Communication and Conflict Management
Jane is a newly graduated practical nurse working in an acute rehabilitation center on night shift (6:45pm-7:15am). Jane has three small children who she gets ready for school in the am and takes to the bus stop. She explained to her employer when she accepted her position that she must leave on time as she is the sole person responsible for her children. The Director of Nursing stated at that time that “overtime is prohibited. You should always leave on time unless there is a major emergency at change of shift. We are open 24 hours a day, and nursing is a fluid profession that moves from shift to shift.”
Jane has found that when she is being relieved by Joanna, she is always late. This has put a strain on Jane’s responsibilities at home, and her overnight babysitter has stated that if it happens again, she will need to look for another sitter. This has caused Jane great stress, and today Joana is scheduled to be Jane’s relief. Anxiety has been pulling at Jane all night.
At 6:45am. Jane has her report sheet prepared and has all her clients taken care of. She is prepared to give report and leave her duties for the day. It is now 7:00am, and unfortunately, Joanna has not arrived. Jane is becoming more anxious and concerned. Jane is concerned she will not make it home in time to relieve her babysitter as promised.
Joanna arrives at 7:01am. Jane asks Joanna to count narcotics first, and then get report. Joanna agrees. The following conversation then occurs:
Jane states: “Thanks, Joanna, for counting first. I really appreciate it. I am going to give you a brief overview of the clients who have had no changes, and then go in depth with those who are ill or have changes in condition. I have everything written on the report sheet, and I will answer any questions as we go, but I need to leave in 8 minutes.”
Joanna replies with a stern loud voice “Who do you think you are? I am not about to take over the unit without a fine tune report. I need to know about everyone, not just those who are sick or getting better. I do not have time to read report. Tell me or I am not taking over.”
Jane became very defensive and upset stating “My shift is over. It is 7:18am. If you wanted full report on all clients, you should have been on time. I wrote everything down. I am now leaving. We counted, you have the keys to the medication cart. I am leaving. Have a good day.”
Initial- write 1 page,and answer all 3 of the question
• How could Jane and Joanna both have handled this situation differently?
• What are examples of therapeutic communication present in the scenario? If there are not any examples, how would recommend incorporating therapeutic communication?
• What is Jane’s legal obligation to her clients and co-workers? Would this be an example of abandoning her clients or is the fact that she left a written report sufficient? Provide rationale for your response.
assume the role of the Director of Nursing. Jane and Joanna have both come to you for help resolving this conflict. How would you respond?
Sample Solution
How Jane and Joanna Could Have Handled the Situation Differently
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Jane:
- Acknowledge the Delay: Instead of diving straight into the report, Jane could have acknowledged Joanna's lateness and its impact. "Hi Joanna, thanks for coming in. I see you're running a bit behind, and I need to leave at 7:15am sharp due to childcare commitments. Can we prioritize the urgent cases and then I can brief you on the stable patients later?"
- Set Boundaries: Jane could have firmly, but respectfully, stated her time constraints. "I've documented everything in the report, but I need to leave in 8 minutes. Is that workable?"
Full Answer Section
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- Offer Solutions:Jane could have offered alternative solutions. "I can give you a quick overview and answer any questions you have while we count narcotics. Then, if you have time later, I can do a more detailed report on the stable patients via email."
- Joanna:
- Apologize for Lateness:A simple apology acknowledges the inconvenience caused. "Hi Jane, I'm so sorry I'm late. Traffic was terrible."
- Emphasize Understanding:Joanna could show empathy for Jane's situation. "I understand you need to leave on time for childcare. How can I best support you in handing over?"
- Work with Time Constraints:Joanna could have acknowledged the time pressure and adapted her approach. "Let's prioritize urgent cases, and I can review the rest on the report sheet later. Is there anything specific you're concerned about?"
- Use "I" Statements:"I feel stressed because I need to leave on time for childcare." (Jane)
- Active Listening:Joanna could show active listening by summarizing key points and asking clarifying questions.
- Focus on Collaboration:Both parties could focus on finding a solution that works for them. "Let's work together to ensure a smooth handover despite the time crunch."
- Not Abandoning Clients:Leaving a written report with medication counts completed suggests Jane did not abandon her patients.
- Potential for Improvement:While a written report is helpful, a verbal handover discussing critical information and changes in condition is generally considered best practice for safe patient care.
- Meet with Jane and Joanna Separately:Gather individual perspectives without blame.
- Acknowledge the Conflict:Recognize the situation and its impact on patient care and staff morale.
- Review Policies:Remind both parties of handover procedures and the importance of on-time arrival.
- Focus on Solutions:Facilitate a discussion to find solutions for timely handovers. This could involve exploring alternative shift schedules, exploring options for Jane's childcare situation if possible, or implementing stricter consequences for lateness.
- Communication and Teamwork:Emphasize the importance of clear communication and teamwork to ensure patient safety and a positive work environment.
- Follow-up:Monitor the situation and ensure communication channels remain open for future conflicts.