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Conflict in Nursing SituationsEssay

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¶ … Setting

The author of this brief report has been asked to assess a nursing care situation and look for a number of things. Those things include the presence of delegation and how well it went, whether conflict arises while looking at these settings, whether delegation was a source of that conflict and so forth. Overall, a situation or scenario that kept rising and that also had an impact on nursing care and quality will be discussed. A recitation of the details and specifics of the malfunction will be covered. This could come, per the assignment, from a real-life practice setting or from a pre-licensure situation. The details that will be included will be what happened, how it happened, and how things were resolved. This will all be contrasted and compared with what Finkelman has to say on the subject of conflict resolution. The best revised strategy, if one exists, will be summarized and covered in detail. The report will end with a conclusion regarding what happened with this report and what was learned. While conflict is sometimes unavoidable and it is not always a bad thing, it needs to be identified, addressed and assessed in the right way.


The situation that the author of this report came across was a fairly simple one. However, the resolution and who should "step up" and resolve the situation is a little more vexing. The problem that emerged was the lack of proper documentation and following the same precise procedure every single time when it came to doing rounds. Meaning, there is a printed listing of what nurses are to be doing on every round and not all of them are following that list. The "important" things such as toileting, checking vitals and so forth are being done pretty well. What is being done (or not done) is not really endangering anyone. However, there is a subtle danger that comes from not being strict and rigid when it comes to doing the required documentation and checking every single time. For example, checking to see if a patient has used the restroom or details about a fall may not seem like a big deal. However, these are things that can absolutely become relevant and important if there is any sort of compliance issue with the state regulators or if there is a lawsuit from a former resident. When it comes to litigation in particular, the law is supposed to be the gold standard when it comes to whether a lawsuit has merit or not. However, lawsuits can be filed by anyone and juries do not always stay within their "yard" when it comes to making decisions. Indeed, nursing homes and other areas are charged with making sure patients are safe but they are in many ways operating with one hand tied behind their back. For example, if a patient has dementia and they are only oriented towards themselves and no other people, medical personnel and otherwise, this can be a danger. Rather than use the call light, they will tend to get out of bed to do what they feel is important such as use the bathroom. The problem is that if those people are injured or frail (or both), their likelihood of falling is rather high and their propensity to have an injurious fall is also very high. At the same time, the use of bed rails, restraints or cameras to control the patients is not allowed. In a situation where one on one care is not possible or practical, this can be vexing and problematic because the nursing home or rehab facility seems to be behind the proverbial eight ball no matter what (Borland, 2012).

Anyhow, documentation is something that is indeed delegated and there is indeed a standard that is supposedly in place. However, there is a dual problem of that standard not being met completely and the management not doing their job and keeping the nurses in line when it comes to following the rules and guidelines. Again, the patients are not in immediate danger nor are they getting "bad" care due to the fall. At the same time, this lack of attention to detail will get a lot of attention from state regulators and/or lawyers should something go wrong. For example, if it is standard for a facility to have a bed alarm on a patient's bed, lack of documenting whether that bed alarm is present and/or functioning could become a very important detail if that patient leaves bed and falls. This is true despite the fact that the bed alarm is not required by law and it is true despite the fact that bed alarms do not usually prevent falls. However, notes being missing about those bed alarms being present and/or functional will be pounced upon by people that are investigating the fall or other happenstance and that would include the family of the patient, the attorneys of the patient and so forth. So long as the facility and its people are doing their job, there should be no fear in making the documentation. In fact, it will protect the facility in the long run (Reising, 2007).

As for the conflict part of this situation, there are nurses among the staff who are doing very good when it comes to documentation and doing all that the rounds call for. There are others that are not performing as well. Because the management is not stepping in and holding the bar at a certain level across the board, the nurses have taken to talking to and about each other when it comes to doing the job and how well it is being done. Basically, there is a discord between the stated values and what is actually being enforced. This discord is brought on by a power vacuum and void and both are being filled with people that should not have to step up or voice their opinions. Indeed, the management needs to keep tabs on the nursing charts and records and they need to speak with and coach the people that are not doing the job completely or correctly. Further, the people that are doing the right thing need to be given positive feedback to let them know that their compliance and attention to detail is being noticed (Fagerman, 1997).

Using Finkelman's conflict resolution steps as a guide, the author of this report would suggest that the following steps be followed. First, there needs to be a shift in focus. There is some good about the issue but there is also some bad. This holds true even though the matter has not blown up in the face of everyone in the form of a dead or injured patient, a lawsuit or something along those lines. Further, there needs to be the creation of a positive and open attitude. Rather than the nurses starting to fight amongst each other, they need to instead work together and understand that while it can take a little extra time to do the rounds as specifically and in as documented a fashion as they should be, there is a very good reason to do so and it is indeed a part of the job to be done. To get everything out in the open, everyone involved needs to state their perspective and opinion so that there is not any ambiguity or confusion as to what is motivating people and what is causing people to act as they are. The people stating their opinions should be fair, they should be honest and they should not continue to operate in a backbiting or immature fashion. The primary focus is and should remain the quality care of the patient. Having details and consistent records is a huge part of giving complete and adept care to patients. Finally, there needs to be the establishment of goals that are shared and mutual (Finkelman, 2012; Finkelman, 2013).

The type of the conflict as described above is due to a leader (or leaders) not filling the power vacuum that has been created due to their lack of leadership and control over the nurses. If there is any industry where the exertion of control and regulation is a must, it would be the healthcare field in general. Whether it be the director of nursing, a supervising physician or the administrator, someone needs to get all of the nurses into the same room and explain that the standards in print will be enforced and followed. After that meeting, that statement needs to be proven by evidence of the fact that management is paying attention. At the same time, it has to be stated that there will be no need for non-management personnel to exert their own control or monitoring as the management will do this on their own. Only in the event that someone (a patient or a worker) is in danger should a nurse do anything and they should go straight to management to do so. At the same time, the… [END OF PREVIEW]

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