Nursing profession problem solving

Conflict Management Resolution Scenario 28 Recap Setting: Hospital Joan Morris, a 67-year-old woman, is admitted to the Telemetry Unit for cerebral angiography. Another patient, a 77-year-old woman with a similar name—Jane Morrison—also is admitted to the same unit for a cardiac electrophysiology procedure. Later that day, a call from the Electrophysiology Laboratory (EP Lab) requests that “patient Morrison” be sent to the lab. The unit secretary mistakenly informs the nurse that Joan Morris is to be sent to the EP Lab. Neither the charge nurse nor the patient’s nurse is aware of a plan for this procedure. They assume that the study has been arranged by the physician despite the absence of a written order in the chart.

Ms. Morris states that she is unaware of plans for the procedure and does not want to go to the lab. The nurse informs Ms. Morris that she can refuse the procedure after she arrives in the lab. In the lab, Ms. Morris once again refuses the procedure and the attending physician is paged, the error is identified, and the patient is sent back to her room. The Charge Nurse is upset that this situation has occurred and is blaming her assigned nurse. How is this conflict resolved? What conflict resolution strategies are used? Characters Charge Nurse: Nurse: Patient-Joan Morris: Unit Secretary: Attending Physician: Skit/Role Play-A distant call from the Electrophysiology Laboratory (EP Lab) requests that “patient Morrison” be sent to the lab. Unit Secretary: (calls the Telemetry Unit- ring ring) Good morning, this is Ms. Ashley Unit Secretary in the EP Lab. May I speak with the nurse for patient Joan Morris? Nurse: Hello, this is Nurse Reuben. How may I help you? Unit Secretary: Hi Nurse Reuben. Ms. Ashley here from the EP Lab. I am calling to inform that patient Joan Morris is to be sent to the EP Lab for a cardiac electrophysiology procedure. They are ready for her. Nurse: Oh, I was unaware she was scheduled for that. Thank you for the information. I will prepare the patient. Unit Secretary: Great, thank you. (hangs up phone) Nurse: (perplexed, turns to Charge Nurse) Are you aware of patient Joan Morris being scheduled for a cardiac electrophysiology? I just got a call from the EP lab. I th Nursing profession problem solving

But you should know what to do, follow protocol, follow up on orders, and if necessary, seek provider clarification. Let me know if you need me. I’m off to morning conferences. Nurse: (proceeds to patient Joan Morris room- knock knock) Patient Morris: Come in Nurse: Good morning, hi I’m Reuben. I will be your nurse today. Can you verify your name and date of birth? Patient: My name is Joan Morris born 1/2/1953 Nurse: Great, thank you. How are you today? Patient: Well I guess I’m alright. Nurse: I understand. Well I am here to transport you to the Electrophysiology Laboratory for your cardiac electrophysiology. They are ready for you. Patient: (confused) A what? No. That’s not what I am here for! I am supposed to have.. Nurse: (interrupting) Maybe the study has been arranged by the physician, an updated order. Patient: (frustrated) I don’t want to go to the lab! My heart is fine. Nurse: (uncertain but reassuring) Ms. Morris you can decline the procedure once you arrive at the lab and check-in. If there is anything else we need to sort out we can do it then. Patient: Well fine, if that’s the only way. I will say no. Nurse: (transports patient to EP Lab)

Hi Nurse Reuben here. I’m checking in patient Joan Morris. I received a call. Patient: I am not supposed to be here! I do not want whatever procedure you are trying to do. Nurse: Yes, there has been some confusion, but the patient would like to refuse. Unit Secretary: (concerned) Oh, I see. You said Ms. Morris, right? I will page the attending. (Proceeds to page and contact the attending physician. Gets off phone) Nurse Reuben? Nurse: Yes Unit Secretary:(in a quiet tone) I apologize but it seems to have been an error. There was another patient Jane Morrison that this appointment was meant for, not Joan Morris. Sorry for any trouble. I will call back to the Telemetry Unit with the correct information. Nurse: Wow, okay. Thank you. (turns to patient) Ms. Morris, great news we can head back to your room. I’m sorry but it was an error. You are not scheduled for the EP Lab. Patient: I told you! What happened? This is not right, no one listened to me. I want to speak to my doctor. Nurse: (transporting patient back to room) I am not sure what happened Ms. Morris. I am sorry for the inconvenience and trouble, but I surely will follow up. We’re back at your room, is there anything I can get you in the meantime? Patient: No, I am fine! Nurse: (embarrassed) Okay. (exits patient room and seeks Charge Nurse) Nursing profession problem solving

Ms. Christina! Do you have a moment? Charge Nurse: Yes, I was also hoping to chat with you. Nurse: Well, I wanted to discuss an error with patient Joan Morris that was taken to the EP Lab. There was a mix up and the order was supposed to be for Jane Morrison. However, that’s not the name the Unit Secretary gave earlier. The client was quite upset. I apologized but I think she is still bothered. This should not have happened. Charge Nurse: (stern tone) Reuben, you are correct, this should NOT have happened. I do appreciate you seeking me out to discuss, prior to me calling for you. I did receive a call from the EP Lab with the corrected patient name for the order, but it should not have gotten to the point of forcing a patient to the lab. Clear protocol and missed steps are evident. Steps that should have been with you. What do you have to say? How do you account for your actions? Nurse: Yes, Ms. Christina. If you remember this morning I asked if you were aware of the order and you were unsure, and neither was I. I know the patient was adamantly against it. I did verify the client but knew there was a sense of urgency. Charge Nurse: Do you remember what I instructed you about orders, protocol, contacting the doctor? Nurse: Yes, I know you gave pointers. I should have done some things, but I do think other factors matter. Can we have a collaborative meeting? Maybe together we can see what can be put in place or reinforced to avoid this mistake again? Charge Nurse: Reuben, I like where your thought process is going. I think that is a great idea. Let’s meet with the EP Lab Unit Secretary and Attending Physician. Nurse: Thank you Collaborative Meeting- All parties reviewed case of patient identity error up to current point. Charge Nurse: Thank you everyone for coming. As discussed, there was an error today with misidentification of two clients with similar names, Joan Morris and Jane Morrison. Both were admitted to our Telemetry Unit but scheduled for different procedures. Joan Morris for a cerebral angiography and Jane Morrison a cardiac electrophysiology procedure. Certainly, we have protocols in place, but reinforcing them and perhaps establishing other measures to avoid such errors is key. Had this continued in any way it could have had further implications and we would not have this near miss. Unit Secretary: I made the initial call for the wrong patient. I should have double checked the patient’s name. Nursing profession problem solving

I did call back to the Telemetry Unit only after uncovering the error. I could have also referred to the patient’s MRN number when speaking with Nurse Reuben. I will be sure to verify two other patient identifiers when requesting a patient report to our lab. Nurse: I agree. I should have probed more and verified those details with Ms. Ashley. I could have placed a callback when the patient was adamant and should have considered informed consent. I did not listen to the patient and could have been a better advocate. I will review the patient chart for updated orders and follow up with a call to the attending if orders are unclear. Attending Physician: That’s what I am here for. I know things get busy, but don’t hesitate to page or call me for clarification. Also, if a patient questions or seems to change their mind on informed consent I must be notified immediately. It could have easily been my error as both patients are under my care. I know we have system name alerts. Charge Nurse: That is correct. In such cases on admission and at any time during patient stay if there is another patient with a similar name, alerts are to be placed. Name alerts tags should be placed outside of patient rooms, on patient charts, and the like. Going forward with each admission, names will be crossed checked and I will reinforce with staff. As far as informed consent, if in question the primary must be notified and that does not require transport to do so. Nurse: I will follow up and collaborate with the nurse for Jane Morrison that both of our patient rooms have Name Alert Tags on the outside of the room. Attending Physician: Thank you. There are clearly a number of checks and balances before I step in. I will also ensure that the alerts reflect on my end. I will be sure to place phone orders or any changes if I can’t get to the patient chart right away. Although this was not the case. This was insightful. Unit Secretary: Yes, the lab can get quite busy, but communication and teamwork make a difference. Charge Nurse: Indeed, it does. Thank you all for indulging this meeting. I think it has been great feedback. We will reinforce protocols, correct the errors identified, track any like situations, and reevaluate effectiveness of interventions as appropriate. Nurse: Thank you. I will stop past Joan Morris’ room and apologize again. Nursing profession problem solving

I want to turn her experience around, let her know she was heard, and things are in order. Charge Nurse: Reuben I like how you have turned this around. Taking accountability and learning. I will be glad to talk with Ms. Morris with you. Attending Physician: As would I. Unit Secretary: If I may, can I tag along? Charge Nurse: Absolutely (Interprofessional team conclude meeting and heads to Joan Morris room-knock knock) Patient: Come in (sees Nurse Reuben first) Where are you taking me this time? Oh my! Nurse: Ms. Morris I just want to offer my sincere apologies again. As I said I was going to get to the bottom of things. Your care and comfort matter to me, well to all of us. (introduces team) Attending Physician/ Charge Nurse/ Unit Secretary: (greet patient, make small talk, offers reassurance) Patient: Well I am just tickled pink; I am famous today. Thank you all so much. Thank you, Mr. Reuben. Nurse: You are most welcome. (team disburses from patient room. Nurse explains name alert sign on door and gives patient education) ***End Scene*** Conflict Management Resolution Introduction The healthcare environment is ever changing and diverse in nature with respect to the daily interactions of healthcare professionals, staff, patients, and factors. These interactions often pose unique challenges to balance a work and healing environment. Where professionals come to work every day and patients seek care in a vulnerable state of mind, the healthcare setting should be a safe place for all. However, naturally conflict can ensue. According to Marquis & Huston (2017), conflict is generally defined as “the internal or external discord that results from differences in ideas, values, or feelings between two or more people” (p.552). Conflict is an expected outcome in a place when considering the variety of different beliefs, values, backgrounds, and goals of individuals. Nursing profession problem solving

Using the setting of a hospital from a workplace point of view, role-play, dialogue, and discussion of a conflict scenario was performed. The scenario involved the domino effect of two patients with similar names admitted to the same hospital unit and the error of informing the nurse of the wrong procedure order. Collectively, conflict arose between key staff including the nurse, unit secretary, charge nurse, and attending physician. This paper aims to analyze conflict management resolve in the role-play using problem-solving skills, communication techniques, and effective conflict resolution management by the key staff involved. Problem Solving Skills (Uses past knowledge to successfully resolve a conflict, collect facts and data, determine available options, pick a solution and implement, and modify or change if required.) Communication Techniques (Uses therapeutic communication techniques, active listening, open ended questions, reflecting, summarizing etc) Effective communication is a vital aspect of any organization. Within the healthcare setting, it allows patients and providers to foster relationships of trust. It also aids in creating a work environment where mutual respect and understanding is shown among nurse leaders and staff. Because conflict is natural and expected, communication serves as the necessary tool to form resolutions. According to Williams et al. (2019), “Managerial communication is critical when conflict conversations are needed” (p. 127). Further, “communication failure is a common root cause of medical error” (Marquis & Huston, 2017). In the scenario presented, there was significant potential for a medical error due to miscommunication. This miscommunication began with the unit secretary mistaking one patient for another when the EP Lab called. Verifying the correct patient to be sent to the EP Lab could have begun with restating information such as the MRN and date of birth. Nursing profession problem solving

Through restating, clarification can be made, and errors can be prevented. Listening to the patient when she stated she did not have any previous knowledge of the procedure should have presented an issue as well. Informed consent is necessary for many procedures, which requires the patient to acknowledge competency regarding them. Without this consent, the nurse should have stopped immediately to clarify before proceeding further. Reflecting on the misunderstanding in the moment would have prevented the patient from being transported and causing further confusion. However, to maintain trust, the staff members involved each offered sincerest apologies. Providing this moment to the patient reopened a line of communication and ensured her that her safety was priority. Once the patient was returned to her room upon realizing the mistake, the nurse manager called for an interdisciplinary meeting among the unit secretary, the nurse, and the physician. Group meetings play an important role in increasing communication among team members as well as improving productivity (Marquis & Huston, 2017). In this meeting each party was given an opportunity to reflect on the error made and ideas for where improvement can occur. As a nurse manager, this step is crucial in resolving issues as it provides opportunity to listen. Marquis and Huston (2017) state, “It is important that the nurse-manager approaches listening as an opportunity to learn” (p.504). Nurse-managers must be willing to listen to subordinates with an open mind and without bias or preconceived notions. Giving time to others to share perspectives allows each to feel heard and as though they are part of the solution. The nurse manager also asked several questions where necessary. Nursing profession problem solving

These questions were aimed directly at improving the process, rather than improving human error. When the solution is focused on process error, it prevents personal blame and allows for a solution that will impact the unit, thereby greatly reducing similar errors in the future. By taking an active role in the resolution, the nurse-manager showed her commitment to both the patient and other staff members. By maintaining an open line of communication between subordinates and other leaders, the nurse-manager is able to remain perceptive and sensitive to the functioning of the unit. Effective Conflict Resolution Management (Review the agreements made for the project by all parties. Review the roles of each team member and responsibilities of each member. Review discussions for potential issues and agreements made) Conflict resolution management is the methods and processes used to find a solution for disputes. According to Marquis and Huston, (2017) “the optimal goal in resolving conflict is creating a win-win solution for all involved”(p.5 57). Common conflict resolution strategies include Compromising, competing, cooperating or accommodating, smoothing, avoiding, and collaborating. However prior to the process of resolution, it is well to know the roles of each team member and responsibilities of each one involved. In the scenario presented, the members that were involved included the Unit Secretary of the EP lab, who is responsible for communicating proper identification and information for scheduled appointments to the nurse; the Nurse, who is responsible for the providing patient centered care to their assigned patients which includes prioritization and proper treatment according to patient care plan and Physician’s order; and the Charge Nurse, who is responsible for supervising the nursing staff, monitoring their needs, and ensuring the needs of the clients and flow of the unit are met. In the scenario, proper strategies are needed to correct the actions of the member involved in the problem. There were two conflict strategies identified and used to seek resolution. Nursing profession problem solving

The first strategy was avoidance, in which “the parties involved are aware of a conflict but choose not to acknowledge it or attempt to resolve it” (Marquis & Huston, 2017, p.559). This strategy was used by the nurse who was blamed by the Charge Nurse, despite both making an assumption that the new order was made by the physician and not updated in the patient chart. Avoidance in this scenario prevents both the nurse and the charge nurse from continuing to blame each other, which can escalate and hinders possible solution with the problem. Rather, the nurse took the responsibility of his action. Avoidance is usually used by people with lower position (Williams et al., 2019). However, according to Moeta and Du Rand (2019) avoidance strategy is considered the least effective approach for conflict management as it creates a lose–lose approach for both parties. The second strategy identified was collaboration, the act of involving both parties to come together and create a “win-win” situation (Williams et al., 2019). This came into fruition through having a discussion and reflective meeting with the team members involved with Ms. Morris’s case which included the Unit Secretary, Physician, Nurse, and the Charge Nurse. This was done by properly selecting a place to have the discussion, which is in a meeting room, rather than having it in the hallway, or in front of the patient. Researchers Moeta and Du Rand (2019) identified that “a non-punitive environment based on trust and openness contributes to effective conflict resolution among staff”. Through the collaborative meeting the team members each presented the problems in Ms. Morris’s case and was able to reflect, recognize, and identify changes that should be implemented. For instance, the Unit Secretary did not thoroughly check or communicate proper patient identification and the nurse did not check or clarify with the Physician about the assumptive change of patient order. In the end, all parties agreed that protocols need to be reinforced such as calling the Physician for questionable order, adhering to informed consent protocols, verifying the patient using two forms of identification, and steps to improve and clarify communication between team members and departments. Additionally, the team members recognized the importance of tracking, monitoring, and protocols needed for patients with similar names being newly admitted throughout the day. A solution to this issue was to have a name alert placed in the system and to have a name alert sign placed on the outside of both pati …Nursing profession problem solving