Nursing conflicts

Trauma Columnist · Apr 15, 2006

Unfortunately, as an ER RN, I have conflicts often. Had one recently which I handled badly. Had an ETOH pt (well known to ER, but no excuses). He was combative and was given Geodon 20mg IM by myself. He was in a room and I had charted q15 minute-30 minute vitals on him throughout the first two hours. Resident physician had been in to see him and everything was cool: he was just going to sleep it off. Attending physician went in and couldn't arouse the guy except with a sternal rub and insisted that he be moved to a room closer to the nurses station and that he be monitored. I argued with the physician that if we hadn't given the Geodon (which I dislike) he wouldn't be unresponsive. I argued a little too forcefully and it got a little heated. This physician and I have worked together for 10 years and we later came to an agreement that his care wasn't compromised, but I shouldn't have been so argumentative.

Lets see, there are many, many others...you learn to deal with conflict and then realize that you sometimes handle it better than other time. There are no excuses for being less than professional and I regret my arguing with this doc. (BTW, this was one of 4-5 patients that I had at the time.

UM Review RN, ASN, RN · Apr 15, 2006

Had a very demanding, confrontational family with a terminally ill patient once. I was about to go off-shift and I could see they were lying in wait for the next nurse, who seriously did not have time for their cra.....er, stuff.

So I headed them off at the pass and introduced myself and asked them if they had any questions.

OMG, I would've had a lesser reaction if I stuck my head down the vent of Vesuvius. I just stood there and tried to answer everything that I could. I explained why this, and how that, and all of the other stuff.

After about 45 minutes, they seemed pleased and never bugged any of the other nurses again.

It was kinda amazing, actually. It was like they wanted to interrogate me to make sure we were really doing everything we could be doing for the patient, but they just had a very adversarial style of doing it.

Daytonite, BSN, RN · Apr 15, 2006

I'm not sure what kind of information you're wanting to get. Any conflicts with patients, families, or doctors I back off of. Not good to openly be arguing with any of those people--at all. Puts your job in jeopardy. You have to be extremely tactful in your dealings with these people. As for conflicts with an institution, kind of the same thing. I never saw a point in fighting. I voiced my opinion. If it was important enough to me and the institution was going to see things my way, I simply quit and moved on.

allthingsbright · Apr 15, 2006

Yeah, I have found working in healthcare not to take things personally. I have had lots of "mean" docs breath down my neck, and some even meaner nurses jump on me but I have always remained assertively polite. I lost it one time when a phlebotomist jumped all over me but I think it was because I was pregnant and overly emotional. LOL! I always take responsibilty for my actions and stay professional. And darn it, "people like me!" (LOL, from saturday night live )

Natkat, BSN, MSN, RN · Apr 16, 2006

Wow I could sure use some advice on dealing with conflict.

I work in a dialysis clinic and we have a problem with a patient's private sitter who wants to "help out" in our clinic. We've told her several times that she cannot do any work in our facility because 1) she's not trained and 2) we are not covered if she hurts someone or gets hurt herself. The other day I saw her "assisting" another patient and I told her to stop - but I was very unkind and un-professional. I feel like such a jerk now. Does this skill come with time or is there somewhere I can learn it?

Daytonite, BSN, RN · Apr 17, 2006

Wow I could sure use some advice on dealing with conflict.
I work in a dialysis clinic and we have a problem with a patient's private sitter who wants to "help out" in our clinic. We've told her several times that she cannot do any work in our facility because 1) she's not trained and 2) we are not covered if she hurts someone or gets hurt herself. The other day I saw her "assisting" another patient and I told her to stop - but I was very unkind and un-professional. I feel like such a jerk now. Does this skill come with time or is there somewhere I can learn it?

First of all, always. . .always, keep your cool (temper). Speak politely and respectfully no matter what the other person is throwing at you. You've got to the be the bigger person. Particularly when you attain a more authoritive position.

For me, it was mostly self-learning. I feel that we got very little practice at these skills in nursing school. I made plenty of errors, let me tell you. I would go home and think, "oh, boy! I didn't say that right!" I'd think about it and decide what I should have said and it would be on my mind for a number of days. I'd formulate better responses in my mind and hope I'd remember them if the opportunity presented themselves to ever use them. I did take one or two seminars in How to Deal with Difficult People over the years. These seminars mostly focus on assertiveness techniques. When I decided to go back for my BSN, Communication 101 was a required class and it was without a doubt a class where I learned a lot about confronting people. We had a required lab connected with this class where we were given scenarios of interpersonal interactions with other people to act out. The focus of this class was, I suppose, politically correct and socially correct ways to handle sticky personal communication problems. There was a good deal of importance attached to the emotions of the people involved in the communication exchanges. I have to also say that a third important component for me has been understanding what my role as a leader is. When you are in a charge position, you have some responsibility, as in your case, to enforce facility rules. Part of that involves being aware of exactly what the rules are.

In your case, I would strongly suggest that you document in writing what you have observed this private sitter doing, what you said to her, that you clearly explained the facility rules with regard to providing nursing care to your facility's clients and make sure it gets to your manager. Compose it on a Word program in a memo format with your boss listed as the recipient. Print it out on a plain white piece of paper. Keep a copy for yourself. The general rule of thumb where someone is not following rules is concerned is that a facility can't do anything without the paperwork (documentation) to back up what they do. Telling your bosses verbally just may not be enough. This sitter needs to be denied access to the facility since she is refusing to follow rules. It's as simple as that. You, however, most likely don't have the authority to tell her that. She's not an employee of the facility and not subject to the same rights as an employee. She's putting the facility in a legal bind. I suspect that if the people who run the clinic were aware that she was doing this and has been ignoring your instructions (which is subordination, by the way) they would not want her there. They have the power to block her from setting foot in the place or to take her into an office and read her the riot act. What she is doing is in the same category as an employee who is taking the initiative to perform duties that are way outside their job description, has been told to stop and has ignored those admonishments and is continuing to do exactly what they please. An employee like that would most likely be fired. In the case of a visitor, the visitor is merely denied entrance to the facility. If they defy those orders, the police are called to remove them. Hope that helps you out.

-Midget- · Apr 17, 2006

I got a Marshal Rosenburg's book, Nonviolent Communication - A Language for Life, from a great friend. I have yet to read the whole thing, but have been flipping through it for a few months. A few days ago, I started reading it again from the begining. It's a great book, and I see it as a great asset to learn to communicate with people in a compassionate way, to make sure everyone's needs are expressed and met...so, I believe applying such concepts in a conflict could be very useful!

Natkat, BSN, MSN, RN · Apr 18, 2006

First of all, always. . .always, keep your cool (temper). Speak politely and respectfully no matter what the other person is throwing at you. You've got to the be the bigger person. Particularly when you attain a more authoritive position. >snip

Thanks for the advice.

I handled this situation all wrong. I'm not in a position of authority and basically have no power in the situation, other than notifying the clinic manager of her persistent behavior of "helping" after she had been asked to stop.

I have already taken a class in interpersonal communications. Obviously nothing stuck in my mind. I suppose it just takes practice to not say the first thing that pops into my mind. Instead I should count to ten and think about what I could say that would be assertive without hurting someone's feelings. I realize this is a skill I will need A LOT when I'm a nurse.

purp4sh · Apr 19, 2006

Thanks to all that posted a message. All comments helped me to see what type of conflicts some have faced and how ones have reacted.

Thanks again