Nurse-Physician Conflict and Resolution

Introduction

Interdisciplinary collaboration is an important part of nursing care in hospitals and primary care settings. Nurses communicate with a variety of health professionals, including physicians, surgeons, lab workers, and other staff. Therefore, it is important for nurse leaders to understand the possible consequences of interdisciplinary collaboration and to seek to improve communication practices to promote better patient outcomes. When it comes to nursing, conflicts in the workplace can have serious effects on patient health. Interdisciplinary collaboration between nurses and other health professionals might become a favorable environment for conflict. Ensuring that the conflict is identified and managed efficiently can help to promote collaboration and reduce the incidence of adverse patient outcomes in nursing practice.

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Description of the Conflict

The observed incident is a recurring conflict, where the communication within the interdisciplinary team is ineffective. The conflict affected the communication between the nurse and the physician working with the same patient. Thus, the observed situation was an intragroup conflict, occurring between the members of the same group (Higazee, 2015). The conflict between team members often arises from failed communication. Intragroup conflicts affect the work of the entire group, often leading to poor patient outcomes and putting the patient’s health and life at risk. Sometimes, interdisciplinary conflicts are facilitated by organizational factors, such as poor regulation procedures in place, lack of guidelines for delegation, high competition among the care providers, lack of support within the group, and more (CNO, 2017). In the present case, the intragroup conflict was somewhat affected by the lack of response from the nurse leader, which led to similar incidents in the future.

Details of the Conflict

The setting of the conflict was a primary care hospital in Miami, FL. In the morning, a 36-year-old female patient was admitted to the hospital due to pain in the lower stomach and blood in the urine. The patient was scheduled for an ultrasound of the kidneys and bladder, which showed signs of acute cystitis. A urine test was also conducted, showing signs of a bacterial infection. The patient was a tourist from France and had no medical record with the hospital. After examining the patient, the physician prescribed antibiotics to treat the infection. However, when the nurse told the patient the name of the antibiotic, she stated that she had taken it in the past with no results. The patient believed that she was resistant to the antibiotic.

At the end of her shift, the nurse passed the information on to the physician. However, he refused to prescribe another antibiotic. The physician stated that, from his experience, this antibiotic was the most suitable for treating cystitis. However, the nurse argued that, if the antibiotic did not work in the past, the infection might be resistant to this type of antibiotic, and thus it would be ineffective this time, too. Still, the doctor refused to change the prescribed treatment plan and asked the nurse to pass the information on to the patient. Although the nurse had managed to explain the rationale behind the treatment plan to the patient, and the patient agreed, the symptoms did not subside. After two days, the nurse confronted the physician again, and he agreed to swap the antibiotic. The patient’s symptoms started to fade, and soon she was released from the hospital.

Although the overall outcome was positive and the patient was treated successfully, using a suitable antibiotic from day one would have reduced her stay and the hospital and sped up the recovery process. In the following week, a similar conflict occurred between another nurse and the same physician, meaning that the situation was not a one-time incident but a recurring conflict.

Four Stages of Conflict

According to McKibben (2017), there are four major stages of conflict: latent, perceived, felt, and manifest phases. During the latent phase, there is unease between the parties, and the conflict becomes imminent (McKibben, 2017). In the present case, the latent stage of the conflict was when the nurse discovered the patient’s concerns and disagreed with the prescribed treatment. The perceived phase is when the parties believe there is a conflict, but try to minimize it or reduce to pay attention to it (McKibben, 2017). Here, the initial confrontation was the perceived phase, as the nurse agreed to treat the patient with the prescribed antibiotics in order to avoid further argument. The decision to minimize the conflict is rarely effective, as it allows the situation to progress to the next stage.

According to McKibben (2017), the felt phase can be characterized by personalized conflict, where one or both of the parties experience discomfort associated with the unresolved situation. Here, the felt phase was the period when the patient was treated by the prescribed plan. As her symptoms did not improve and the patient continued to suffer from pain and irritation, the nurse was experiencing discomfort and contemplated confronting the physician again. Lastly, the manifest phase occurs when the conflict is expressed; here, the manifest phase was the second confrontation, leading the physician to prescribe a different antibiotic.

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Delegation

Delegation can become a key cause of conflict, as it can have a significant effect on intragroup communication and management. Common mistakes in the delegation that lead to conflict are under-delegation, over-delegation, and inappropriate delegation (Stanley, 2016). Under-delegation occurs when one party takes on too many duties, refusing to delegate some of the tasks to the other party (Stanley, 2016). This type of behavior often occurs when one party has a significantly larger amount of knowledge and experience. In the present case, the nurse was a recent graduate, whereas the physician had over 20 years of experience in the clinical setting. Thus, under-delegation was part of the problem that led to the conflict. If the physician had trusted the nurse to find a suitable alternative to the prescribed antibiotic, the conflict would have reached a resolution. Under-delegation also contributes to the persistence of the conflict, as the physician makes the same delegation decisions with other young nurses. Establishing trust and mutual respect within the team could help to prevent similar situations in the future by encouraging appropriate task delegation.

Strategies for Conflict Resolution

In order to help the nurse leader to resolve the conflict and prevent it from recurring in the future, it is critical to ensure that appropriate measures are taken at the organizational level. First of all, it is essential to establish a corporate policy on task delegation in multidisciplinary collaboration. As shown by the College of Nurses of Ontario (CNO, 2017), one of the critical factors influencing workplace conflicts is that “organizational policies are not communicated to staff or adhered to at all levels” (p. 7). Ensuring that all team members are aware of their roles when it comes to delegation would help to avoid under-delegation and over-delegation in the future, thus preventing conflicts.

Secondly, it is essential to introduce and maintain confidential reporting mechanisms for nurses and other team members to report workplace conflicts (CNO, 2017). Using this strategy would assist nurse leaders in identifying and addressing conflicts promptly, thus facilitating conflict resolution. Finally, it would also be useful to educate nurses in team conflict communication. According to a study by Hartman and Crume (2014), “Awareness of conflict and an understanding of communication behaviors leading to more competent conflict management will create higher quality team performance” (p. 107). Besides, training in conflict resolution should introduce nurses to several widespread workplace conflict scenarios, thus enabling them to practice conflict resolution skills (Hartman & Crume, 2014). Overall, training would assist nurses in developing communication skills as well as introduce them to the fundamental principles of effective conflict management.

In collaborating with the nurse leader, I would present them with research indicating the effectiveness of these solutions, as well as with appropriate official guidelines for conflict resolution in the workplace. Ideally, all of the above strategies should be implemented. However, I believe that the most practical approach of the ones offered is to improve conflict reporting. As noticed during the observation, most intrateam conflicts go unnoticed by the nurse leader, and thus no resolution is achieved. Introducing a confidential reporting scheme would allow the nurse leader to note all the conflicts occurring within the unit and to act appropriately.

Conclusion

All in all, the present assignment improved my understanding of workplace conflict in nursing in three ways. Firstly, it illustrated some of the key communication problems in interdisciplinary collaboration and their effect on patient outcomes. Secondly, the detailed study of the situation showed that delegation is among the fundamental forces prompting the development of workplace conflict. Finally, it demonstrated how successful strategies for conflict resolution and prevention would aid me in ensuring effective collaboration between team members and avoiding recurring workplace conflicts in my future work.

References

College of Nurses of Ontario (CNO). (2017). Conflict prevention and management: Practice guideline. Web.

Hartman, R. L., & Crume, A. L. (2014). Educating nursing students in team conflict communication. Journal of Nursing Education and Practice, 4(11), 107-118.

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Higazee, M. Z. A. (2015). Types and levels of conflicts experienced by nurses in the hospital settings. Health Science Journal, 9(6), 1-6.

McKibben, L. (2017). Conflict management: importance and implications. British Journal of Nursing, 26(2), 100-103.

Stanley, D. (Ed.). (2016). Clinical leadership in nursing and healthcare: Values into action. Hoboken, NJ: John Wiley & Sons.

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