Clinical Leadership and Management in Nursing and Specialisations

Table of Contents

Introduction.

Brief.

Position in the ward.

Measures for immediate resolution.

Elaboration of the steps that are taken for the resolution of the conflict

Patient and staff outcome.

Changes that took place for the prevention of similar incident

Recommendations for the future.

Conclusion.

References.

Introduction to Nursing 

Nursing is a profession which is based on many standards and protocol with a singular goal of better patient outcome and health of the patient as the priority (Murray, 2017). One of them is a collaborative practice that is to be conducted between the colleagues at all the levels in the healthcare team of the patient and as well as the patients (van Dongen et al., 2016). When the healthcare professionals work as a team, it is seen that there can be a professional difference of opinion or other things which can lead to conflicts between the professionals (Bochatay et al., 2017). These differences can be due to any number of reasons like values, attitudes, needs or expectations, lack or improper communication and information. In the field of healthcare, it is required that the conflicts are resolved immediately and pacified over time such that the patient outcome and the quality of care are not affected (Bochatay et al., 2017).When there is diversity in a team of healthcare profession, it is seen that it may lead to conflict because the beliefs and values might vary. Nurses often feel that the conflicts should be avoided but it is part of the workplace and it should be resolved as early as possible. It is required so that there can be growth and change in such a way there can be a positive outcome. The aim of the present essay is to provide a brief of a conflicting situation, steps taken to resolve it, the associated outcome for the patient and healthcare staff, changes that might have taken place and recommendation for prevention.

Brief of Professional Conflict and Resolution

In a clinical placement, there are many nurses who work in a single posting and on a rotation basis for the care of patients. The rotation of posting is always made in such a manner that the patient to nurse ratio is maintained and adequate care can be provided to the patient. One of the important ways for infection control in a hospital setting is the maintenance of proper hand hygiene by the healthcare professionals including nurses. As nurses are the ones who are most in common contact with the nurses, it required that they maintain the best possible level of hand hygiene. Recently, there was a new inclusion to the workforce of the nurses wherein an experienced nurse from a different hospital shifted to the current workplace. As a team leader, it was the responsibility to make sure the nurse understands the working of the unit and work similarly to obtain the same level and quality of care. During one of the rounds in the clinical posting, it was seen that there was a conflicting situation between an existing nurse and the newly hired nurse. The older exiting nurse (nurse A) was following the five moments of hand hygiene which is recommended by the World Health Organization and the newly hired nurse (nurse B) was not following the compliance of hand hygiene between the patients. Nurse A in front of the patient and other staff members who were present confronted the nurse B which led to a heated argument. This raised questions from the patients as well as their carers regarding the quality of patient care that is being provided by the nurses and that it might affect the outcome of the patients.

Position in The Ward

The current situation was seen in the medical ward of the healthcare setting where the role of the nursing team leader was played. As a nurse, it is required that the first priority is to make sure that quality of the care is provided by the nurses who are in the team and this care is to be the best possible, appropriate and safe so that the quality of care can be maintained (Ekström & Idvall, 2015). Depending on the healthcare setting, the roles and responsibilities of the nurse leader changes but at the core, it remains the same. It is to provide the nursing care to the patients which include chronic care, palliative care and other areas of specialist care to the patients (Klarare et al., 2020). As a nurse leader, one is responsible for the team that is under the leader and make sure that everyone is working up-to-the same standard and make sure that patient remains the priority (Ellis, 2018).

The core of the role is to develop the team of nurses to make sure the above-mentioned things can be done. A nurse leader by the practice of self should set an example for the nurses under them in the team to maintain the level of care. One of the responsibility as a nurse leader is to work in such a way that he/she can be an advocate for the patients, their family members, carers and even nurses (Morsiani et al., 2017). This includes actions that involve resource allocation and promotion of a positive work environment which can be maintained by the nature of problem-solving, communication and collaboration. In act to be an advocate for nurses, one of roles and responsibilities is to make sure that if any conflict arises it is resolved immediately so that it does not affect patient care (Joel, 2017).

Measures for Immediate Resolution

As the situation rise in front of the patient and other clinical staff, it is first required that the situation is resolved such that it is not implicated on the process of care provision for the patients (Brüggemann et al., 2019). The present conflict rose because of the difference of opinion about the compliance of hand hygiene. The nurse B who came from a different hospital setting was used to working in a specific way now in a new setting should conform to the present procedures and policies. First, both the nurses are asked in a polite manner to move away from the ward into a room where further communication can happen (Lahana et al., 2019). Another nurse is asked to take over the care of the relevant patient so that the care is not hampered. Second, as a nurse, it is required that the resolution of the conflict is mediated by the nurse leader to further contain the situation (Shah, 2017). Third, both the nurse A and B are asked to put their side of the incident and then the situation needs to be analyzed. Lastly, both the nurses are explained that the aim of the nursing care is to maintain the care of the patient such that the care is safe and appropriate (Labrague& McEnroe–Petitte, 2017). The nurse B who is new to this work environment is made to understand that the protocol of the patient care but this should be done on a personal basis and not as a reprimandin front of co-workers or patients.

Elaboration of The Steps that Are Taken for The Resolution of The Conflict

First, both the nurses are removed from the situation in a diplomatic manner and both of them are asked to exit the situation and move to the break room (Angelo, 2019). This is important because this has a negative effect on the patients and healthcare personnel should not be reprimanded in front of other staff members because it is not good for the confidence and morale. As a team leader, it is required that the importance is given to the patients' safety and care followed by working and integrity of the team. It has to be made sure that a different nurse is put in charge of the care of the patient or patients who were being taken care of by either of the nurses. This is done so that there does not arise a gap in the patient care. Next,both the nurses are asked about the situation and given adequate time to explain them in terms of conflict. This is done in a consecutive manner so that the conversation does not overlap and the nurses feel that they were given the opportunity to put forward their side of the story (Angelo, 2019). Next, the nurse leader is to mediate the talk such that the conflict is resolved and not increased. The nurse A is explained that the such if there was such an issue the matter should have been brought to the notice of the nurse leader and if the confrontation was required it should have to be done individually and not in the ward especially in front of patients (Angelo, 2019). Lastly, nurse A is asked to leave and nurse B is explained the importance of hand hygiene by the nurses as it is required for the reduction of infections in patients. The policies of the institution are explained to the nurse and it is emphasized that as a nurse working in the organization is required to follow the same.

Patient and Staff Outcome

The present situation of the conflict is pertaining to the compliance of hand hygiene by the nurse conforming to the internationally given standard for patient care. As per the registered nurses' standards as well the nurses should work in such a way that appropriate and safe care is provided (Taylor et al., 2018). There is also the provision of national safety and quality of healthcare services and prevention and containment of infection in the hospital care setting to reduce the incidence of hospital-acquired infection (Ocampo et al., 2017). The staff outcome that can be seen as a part of the present conflicting situation is that the healthcare professionals including nurses are reinforced with the importance of hand hygiene and the role played by them in patient safety. The other forms of practice which might not be complying with the safety standard can be identified (Ocampo et al., 2017). This incident can be used as an opportunity to implement practice which can increase the standard of practice to the same level such that the level of care provided to the patient is the best.

The patient outcome that can be seen as a result of the conflicting situation is that the level of care that can be provided to patients is best and the adverse outcome can be avoided. It is a known fact that if hand hygiene is reduced among healthcare professionals including nurses, it increases the incidence of healthcare-associated infection (Gould et al., 2017). These infections can have adverse outcomes for the patients in terms that it can extend the stay in the hospital, cause complications and even death in some patients. The outcome of the patients can be improved in by the lessons of present conflict that it is required that the nurses should maintain the same level of quality of care which is according to the set standards and policies (Gould et al., 2017).

Changes that Took Place for The Prevention of Similar Incident

In order to prevent such incidents from happening again, the nurses were given training such that these differences can be spoken about in a sophisticated manner and that the outburst is not made in front of the patients. The nurses are given the option if they feel that someone is not maintaining the level of infection control they may confront or talk to the involved personnel in a way which is professional (Taylor et al., 2018). If this does not work they can always come and talk about it to nurse leader or team leader so that appropriate measures can be taken. Grievance boxes can be set up for the patients as well as other staff members so that active conflict can be resolves (De Bono, 2018). The nurses are given training such that they can get their techniques of hand hygiene up-to-date and in turn help in making the health outcome of patients better. The nurses are given the opportunity for continued professional education and workshops to increase the level of knowledge and practical skills. The survey is conducted to understand the perception of nurses and any barriers which are present for the compliance to the proper hand hygiene measures and the nurses are observed so that this can be avoided in the future (De Bono, 2018).

Recommendations for The Future

Conflicts are common in any workplace and it is not good or bad but it can be used as constructive criticism is that the information can be used for the betterment of the practice and in turn, can help in the have positive health outcomes for the patients (Gould et al., 2017). All the nurses are given training for the best level of patient care during the education and it is combined with the experience and nursing unit measure to make the practice of a nurse. The nurses should opt for continued professional development and education so that they can continuously make a better practice and it should be such that is it is evidence-based. The nurses in the present case the nurses who are of different shift according to the appropriate time should be given training so that the hand hygiene importance can be reinforced (Gould et al., 2017). The barriers that might be present for hand hygiene should be evaluated further so that the barriers can be addressed. This is a required measure so that the patient outcome can be improved and the nurses’ practice can be the best. The procedures and protocol are to be made such that they are stringent as the main aim of the healthcare is positive and better health of the patient. It is recommended that the nurses are to be evaluated on a regular basis and the deficient areas are identified so that a personalized and focused training can be done. The training should be done in such a way that it is regular and the effectiveness of the training can be done (Gould et al., 2017).

Conclusion on Professional Conflict and Resolution

 Nurses are an integral part of healthcare and work with patients and care can influence the health outcome of the patient. Registered nurses are expected to follow the standards that are given and one of the expectations of good practice is to have a collaborative practice. To maintain the collaborative is it possible that such a situation can arise which might be conflicting and it is required that these conflicts are resolved. In the present essay, one of those situations were analyzed involving two nurses where one of them was not following the given protocol of hand hygiene. The conflict was resolved when by the team leader who first removed the nurses from the situation and assigned a different nurse for the care of the patient. The nurses were spoken in private to understand the situation and were instructed or made to understand separately so that the confidence of the nurses is not reduced. To prevent such incidences from occurrence in the future it is required to understand their perceptions regarding the compliance of hand hygiene so that barriers can be identified and addressed. It is recommended that the nurses should be trained to reinforce the knowledge and skills as well as the practice should be emphasized as evidence-based. The main of healthcare is the betterment of patients with positive health outcomes.

References for Professional Conflict and Resolution

Angelo, E. (2019). Managing interpersonal conflict: Steps for success. Nursing Management50(6), 22. https://doi.org/10.1097/01.NUMA.0000558479.54449.ed.

Bochatay, N., Bajwa, N. M., Cullati, S., Muller-Juge, V., Blondon, K. S., Perron, N. J., ... & Savoldelli, G. L. (2017). A multilevel analysis of professional conflicts in health care teams: Insight for future training. Academic Medicine92(11S), S84-S92. https://doi.org/10.1097/ACM.0000000000001912.

Brüggemann, J., Persson, A., & Wijma, B. (2019). Understanding and preventing situations of abuse in health care–Navigation work in a Swedish palliative care setting. Social Science & Medicine222, 52-58. https://doi.org/10.1016/j.socscimed.2018.12.035.

De Bono, E. (2018). Conflicts: A better way to resolve them. Random House.

Ekström, L., & Idvall, E. (2015). Being a team leader: Newly registered nurses relate their experiences. Journal of Nursing Management23(1), 75-86. https://doi.org/10.1111/jonm.12085.

Ellis, P. (2018). Leadership, management and team working in nursing. Learning Matters.

Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.CD005186.pub4.

Joel, L. A. (2017). Advanced practice nursing: Essentials for role development. FA Davis.

Klarare, A., Lind, S., Hansson, J., Fossum, B., Fürst, C. J., & Lundh Hagelin, C. (2020). Leadership in specialist palliative home care teams: A qualitative study. Journal of Nursing Management28(1), 102-111. https://doi.org/10.1111/jonm.12902.

Labrague, L. J., & McEnroe–Petitte, D. M. (2017). An integrative review on conflict management styles among nursing students: Implications for nurse education. Nurse education today59, 45-52. https://doi.org/10.1016/j.nedt.2017.09.001.

Lahana, E., Tsaras, K., Kalaitzidou, A., Galanis, P., Kaitelidou, D., & Sarafis, P. (2019). Conflicts management in public sector nursing. International Journal of Healthcare Management12(1), 33-39. https://doi.org/10.1080/20479700.2017.1353787.

Morsiani, G., Bagnasco, A., & Sasso, L. (2017). How staff nurses perceive the impact of nurse managers’ leadership style in terms of job satisfaction: A mixed method study. Journal of nursing management25(2), 119-128. https://doi.org/10.1111/jonm.12448.

Murray, E. (2017). Nursing leadership and management: For patient safety and quality care. FA Davis.

Ocampo, W., Geransar, R., Clayden, N., Jones, J., de Grood, J., Joffe, M., ... & Conly, J. (2017). Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. American Journal of Infection Control45(10), 1116-1126. https://doi.org/10.1016/j.ajic.2017.05.014.

Shah, M. (2017). Impact of interpersonal conflict in health care setting on patient care; The role of nursing leadership style on resolving the conflict. Nurse & Care Open Acces Journal2(2), 00031. https://doi.org/10.15406/ncoaj.2017.02.00031.

Taylor, C., Lynn, P., & Bartlett, J. (2018). Fundamentals of nursing: The art and science of person-centered care. Lippincott Williams & Wilkins.

van Dongen, J. J. J., Lenzen, S. A., van Bokhoven, M. A., Daniëls, R., van der Weijden, T., & Beurskens, A. (2016). Interprofessional collaboration regarding patients’ care plans in primary care: A focus group study into influential factors. BMC Family Practice17(1), 58. https://doi.org/10.1186/s12875-016-0456-5.

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