Here are 4 steps to handle any conflict
By Tonia D. Aiken, RN, BSN, JD
President
Nurse Attorney Resource Group
New Orleans
James Aiken, MD, MHA, FACEP
Assistant Professor of Emergency Medicine
Louisiana State University School of Medicine
New Orleans
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Patient Smith presents to a busy ED with abdominal pain. Eventually, after delays in getting appropriate lab results, X-rays, and an on-call physician consultation, a decision is made to admit Mr. Smith for observation. Unfortunately, the hospital has no available beds. Six hours later, he is moved to the hallway to clear a bed for other patients awaiting ED evaluation. The patient and family are extremely upset and become verbally abusive. Sound familiar? Nurses in all areas are faced with conflict. However, as an ED nurse, you deal with far more incidences of conflict that must be resolved effectively and expediently.
Acute stressors causing conflict in the ED include daily high-acuity patient load, overcrowding, and lack of on-call backup. Other stressors include bioterrorism threats, disasters, patient deaths, and errors in the workplace. These stressors can be emotionally draining, create conflict, and interfere with your ability to function. If you keep an open mind and attitude, you can create solutions acceptable to all. Here are four steps to resolve conflicts in the ED:
1. Find out exactly what the patients and family members want to happen. Use the following steps to facilitate discussions:
- Identify differences in perception and interpretations of the facts.
- Have the parties discuss each of their needs.
- Have the parties imagine themselves in the other parties’ shoes.
- Lay the ground rules that no one will be blamed for the problem.
- Lay the ground rule that all will be discussed.
- Encourage each side to make proposals that appeal to the other party or satisfy their interests.
- Before beginning, make sure the key players with authority are a part of the negotiations and discussions.
- Acknowledge the other party’s emotions, such as fear or anger. Do not ignore or dismiss the other’s feelings.
Symbolic gestures in the form of an apology, removal of a fee for service, or a sincere expression of sympathy or understanding helps to defuse emotionally charged situations. Maintain open communications in negotiations, mediations and discussions by listening carefully. Focus on the party speaking, and eliminate intrusions such as cell phones, pagers, or telephones. Summarize points made by the other party and use body language that shows you are hearing what is being said; for example, lean forward, nod your head, and keep your arms in an open position and not crossed over your chest.
2. Listen to what the family and patient are saying. Often the chaos and noise in the ED exacerbates tension and ill feelings. If possible, bring the patient and family members to a private, quiet area that will diminish anxieties. Demonstrate a true willingness to bring about a solution to the problem. Try to identify underlying needs such as privacy, confidentiality, or respect that fuels their position. The family may identify a different need than the patient, so be sure to discuss the needs of both parties. For example, the patient in the hallway may be concerned about confidentiality, whereas the family is upset over a perceived lack of respect for their loved one.
Instead of focusing on past events or problems, concentrate on future solutions. Remain open to suggestions and proposals for solutions, such as stricter adherence to policy and procedure for stat work, revamping the system for releasing beds, or developing better communication through staff meetings. Empathize with the patient/ family, who subsequently may be more willing to accept other options and solutions.
3. Brainstorm for solutions. Everyone’s suggestions should be considered for a win/win outcome. Refrain from using the terms "but," or "however" because they stop creative problem solving. For example, "I agree that Mr. Smith should be moved into the unit as soon as possible, and . . ." instead of saying, "I agree with what you are saying, but . . ."
4. Use objective criteria. Base your statements on such items such as professional standards, legal precedent, and medical findings. For example: "Mr. Smith’s lab work was stat and should have been drawn in 20 minutes. This is based on our policy and procedures and the medical finding that he may have a gastrointestinal bleed."
[Editor’s note: The Nurse Attorney Resource Group is a medicolegal educational company that advises nursing schools in developing legal nurse consultant programs nationwide. The authors can be contacted at: 81 Yosemite Drive, Suite 100, New Orleans, LA 70131. Telephone: (504) 392-2927. Fax: (504) 392-3298. E-mail: [email protected].]
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