Mediating Conflict between Nurses in an Emergency Room

At the hospital where I am an emergency unit administrator, there currently are no procedures in place for managing conflict, which is unfortunate because health care facilities in general are environments in which “the opportunity for conflict is accelerated by increased intensity of interaction and human communication” (Porter-O’Grady, 2004, p. 283).

Emergency rooms, in particular, typically require rapid responses to crises, under conditions of overcrowding and understaffing (Esleman, 2003). Because these conditions are conducive to human error of varying magnitude, the situation of one nurse reporting another one for administering the wrong dose of a medication is unusual.

In checking the facts, the patient suffered no harm, and the nurse responsible for administering the wrong dose has worked in this emergency room for more than seven years, there are no records of previous mistakes, and has consistently received excellent evaluations from her immediate supervisors. The nurse reporting the error has worked at the emergency room for several months, beginning after he graduated with excellent grades and recommendations from a highly regarded university.

The approach I used in mediating this dispute is based on findings that successful resolution requires the participants to perceive the procedure and the mediator as fair, and to participate in establishing criteria for dispute resolution (Thibaut & Walker, 1975, as cited in Shapiro & Brett, 2003; Bies & Moag, 1986). Most of us don’t think of ourselves as biased, but there has been consistent evidence that both perception and memory are easily distorted by implicit, i. e. , unconscious, bias (Schacter, 2001).

For example, when given a list of made-up names, including some stereotypically African-American ones, and told some may be familiar because they were the names of criminals, participants were more likely to identify the African-American names as familiar than the other names, and, similarly, when given a list of made-up names of women and men and told some were names of famous people, participants identified more male than female names as belonging to a famous person (Schacter, 2001). The nurse who was reported is an African-American woman and the nurse reporting her is a white male.

In my own case, I recognized I found it difficult to understand why the latter reported such a typical emergency-room occurrence and would need to be careful about not allowing bias of my own to influence my behavior. The two nurses and I sat at a small but comfortable table in a private room. I explained that the only rule I was setting would be that none of us would interrupt whoever was speaking because doing so would make it more difficult to avoid a frequent problem in resolving disputes, misinterpretation of what participants in a dispute were saying (Walton, 1989, as cited in Handout, 2007).

I asked who would like to explain the dispute first. Fortunately, the accused nurse did not object when her accuser began to speak. He said that when the other nurse’s shift ended, he was asked to care for the patient. In reading the chart, he noticed that the doctor had ordered that the patient be given a 300 mg Naproxen tablet (used for pain and sold over-the-counter as Alleve), but the previous nurse had written she had given a 250 mg tablet.

He said that failing to report the nurse’s error was in violation of what he had learned in his course in Professional Ethics and that if the error were ignored, the next time a mistake could be made that would cause serious harm. He said that students in his nursing program were given an Ethical Behavior Test, designed for nurses (Dierckx de Casterie, Grypdonck, & Vuylsteke-Wauters, 1997), and that ethical behavior required taking responsibility for one’s mistakes.

The nurse who was accused said she was responsible for the mistake, she thought it probably was caused by 250 mg being the most usual dose ordered, but now assumed the higher dose was ordered because of the patient’s weights. She said she always tried to be careful, intended to try even harder in the future, but didn’t believe she deserved being reported for the kind of error that unfortunately occurred too often in emergency rooms. The two of them did most of the talking on topics including moral reasoning, living in a litigious society, and working conditions that required flexibility in judgments.

The first nurse concluded he was learning about a very unfortunate reality of health care in the “real” world and no longer wanted the other nurse to be written up.

References

Bies, R. , & Moag, J. (1986). Interactional justice: Communications criteria in fairness. Greenwich, CT: JAI Press. Dierckx de Casterie, B. , Grypdonck, M. , & Vuyisteke-Wauters, M. (1997). Development, reliability, and validity of the Ethical Behavior Test: A measure for nurses’ ethical behavior. Journal of Nursing Measurement, 5, 87-112. Esleman, A. (2003). The crisis in our emergency rooms. Retrieved on December 18, 2007 from

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