on individual roles within interdisciplinary teams.
Effective collaboration requires cordiality and respectful inter-professional communication to address shared concerns about individual roles in interdisciplinary care. It encompasses cooperation, sharing, and interdependency (Wolfe et al., 2018). Communicating effectively would allow physicians and APRNs to engage in a conversation regarding their roles in interdisciplinary contexts.
An example of how collaboration can support effective inter-professional care and promote the resolution of the role conflict is interdisciplinary rounding. Joint bedside rounds that involve physicians and APRNs occurring three times a week would provide opportunities to discuss treatment plans and assign individual roles. A bi-weekly conference of both parties would help deliberate if the intended outcomes were reached.
Reflection on Learning
Conflict is inevitable in a team setup. However, positive outcomes can be realized if disputes are well handled. I have learned that each conflict situation is unique and may require a different reaction mode with variable levels of assertiveness and cooperativeness. The five conflict-handling techniques – competing, accommodating, avoiding, collaborating, and compromising – yield different outcomes depending on the context in which they are applied. Therefore, appropriate use of any of the approaches would avoid escalating tensions even further. In my role as an advanced practice leader, I would use the competing approach to defend what I believe to be correct clinical decisions, accommodate divergent views, avoid potentially threatening situations, work collaboratively in interdisciplinary teams, and compromise on issues to avoid affecting patients outcomes.
A Summary of Key Points
The APRN role conflict is pervasive within interdisciplinary teams. The scope-of-practice restrictions and a lack of facility-level strategies for integrating APRNs into care processes are the main barriers to the resolution of this dispute. The TKI model provides a conflict-handling framework that includes five reaction modes. The most appropriate approach in resolving the APRN role conflict is the collaborative style. It supports APRNs and physicians to address individual concerns while prioritizing patient outcomes as the common goal.
References
American Nurses Association. (n.d.). Advanced practice registered nurse (APRN). Web.
Dubree, M., Jones, P., Kapu, A., & Parmley, C. L. (2015). APRN practice: Challenges, empowerment, and outcomes. Nurse Leader, 13(2), 43-49. doi:10.1016/j.mnl.2015.01.007
Fealy, G. M., Casey, M., O’Leary, D. F., McNamara, M. S., O’Brien, D., O’Connor, L.,… Stokes, D. (2018). Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. Journal of Clinical Nursing, 27(19), 3797-3809. doi:10.1111/jocn.14550
Wolfe, A. D., Hoang, K. B., & Denniston, S. F. (2018). Teaching conflict resolution in medicine: Lessons from business, diplomacy, and theatre. MedEdPortal: Journal of Teaching and Learning Resources, 14, 1-12. doi:10.15766/mep_2374-8265.10672