Introduction
Conflict is a process that occurs as a consequence of differences between common goals, values, actions, and beliefs of two or more individuals (Higazee, 2015). It is a highly volatile situation that can halve either positive or negative result for all involved parties. Conflict is an inherent feature of almost every organization where human interaction occurs on a continuous basis. The hospital setting is associated with a high level of stress; therefore, the environment of health care organizations significantly increases the probability of conflict occurrence (Higazee, 2015). There are many explanations for conflict between different individuals or teams of professionals within health care delivery setting: competition between health care practitioners, differences in social and economic values of individuals, reform, limited resources, unclearly defined roles, poor interpersonal skills, and variations in “expectations about level of performance in various nurses’ roles” (Higazee, 2015, p. 94).
This paper will examine the nature of a conflict that occurred as a result of relationships between the unlicensed assistive personnel (UAP) and registered nurses (RNs). It will explore the unresolved conflict and provide strategies for its resolution. The paper will also outline the four stages of conflict and will connect them with the situation at hand.
Background
According to the American Nurses Association, delegation is the process of transferring “responsibility for the performance of a task from one individual to another while retaining accountability for the outcome” (Potter et al. 2010, p. 157). The model of care that utilizes assistive personnel emerged as a response to the shortage of RNs. Therefore, numerous hospital settings hire individuals who have received special training and are able to perform assistive functions such as collection of specimens, ambulating, measurements of vitals, and monitoring (Potter et al., 2010).
Both the American Nurses Association and National Council of State Boards of Nursing (NCSBN) specify that one of the main responsibilities of chief nursing officers is to monitor the level of delegation competence of both nursing assistive personnel (NAP) and RNs in their hospital (Potter et al., 2010). However, it should be noted that each individual RN is responsible for their nursing practice; therefore, they are accountable for proper delegation procedures and practices. Moreover, every RN has to ensure that the level of communication during the process of delegation is sufficient enough to provide health care services consistent with the requirements of national standards of health delivery as well as Nurse Practice Acts at the state level (Potter et al., 2010).
Conflict
A situation described below occurred in a hospital setting in Miami. An UAP member that had an extremely limited amount of preparation was assisting RN in delivering health care services in acute care hospital. The relationships between them were delineated by the American Nurses Association according to which “RNs retain ultimate responsibility, accountability, and legal liability not only for delegated work but also for any associated errors” (Kalisch, 2011). The UAP member had both clinical responsibilities such as monitoring vital signs, ambulation, toileting, and turning among others and nonclinical such as making sure that environment stays orderly.
The disputes between the RN and the UAP member occurred immediately after the nursing assistant became a part of the nursing team. However, the RN was also newly licensed and, therefore, the level of her proficiency in properly conducting the delegation process was low. Moreover, the RN did not have a clear grasp of her accountability for all tasks that were clearly delegated. The situation preceding conflict occurred when the RN failed to provide the UAP member with clear directions. She asked the nursing assistant to ambulate a patient.
However, directions provided by the RN did not specify the number of times the process should be done. Furthermore, the RN failed to mention that the patient in discussion needed the involvement of more than one person for safe ambulation. As a result, the UAP member tried to walk the patient without asking for additional help. During the ambulation, the patient almost fell on the floor. The conflict occurred when the patient complained to the RN about the situation. Even though the RN was not willing to express her concern about the incidence, she tried to discuss it with the UAP member; however, due to the lack of conflict resolution skills, the situation was not resolved. Moreover, the nurse assistant expressed her reluctance to receive negative feedback. Therefore, the conflict was not resolved.
Analysis
All conflicts can be divided into two groups: intrapersonal and interpersonal. Intrapersonal conflict is one that occurs between two individuals. Interpersonal conflicts, on the other hand, occur between groups of people (Higazee, 2015). Therefore, the conflict described above was an intrapersonal one. The theme of the conflict was a delegation process. It could be argued that the conflict occurred due to the RN’s lack of management and interpersonal skills as well as the insufficient level of delegation competence. The process of delegation is extremely important because if it is not properly performed there is a chance of negative health outcome for a patient (Higazee, 2015).
Moreover, poor delegation might result in missing nursing care such as lack of emotional support, ambulation or hygiene procedures (Potter, Deshields, & Kuhrik, 2010). It should be noted that effective communication is a key to the delegation. Taking into consideration that both the RN and the UAP member failed to reach an agreement and resolve the conflict, it is clear that both of them had significant differences in the perception of proper delegation practices. According to Finkelman, there are four stages of conflict: antecedent conditions, perceived conflict, manifest behavior and conflict resolution or suppression (2006).
This model of conflict could be applied to the situation described above. It could be argued that antecedent conditions for conflict were the inability of the RN to provide clear instructions relating to ambulation and the insufficient level of delegation competence. Moreover, the both parties exhibited the lack of proper communication skills thereby creating another condition for conflict occurrence. Perceived conflict stage was demonstrated by the UAP member’s unwillingness to receive negative feedback. It led to the development of undesirable feelings by the two parties. The third stage manifested in the conversation between the UAP member and the RN and ended in the fourth stage of conflict suppression.
In order to resolve the conflict and avoid reoccurrence of a similar dispute in the future, it is necessary to notify a nurse leader about the situation. The nurse leader is responsible for monitoring the level of delegation competence of both nursing assistive personnel (NAP) and RNs in their hospital; therefore, they have to carefully study the details of the conflict and develop successful strategy for fostering teamwork during the process of delegation (Almost, Doran, Hall, & Laschinger, 2010). To this end, it is necessary to collaborate with a nurse leader by providing them with all details about the situation as well as factors that contributed to the conflict in order to reach consensus on the best strategy for dealing with it (Almost et al., 2010).
According to Leever et al., all conflicts could be viewed from a two-dimensional perspective: satisfaction of one person’s concerns and satisfaction of another person’s concerns that occur during conflict situation (2010). It could be argued that an effective nursing leader has to integrate both dimensions by using one of the following styles of conflict resolution: integrating, obliging, forcing, avoiding, and compromising (Leever et al., 2010). The successful strategy would include the integrating style of conflict management that is associated with the high level of concern for both parties in a conflict situation. It is clear that one of the reasons for the conflict occurrence was the lack of collaboration between the RN and the UAP member.
Moreover, collaboration is a dynamic process that does not occur spontaneously and is not self-generating in its nature (Leever et al., 2010). Therefore, a good nursing leader has to promote collaboration between the two parties in order to prevent the conflict situation from reoccurring in the future. Furthermore, they should foster open and direct communication that would help both individuals in assuming their responsibilities for solving the conflict. An effective nursing leader should also conduct delegation training for both RN and UAP member of the hospital in order to ensure that the level of proficiency in properly using the delegation process is sufficiently high.
Conclusion
The intrapersonal conflict resulted from the lack of proper communication skills. The two involved parties were inexperienced and exhibited a low level of delegation competence. In order to effectively deal with the conflict in the future, it is necessary to conduct an adequate delegation training as well as initiate a set of procedures facilitating open communication.
References
Almost, J., Doran, D., Hall, L., & Laschinger, H. (2010). Antecedents and consequences of intra-group conflict among nurses. Journal of Nursing Management, 18(8), 981-992.
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.
Kalisch, B. (2011). The impact of RN-UAP relationships on quality and safety. Nursing Management (Springhouse), 42(9), 16-22.
Leever, A., Hulst, M., Berendsen, A., Boendemaker, P., Roodenburg, J., & Pols, J. (2010). Conflicts and conflict management in the collaboration between nurses and physicians – a qualitative study. Journal of Interprofessional Care, 24(6), 612-624.
Potter, P., Deshields, T., & Kuhrik, M. (2010). Delegation practices between registered nurses and nursing assistive personnel. Journal of Nursing Management, 18(2), 157-165.