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Sample Answer for NR 510 Week 5: Conflict at the Office Discussion Included After Question
NR 510 Week 5: Conflict at the Office Discussion
You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient’s chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you.
Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety.
What is your response to the medical assistant? What actions do you take to redirect the flow away from arguments and back to patient care?
Provide rationales and evidence to support your decisions.
A Sample Answer For the Assignment: NR 510 Week 5: Conflict at the Office Discussion
Title: NR 510 Week 5: Conflict at the Office Discussion
The answer to this question has to be addressed based on the type of person with whom I am going to engage. Much of what I say to the MA will be based on my prior knowledge of the person and my perceptions about how they think and act. The problem revolves around losing sigh of why we are here and what our priorities must be. When we allow our own personal feelings of problems interfere with our work it can become a source of concern. in this situation is could have well compromised the well being of a patient. My goal would be to make the MA understand the importance of maintaining focus and how this can be a safety issue as well as affecting the unit as a whole (Yang &Treadway, 2016). Personal interactions can be difficult but maturity dictates that there is an appropriate time and place to resolve personal issues and an acceptable manner in which to conduct yourself. These expectations must be met or there will be consequences. I would remind the MA that they are a professional and that they must maintain that status or risk losing the respect of co workers and patients.
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Yang, J., & Treadway, D. C. (2016). A Social Influence Interpretation of Workplace Ostracism and Counterproductive Work Behavior. Journal of Business Ethics, 148(4), 879-891. doi:10.1007/s10551-015-2912-x
Many times administration is not aware of conflicts because staff are afraid of the repercussions. When administration becomes aware of the conflict they question why the staff didn’t come to them sooner. Let’s say admin has come to you to see why you think the staff are not coming to them. You know it is because the staff are scared to but aren’t sure how to put it nicely to administration that the staff are “scared” of them. How could you hold this conversation with admin?
The method I would use to approach this subject would be to first point out the simple fact that there is a gap in the relationship between staff and management evidenced by the unwillingness of staff to approach administration regarding personnel issues and conflicts. It takes work to establish and build a relationship and it is all based on trust. Trust is something that must be earned by administration. It has been my general observation that staff tend to think of administration as represent the organization and not the staff. There are exceptions to this rule but they are the minority. It is easy to see this when looking at a strong manager with whom people connect. They have faith and trust and are willing to engage with those types of managers. I have seen other managers that people will not go to and do not trust. The point is that if there is no trust there is no desire to seek help due to lack of confidence in issues being addressed fairly. We have a manager at my place of employment who fits this stereotype. No one seeks her out because they have no faith in her willingness to help. My advice to the administration would be to work on establishing trust by showing the staff you care about their issues in the same way you care about the priorities of the facility.
While management can be intimidating, it is important that they remain open to discussion when employees want to voice their concerns. This is a problem in my practice where the supervising MD can be very intimidating but once you get to know him you see he has an open door policy and will speak to you anytime you want to. He may not tell you what you want to hear because he is going to be brutally honest but he respects you for the decision to pull him aside and voice your concerns. This is imperative to the success of a practice.
After reviewing the case study, I do see that the staff has lost sight of what’s important, which is caring for the patients. However, as for me, the tone and attitude of my response would not be based on whom I’m speaking to. I would respond to whomever all the same way with a professional tone and attitude. Our response to unprofessional behavior is just as important as our message and point we are trying to get understood (MacLean, Coombs, and Breda, 2016). I do agree with you that what we say may depends on our prior knowledge and how they think and act. In this case study I do believe that the medical assistants allowed their personal feelings and emotions interfere with their work and how they conduct themselves at work, in a professional environment. I do believe that this kind of behavior will not be resolved overnight or in one intervention due to the fact that the behavior of the MAs have been conducted and accepted for so many years. As professional APN FNP we ought to make it our goal to refocus the MAs on what’s important, caring for the patients in a safe manner.
MacLean, L., Coombs, C., & Breda, K. (2016). Unprofessional workplace conduct…defining and defusing it. Nursing Management, 47(9), 30-34. doi:10.1097/01.NUMA.0000491126.68354.be
As future NP’s we will all have different approaches on how to handle office misconduct that may ultimately effect patient care and morale. However, I do feel like these case scenarios will help guide us as to what type of culture we want to create. I do understand your point where maturity and acceptable manners must be conducted into order to function as a whole unit. According to Porter-O’Grady (2015) it is often to not react immediately, ask questions to gain as much information about the error and avoid criticism. Team culture must be developed through positivism and make a slow transition to create purposeful and deliberate work behaviors and actions so that health errors are not educated. Transforming office culture is a collective slow process where we learn by mistakes and work as a team to change them for the better outcome of patients and staff members. I have worked in various facilities where they was collective and collaborative discussions and were the culture was often administrative and had punitive functions. As a staff employee i have always operated best under a culture of caring and collaboration. I have felt protected and valued even if errors had occurred. To err is human. A point we must all come back to. However, strong work ethic, accountability and desire to work must all be attributes staff possess. As as you mentioned, at times some people just don’t have these values and do not work well in a certain environment.
Porter-O’Grady, T. & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4th ed). Retrieved from https://bookshelft.vitalsource.com (Links to an external site.)Links to an external site.
It has been noted in nursing that work incivility is unfortunately common in the workplace. Incivility can commonly occur because nurses work in fast paced environments that involves human life, numerous workplace hazards and long hours. Because of this high intense situations, this can lead to stress and fatigue that contributes to work incivility. Incivility and bullying are similar but have different definitions as incivility refers to rude and disorderly conduct like gossiping, spreading rumors or refusing to assist the coworker facing the incivility. Bullying takes it one step further because this action is deliberate, occurs with more frequency and intensity. It is not just one occurrence but is carried out in multiple occurrences in an effort to offend, distress and humiliate an intended recipient. Examples of bullying can include hostile remarks, taunting, verbal attacks/intimidation, and withholding support. (Palumbo, 2018)
According to Kisner (2018), there are three different kinds of prevention. Primary prevention aims are designed to prevent incivility, bullying and workplace violence altogether. Secondary prevention aims to reduce the impact of these negative actions on recipients. Tertiary prevention aims to reduce negative consequences through reporting procedures and employer assistance and counseling programs. When experiencing or being in these situations, nurses are advised to address wrongdoers by using skills that combat against it and/or by seeking colleague support. Interventions also include sharing information with employers to set up or refine policies that prevent bullying through follow through interventions to meet the goal of zero tolerance, stopping the person causing the incivility. (Palumbo, 2018)
In the example given above, I would first professional state the importance of patient care and how important vital signs serve as a direct tie to patient care. This situation is complex as one would have to ask the MA what exactly was going on to cause the argument. I would ask her in a more private area like conference room or break room to explain the issue. I would also advice her to talk to management about the issue to see if this can be handled and dealt with. I would also bring this situation up to management to see what can be done about this situation and the rising levels of arguments. I would suggest having a meeting with the whole staff and possible huddles before the beginning of each shift to remind staff the importance of preventing incivility. There should be rules to not have arguments in the hallways, in front of patients or nurses’ station. There should also be zero tolerance in constant arguments. For the first time, a warning, education and a personal meeting with the parties involved should take place. If it keeps happening, a write up and if it keeps going, higher consequences like suspension or termination should occur. Staff should work together to keep a positive flow and energy on the unit as this will help with proper patient care. Combating against workplace violence takes the whole unit to put in positive effort. (McNamara, 2016)
Kisner, T. (2018). Workplace incivility: How do you address it?. Nursing, 48(6), 36. doi:10.1097/01.NURSE.0000532746.88129.e9
McNamara, S. A. (2016). Column: Incivility in Nursing: Unsafe Nurse, Unsafe Patients. AORN Journal, 95535-540. doi:10.1016/j.aorn.2012.01.020
Palumbo, R. (2018). Incivility in nursing education: An intervention. Nurse Education Today, 66143-148. doi:10.1016/j.nedt.2018.03.024
Absenteeism is a common thing I hear staff discussing (they are frustrated with the amount of work one employee misses over a short course of time). Conflict can cause absenteeism but do you think this can be reversed as well? In other words, can absenteeism cause or worsen conflict?
I think because absenteeism will always have a negative stigma placed to it. Usually when people are absent from work, it is usually a negative issue that is making them have repeated call-ins. Burn-out, bullying,home, family, illness, dislike for the job are several reasons why nurses and even from any other job can result in multiple or constant call-ins and tardiness. Most of the time, there is a common negative association with these occurrences. It leads to warnings, write-ups and possible suspension/termination. Positive satisfaction in job leads to a decrease number of call-ins and tardiness. Management would have to investigate what exactly leads to a specific employee that is having this issue. If there is something that can be done, usually good management will try to work with the employee to see what can be done. I believe if constant absenteeism is occurring, this can lead to worsening the conflict. The issue is not resolved in this situation, so this can lead to more work incivility as the employee(s) causing the issue do not work on solving the issue. Plus, this constant call-ins will have the other staff grow increasingly frustrated with being short-staffed. Management should not let it go under the table and should address the situation. (Morin, 2017)
Morin, K. (2017). Association of the nurse work environment with nurse incivility in hospitals. Journal Of Nursing Management, 26(2), 219-226
I agree that there are many reasons behind why people miss work or are frequently late. many of these issues can be avoided with planning and changes in behavior. There are instances where the issue is related to something the employee is going through and may need help with. i think management needs to have some relationship with their workers and be able to offer help when they see a pattern of negative behaviors. Getting ahead of the issue is a great way to help both the employee and the facility avoid the costly and troublesome impact that absenteeism can have on the team. Facilities should be invested in their employees and understand that good morale is important to productivity and satisfaction. Early intercession can mitigate potential issues before they can grow.
Incivility and bullying can cause great conflict within an office. As a leader we need to determine who the perpetrators are before they cause good hardworking staff to leave the practice. Weiss (2007) states “one of the central characteristics of office friction is that troublemakers tend to stay on the job while victims-some of who might be your most knowledgeable and efficient workers-leave” (p. 69). Weiss suggests talking to the parties privately and specifically address the problems before they get out of hand. I agree with having a meeting to discuss the office friction and have the staff develop a plan to better work together, giving the staff ownership of the problem may help to ease the tension. In this situation where the practice is part of a larger organization there should be protocols in place for disciplinary action, since this scenario could have caused patient harm, the MA should be disciplined.
Weiss, G. (2007). Employee conflict leads to high turnover and alienates patients. Here’s how to achieve détente. Medical Economics, 64-73.
I agree as I see situations that escalated were not dealt with properly when it comes to work incivility were the parties involved did not go to a more private place to settle the situation. I have seen where two nurses were fighting and arguing about the work assignment with the manager right in front of the situation. The manager did not deescalate the situation by telling them to stop or take it to a more private area like the conference room or the break room. She did not diffuse the situation by separating the two nurses to help calm their emotions down. In fact, it was in the middle of the hallway where patients could see and hear if they passed by and listened. This makes the unit look unprofessional and may hinder how the patient or patient’s family members view or see the unit or even the whole hospital. However, I believe that the two parties involved received a warning to not do that again because it did not adhere to the hospital’s core values. However, I believe that when the situation was occurring, immediate intervention should be happening to deescalate the situation and prevent it from getting out of hand. As fellow employee, we should do our best to stop work incivility.
See Also: NR 510 Week 2 Discussion 2