Nursing practice is associated with a high level of collaboration among professionals working closely together to provide safe and efficient health care services. Interdependent work roles of nurses significantly contribute to the development of a conflict.
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A conflict is a dynamic process that occurs because of differences between peoples’ values, expectations, and beliefs (Higazee, 2015). Scholars ascribe nursing conflicts to “incompatible goals and recurrent, normative strife” (Moreland & Apker, 2015, p. 1). Other reasons for conflict occurrence include incompatible goals, patient care disagreements, recurrent disagreements, limited resources, unclearly defined roles, differences in values, lack of communication skills and time, and differences in skills among others (Higazee, 2015).
This paper aims to explore the nature of conflict in the context of patient care. It will look at a conflict that occurred between the unlicensed assistive personnel (UAP) member and a registered nurse (RN) in a Miami hospital setting. The paper will examine the four stages of conflict—latent conflict, perceived conflict, felt conflict, and manifest conflict—and explain how they relate to the unresolved conflict described below. Moreover, it will also suggest the best strategy for the resolution of the conflict as well as provide the rationale for selecting it.
The American Nurse Association (ANA) defines delegation as a practice of transferring “responsibility for the performance of a task from one individual to another while retaining accountability for the outcome” (Higazee, 2015, p. 94). The model of health care that relies on the utilization of UAPs has been created to address the ever-intensifying problem of the shortage of RNs. Its development has led to numerous hospitals across the U.S. hiring individuals capable of carrying out clinical responsibilities such as specimen collection, ambulating, and measurement of vitals among others as a part of an assistive role (Higazee, 2015). Even though each nursing professional is responsible for the performance of their duties, the role of a chief nursing officer presupposes the monitoring of the level of delegation in their organization. However, it should be noted that RNs are the ones that have to ensure that proper communication is established during the process of delegation and that it corresponds with the expectations of standards for health care delivery outlined by both national regulatory laws and Nurse Practice Acts (Higazee, 2015).
A conflict described below took place in a Miami hospital setting. It occurred between a UAP member that did not have a sufficient level of preparation and an RN working together in an acute care hospital. It should be noted that this type of professional relationship is regulated by ANA which places “ultimate responsibility, accountability, and legal liability” on an RN “not only for delegated work but also for any associated errors (Mueller & Vogelsmeier, 2013, p. 22). Clinical responsibilities of the UAP worker included helping the RN to carry out basic nursing procedures including ambulation, toileting, specimen collection as well as measuring and monitoring patients’ vital signs. The nursing assistant also performed non-clinical duties such as helping to maintain a proper hospital environment. The conflict took place immediately after the UAP member had been included in the nursing team. The fact that the RN lacked experience and was newly licensed substantially contributed to the development of the conflict because she had a low level of understanding of basic principles of proper delegation practices.
In addition to lacking delegation skills, the RN did not understand that she was ultimately responsible for the outcomes of plainly delegated tasks. The failure to unequivocally outline the directions necessary for the proper ambulation of a patient to the UAP member was a situation that led to the occurrence of the conflict. The RN ordered the UAP member to ambulate the patient without providing her with specifics on timing. Furthermore, the RN made the error of not letting the nursing assistant know that it takes more than one individual to safely perform the process of ambulation. As a result of poorly conducted ambulation, the patient was almost dropped on the floor. Later, he complained to the RN about the UAP walking him without asking for additional assistance from other members of the nursing team. Even though the RN tried to engage the UAP and discuss the situation with her, the nursing assistant was reluctant to receive negative feedback and admit her guilt. As a result, the conflict remained unresolved.
According to Higazee (2015), all conflicts can be roughly divided into intrapersonal (two people) and interpersonal (groups of people). The conflict was an intrapersonal one because it involved a dispute between the two individuals. The delegation process played a main part in the conflict. The reason for the conflict occurrence was the insufficient understanding of the proper delegation procedure by the RN as well as a lack of communication and leadership skills.
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Finkelman’s framework of conflict includes the following phases: latent conflict, perceived conflict, felt conflict, and manifest conflict (Finkelman, 2006). By analyzing the conflict described above with the help of Finkelman’s model, it becomes clear that the failure of the RN to follow proper delegation procedures at the stage of instruction was the reason for latent conflict. Another antecedent condition for the occurrence of the conflict was the poor interpersonal skills of the RN. The unwillingness of the UAP member to participate in an open dialogue was a manifestation of the perceived conflict phase. As a result of negative feelings generated by the situation in both parties, the felt conflict stage expressed through the dialogue has led nowhere, thereby resulting in the suppression of the manifest conflict.
The best resolution strategy of the conflict includes the involvement of a nurse leader. It has to do with the fact that nurse leaders are accountable for the level of delegation competence among their staff which also includes UAP members (Mueller & Vogelsmeier, 2013). Therefore, a nurse leader has to be briefed on the specifics of the conflict and the factors that contributed to its occurrence. An effective nursing leader will analyze the conflict from a two-dimensional perspective to find a win-win solution satisfying both parties. The successful strategy for resolving this dispute includes some of the following elements of conflict resolution: integration, obliging, forcing, and compromising (Mueller & Vogelsmeier, 2013). Furthermore, a good nursing leader would understand that a lack of collaboration substantially contributed to the conflict occurrence. Therefore, to avoid a similar situation in the future, they would promote collaboration between the UAP member and the RN by explaining to them the importance of team effort in the delivery of safe and effective health care services. Delegation training for the parties to the conflict is another part of the successful strategy for dealing with the conflict.
The conflict between the RN and the UAP member occurred as the result of poor delegation training and a lack of communication skills. The promotion of open communication between both licensed and unlicensed members of the nursing team as well as regular monitoring of delegation skills will help to avoid the occurrence of a similar conflict in the future.
Finkelman, A. (2006). Leadership and management in nursing. Upper Saddle River, NJ: Pearson Prentice Hall.
Higazee, M. Z. A. (2015). Types and levels of conflicts experienced by nurses in the hospital settings. Health Science Journal, 15(1), 93-98.
Moreland, J., & Apker, J. (2015). Conflict and stress in hospital nursing: Improving communicative responses to enduring professional challenges. Health Communication, 14(1), 1-9.
Mueller, C., & Vogelsmeier, A. (2013). Effective delegation: Understanding responsibility, authority, and accountability. Journal of Nursing Regulation, 4(3), 20-26.